Pancreas is an important gland located behind the stomach. It has multiple functions to play in the body. One of its roles is to produce pancreatic enzymes which help in breakdown and digestion of food. Exocrine pancreatic insufficiency is a condition in which pancreas is not able to produce the required digestive enzymes that can help digest the food.
Lipase, protease and amylase are three enzymes produced by pancreas. At least 90% of lipase is utilized for breakdown of fat molecules, so they can be absorbed by small intestine. Proteases breakdown protein while enzyme amylase in involved in breakdown of carbohydrate.
The symptoms of pancreatic insufficiency are apparent only when the production of enzyme lipase is reduced to 5 to 10 % of the normal. Fat malabsorption is perhaps the most prominent symptom pancreatic insufficiency.
What Causes Exocrine Pancreatic Insufficiency?
Exocrine pancreatic insufficiency (EPI) can develop when pancreas stops producing and releasing pancreatic enzymes. It can affect normal digestion. Various diseases and factors can cause damage to the pancreas that can lead to pancreatic insufficiency.
- Pancreatitis: Pancreatitis is inflammation of the pancreas. It can be acute or chronic. Acute pancreatitis is frequently caused due to alcohol abuse, raised triglyceride level in blood, abdominal trauma, and medications such as steroids. Chronic pancreatitis is caused by drinking alcohol for many years. Both the forms of pancreatitis damage the cells of pancreas which secrete enzymes. This leads to exocrine pancreatic insufficiency.
- Pancreatic cancer: Insufficient amount of pancreatic enzyme is common in people suffering from pancreatic cancer. EPI can occur if cancer develops after pancreatitis. Insufficiency can also occur if the tumor compresses and blocks pancreatic duct through which pancreatic juice passes to the duodenum.
- Gastrointestinal surgery: Exocrine pancreatic insufficiency can also occur when a part of stomach or pancreas is surgically removed.
- Cystic fibrosis: It is a genetic disease which causes formation of thick and sticky mucus in lungs, digestive tract and in other organs. Majority of people suffering from cystic fibrosis develop EPI.
- Celiac disease: It is an inherited genetic disease in which patient is unable to digest foods that contain gluten. Gluten is a protein that is found in wheat, barley, rye, corn etc.
- High level of triglyceride: Triglyceride is a type of fat. Its high concentration in blood can affect pancreas leading to EPI.
- Zollinger –Ellison syndrome: In this rare condition, patient often has exocrine pancreatic insufficiency.
Symptoms Of Exocrine Pancreatic Insufficiency
In the beginning patient may not manifest any symptoms. But as the pancreas start producing very less amount of enzymes, fat digestion is first to get impaired. Patient with EPI presents with following symptoms:
- Weight loss: It occurs due to difficulty in breakdown and absorption of fat and other nutrients.
- Steatorrhea: In this condition patient typically passes loose, pale, bulky, greasy, and offensive smelling stools that are difficult to flush out from the toilet pan. It is a prominent symptom of EPI. Steatorrhea occurs when lipase production drops only to 5 to 10 percent than normal. Fat present in food is not able to digest due to lack of lipase enzyme. It passes through the intestine unabsorbed leading to greasy and pale stool.
- Abdominal pain: Patient experiences pain, gasses and bloating of abdomen when the food is not digested due to lack of pancreatic enzymes.
- Diarrhea: Stools become watery as more and more undigested food enters into the large bowel.
- Malnutrition and vitamin deficiency: Due to lack of enzymes, the fat content in food is not able to break into smaller molecule. Fat cannot be absorbed into the blood stream. Hence vitamins that are soluble in fat such as A, D, E, K are lost in the undigested fat. This leads to various symptoms of vitamin deficiency such as osteoporosis, muscle wasting, vision problems, etc.
Treatment For Exocrine Pancreatic Insufficiency
Due to exocrine pancreatic insufficiency the body is not able to digest fats, carbohydrates and protein from the food. Treatment is focused on eating healthy diet and taking enzyme pills which suffices the need of enzymes that the pancreas is not able to produce. The pills have to be taken during the meals so that its action can breakdown the food and facilitate easy absorption.
Doctors also prescribe proton pump inhibitor medicines so that the supplementary enzymes are not destroyed in the stomach by its acids. Diet also plays an important role in exocrine pancreatic insufficiency.
- Drink enough water daily to keep the body well hydrated.
- Patient should eat healthy fats. Thus fish, nuts, seeds, coconut oil, olive oil, are used in preparing food. Patient has to avoid eating animal fat, processed foods that contain hydrogenated oils.
- Eat smaller meals and part them in six times in a day instead of three large meals. It will make digestion of fat and protein easier.
- Take multivitamin supplement which consists of A, D, E, and K.
- Avoid alcohol consumption if you have past history of pancreatitis.