Pancreatic Insufficiency

The pancreas is a soft, finely lobulated gland located behind the peritoneum on the posterior abdominal wall and has both endocrine and exocrine functions. It plays an essential role in the digestion, absorption, and metabolism of carbohydrates, fats, and proteins. Exocrine pancreatic insufficiency (EPI) refers to a reduction in pancreatic enzyme activity (mainly pancreatic lipase) in the intestinal lumen below the threshold required for digestive functions. These changes could be due to inadequate pancreatic stimulation of pancreatic secretion, insufficient secretion of pancreatic digestive enzymes by the pancreatic acinar cells, or outflow obstruction of the pancreatic duct and inadequate mixing of the pancreatic enzymes with food. Patients with EPI may present with clinical manifestations such as steatorrhea, flatulence, weight loss, and abdominal pain of variable location and severity. The disease is associated with impairment of quality of life, increased risk of complications due to malnutrition and changes in bone density, and increased risk of motility. While pancreatic malfunction could affect both endocrine and exocrine functions of the pancreas, the term pancreatic insufficiency usually refers to exocrine rather than endocrine deficiency. In this activity, we will focus on exocrine pancreatic insufficiency.