From the Guidelines
Symptoms of pancreatic issues include abdominal pain, unexplained weight loss, nausea, vomiting, oily stools that float, and yellowing of the skin and eyes, which can be managed with pancreatic enzyme replacement therapy and dietary changes, as recommended by the most recent study 1. The pancreas serves two critical functions: producing digestive enzymes and hormones like insulin that regulate blood sugar. When the pancreas is damaged or inflamed, both these functions can be compromised, leading to digestive difficulties and blood sugar regulation problems.
Common Symptoms
- Abdominal pain (often radiating to the back)
- Unexplained weight loss
- Nausea
- Vomiting
- Oily stools that float (steatorrhea)
- Yellowing of the skin and eyes (jaundice) Other common signs include digestive problems, changes in bowel movements, new-onset diabetes, and fatigue. The severity and combination of symptoms depend on which part of the pancreas is affected and the specific condition.
Management
According to the study by Malabsorption 1, the gold standard treatment of pancreatic exocrine insufficiency (PEI) is the administration of exogenous enzymes (pancreatic enzyme replacement therapy, (PERT)), which reduce fat malabsorption thereby helping to achieve normal nutritional status. A diet rich in carbohydrates and protein, with a reduced fat content, is recommended, along with frequent small meals to achieve an adequate intake 1. Additionally, fat-soluble vitamins (vitamin A, D, E, K) as well as other micronutrients should be supplemented if clinical deficit is apparent 1. It is essential to note that anyone experiencing persistent abdominal pain, unexplained weight loss, or jaundice should seek immediate medical attention, as these could indicate serious pancreatic conditions requiring prompt treatment.
From the Research
Symptoms Related to Pancreas Issues
- Pancreatic insufficiency can cause malabsorption of nutrients, leading to symptoms such as weight loss, diarrhea, and abdominal pain 2
- Acute pancreatitis is characterized by abdominal pain, nausea, vomiting, and fever, and can be managed with opioids, although their effectiveness and safety are still being studied 3
- Pancreatic enzyme replacement therapy is a safe and effective treatment for pancreatic exocrine insufficiency, with starting doses of at least 30-40,000 IU with each meal and 15-20,000 IU with snacks 4
- Morphine, an opioid commonly used for pain management, has been shown to worsen the severity of acute pancreatitis and prevent pancreatic regeneration in mouse models 5
- Exocrine pancreatic insufficiency is a common complication of acute pancreatitis, with a pooled prevalence of 62% during admission and 35% during follow-up, and is more common in patients with severe acute pancreatitis, pancreatic necrosis, and alcohol etiology 6
Causes of Pancreatic Insufficiency
- Chronic pancreatitis
- Cystic fibrosis
- Pancreatic cancer
- Acute pancreatitis
- Pancreatic surgery
Diagnosis and Treatment
- Testing fecal elastase-1 level is useful for the diagnosis of pancreatic exocrine insufficiency 4
- Pancreatic enzyme replacement therapy should be taken in divided doses throughout meals, and patients who do not respond to initial dosages should be evaluated for alternative etiologies and pancreatic enzyme replacement therapy optimized 4
- Opioids may be an appropriate choice in the treatment of acute pancreatitis pain, but their effectiveness and safety are still being studied 3