From the Guidelines
Pancreatic insufficiency is primarily caused by conditions that damage the pancreas and impair its ability to produce digestive enzymes, with chronic pancreatitis being the most common cause, as supported by the most recent study 1. The most common causes of pancreatic insufficiency include:
- Chronic pancreatitis, which involves ongoing inflammation that progressively destroys pancreatic tissue, with alcohol abuse being a leading trigger, as noted in 1 and 1
- Cystic fibrosis, which blocks pancreatic ducts with thick mucus, particularly in younger patients, as discussed in 1 and 1
- Other significant causes include pancreatic cancer, previous pancreatic surgery, autoimmune pancreatitis, and severe acute pancreatitis episodes, as mentioned in 1 and 1 The underlying mechanism involves insufficient production or delivery of digestive enzymes, resulting in maldigestion and malabsorption of nutrients, especially fats, leading to symptoms like steatorrhea, weight loss, and nutritional deficiencies, as explained in 1 and 1. Key points to consider in the management of pancreatic insufficiency include:
- The use of pancreatic enzyme replacement therapy (PERT) to improve outcomes, as recommended in 1
- Routine supplementation and monitoring of fat-soluble vitamin levels, as suggested in 1 and 1
- Dietary modifications, such as a low-moderate fat diet with frequent smaller meals, to manage symptoms and improve nutrition, as discussed in 1 and 1
From the FDA Drug Label
DESCRIPTION: PancrePlusis a pancreatic enzyme concentrate of porcine origin. It is indicated for use as a digestive aid in replacement therapy where digestion of protein, carbohydrate and fat is inadequate due to exocrine pancreatic insufficiency. The cause of pancreatic insufficiency is not directly stated in the provided drug label. Exocrine pancreatic insufficiency is mentioned as a condition where the digestion of protein, carbohydrate, and fat is inadequate, but the label does not specify what causes this insufficiency 2.
From the Research
Causes of Pancreatic Insufficiency
The causes of pancreatic insufficiency can be varied and include:
- Cystic fibrosis 3, 4, 5
- Pancreatic cancer 3, 4, 5
- Acute and chronic pancreatitis 3, 4, 6
- Pancreatic surgery 3, 4, 5
- Metabolic diseases such as diabetes 5
- Impaired hormonal stimulation of exocrine pancreatic secretion by cholecystokinin (CCK) 5
- Celiac or inflammatory bowel disease (IBD) due to loss of intestinal brush border proteins 5, 7
- Gastrointestinal surgery (asynchrony between motor and secretory functions, impaired enteropancreatic feedback, and inadequate mixing of pancreatic secretions with food) 5, 7
Diagnosis and Treatment
Diagnosis of pancreatic insufficiency can be determined through methods such as measurement of fecal concentration of elastase and fecal fat analysis 6. Treatment of pancreatic insufficiency typically involves pancreatic enzyme replacement therapy (PERT) 3, 4, 6, 5, 7. The goal of PERT is to provide the duodenal lumen with a sufficient amount of active lipase at the time of gastric emptying of nutrients 7.
Factors Affecting Treatment Efficacy
Factors that can affect the efficacy of PERT include: