From the Guidelines
Pancreatic insufficiency symptoms include steatorrhea with or without diarrhea, weight loss, bloating, excessive flatulence, fat-soluble vitamin deficiencies, and protein-calorie malnutrition. These symptoms occur because the pancreas fails to produce enough digestive enzymes to properly break down food, especially fats, proteins, and carbohydrates. Without these enzymes, nutrients cannot be properly absorbed in the intestines, leading to malabsorption. The severity of symptoms typically correlates with the degree of enzyme deficiency, with symptoms usually appearing when enzyme production falls below a certain threshold.
Key Symptoms
- Steatorrhea (greasy and foul-smelling stools)
- Diarrhea
- Weight loss
- Bloating
- Excessive flatulence
- Fat-soluble vitamin deficiencies (A, D, E, and K)
- Protein-calorie malnutrition These symptoms are supported by the most recent and highest quality study, which provides the best practice advice for the evaluation and management of exocrine pancreatic insufficiency 1.
Diagnosis and Treatment
Diagnosis of pancreatic insufficiency can be made using the fecal elastase test, which is the most appropriate initial test and must be performed on a semi-solid or solid stool specimen 1. Treatment involves pancreatic enzyme replacement therapy (PERT), which should be taken during meals to aid digestion. The initial treatment dose should be at least 40,000 USP units of lipase during each meal in adults, and one-half of that with snacks, adjusting as needed to control symptoms 1.
Monitoring and Follow-up
Monitoring of nutritional status, including anthropomorphic measurements, serum biomarkers, and clinical assessment, is essential in patients with pancreatic insufficiency 1. Baseline measurements of fat-soluble vitamin levels and serum markers of malnutrition should be obtained, and repeated annually or as needed. A baseline dual-energy x-ray absorptiometry scan should also be obtained and repeated every 1-2 years to assess bone density.
Lifestyle Modifications
Lifestyle modifications, such as a low-moderate fat diet with frequent smaller meals and avoiding very-low-fat diets, can help manage symptoms and improve nutritional status 1. Patients should also be advised to avoid smoking and excess alcohol consumption, which can exacerbate pancreatic insufficiency.
Multidisciplinary Care
A multidisciplinary evaluation, including a dietary assessment from a certified dietitian and coordination of care with an endocrinologist, can help establish the state of the patient's digestive and endocrine systems and provide comprehensive care 1.
From the FDA Drug Label
The data described below reflect exposure to CREON in 92 patients: 67 patients aged 4 months to 43 years with exocrine pancreatic insufficiency due to cystic fibrosis (Studies 1,2, and 3) and 25 adults with exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatectomy (Study 4)
The symptoms of pancreatic insufficiency (Exocrine Pancreatic Insufficiency - EPI) are not directly stated in the provided drug label. However, based on the adverse reactions reported in the clinical trials, some possible symptoms of EPI that may be alleviated by the treatment include:
- Abdominal pain
- Diarrhea
- Flatulence
- Constipation
- Nausea
- Vomiting
- Frequent bowel movements
- Abnormal feces 2
From the Research
Symptoms of Pancreatic Insufficiency (Exocrine Pancreatic Insufficiency - EPI)
The symptoms of pancreatic insufficiency (EPI) include:
- Abdominal cramps 3
- Steatorrhea (excess fat in feces) 4, 3, 5
- Malnutrition 4, 3, 5
- Weight loss 3, 5
- Abdominal discomfort 5
- Creathorrhea (excess undigested carbohydrates in feces) 5
- Nutritional deficiencies 4, 3, 5
- Gastrointestinal symptoms such as stomach pain, nausea, and bloating 6
Clinical Manifestations
Clinical manifestations of EPI also include:
- Malabsorption of fat, proteins, and carbohydrates 4, 5
- Increased nutrient delivery to distal intestinal sites, causing symptoms by profound alteration of upper gastrointestinal secretory and motor functions 4
- Persistent gastrointestinal symptoms 7
Diagnosis and Treatment
Diagnosis of EPI is based on assessments of exocrine pancreatic function, such as fecal fat quantification and (13) C-triglyceride breath test 3. Treatment of EPI involves pancreatic enzyme replacement therapy (PERT) to ensure a normal nutritional status and relieve maldigestion-related symptoms 4, 3, 5, 6.