From the Guidelines
Pancreatic exocrine insufficiency (PEI) is a condition where the pancreas doesn't produce enough digestive enzymes, leading to maldigestion and malabsorption of nutrients, and its effects include steatorrhea, weight loss, abdominal pain, and nutritional deficiencies that can significantly impact quality of life and long-term health. The effects of PEI can be managed with pancreatic enzyme replacement therapy (PERT) and dietary modifications. According to the most recent study 1, the use of PERT in patients with chronic pancreatitis and PEI improves outcomes, and it is also an essential part of managing EPI and nutrition in the setting of cystic fibrosis.
Key Effects of PEI
- Steatorrhea
- Weight loss
- Abdominal pain
- Nutritional deficiencies
- Reduced quality of life
- Increased mortality if left untreated
Management of PEI
- Pancreatic enzyme replacement therapy (PERT) is required once PEI is diagnosed 1
- Dietary modifications, including a low-moderate fat diet with frequent smaller meals and avoiding very-low-fat diets
- Routine supplementation and monitoring of fat-soluble vitamin levels
- Regular follow-up to assess symptom improvement, weight maintenance, and stool characteristics
Important Considerations
- PERT should be taken during the meal, with the initial treatment of at least 40,000 USP units of lipase during each meal in adults and one-half of that with snacks 1
- A proton pump inhibitor like omeprazole can improve enzyme efficacy by reducing gastric acid that might deactivate the enzymes
- Patients should be monitored for nutritional deficiencies and take fat-soluble vitamin supplements (A, D, E, K) as needed
From the Research
Effects of Pancreatic Exocrine Insufficiency (PEI)
The effects of PEI can be severe and impact the quality of life, increasing morbidity and mortality. Some of the key effects include:
- Nutritional malabsorption and deficiencies 2, 3, 4, 5, 6
- Steatorrhea (excess fat in feces) and creathorrhea (excess undigested carbohydrates in feces) 3, 5, 6
- Abdominal discomfort 3
- Weight loss 3, 4, 5
- Malnutrition-related complications, such as osteoporosis 5
Clinical Impact
PEI can result from various conditions, including:
- Pancreatic disease and surgery 2, 3, 4, 5, 6
- Chronic pancreatitis 3, 4, 5
- Cystic fibrosis 3, 4, 6
- Pancreatic cancer 4, 6
- Upper gastrointestinal surgery 2
- Extrapancreatic diseases, such as celiac disease and Crohn's disease 6
Diagnosis and Treatment
Diagnosis of PEI should be based on a global assessment of symptoms, nutritional status, and a pancreatic secretion test 2. Treatment options include: