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Dx Pancreatic Insufficiency Treatments:

Exocrine Pancreatic Insufficiency

Exocrine pancreatic insufficiency (EPI) is a condition characterized by deficiency of the exocrine pancreatic enzymes, resulting in the inability to digest food properly, or maldigestion. The etiology of this deficiency includes both pancreatic and nonpancreatic causes.

The exocrine pancreas produces 3 main types of enzymes: amylase, protease, and lipase. Under normal physiologic conditions, the enzymes (specifically, lipase) break undigested triglycerides into fatty acids and monoglycerides, which are then solubilized by bile salts. Because the exocrine pancreas retains a large reserve capacity for enzyme secretion, fat digestion is not clearly impaired until lipase output decreases to below 10% of the normal level.

The diagnosis of exocrine pancreatic insufficiency (EPI) is largely clinical. It may go undetected because the signs and symptoms are similar to those of other GI diseases or because the signs and symptoms are not always evident, due to dietary restrictions.

A complete laboratory evaluation (including pancreatic function testing) is required not only to diagnose EPI but also to determine the extent of the malabsorption and assess the manifestations of the underlying disease, if present.

Management of EPI is based primarily on pancreatic enzyme replacement therapy (PERT) but may also include lifestyle modifications and vitamin supplementation as appropriate (see Treatment).

Medications Used in Treatment:
1. Enzyme Replacement: Creon®, Zenpep®, Pancreaze®, Viokase®, Ultresa® /pancrelipase

*[Editor] Major research publications call into question even the benefit of prescription enzyme medications for pancreatic insufficiency. "The major adverse events were tolerable gastrointestinal tract symptoms, such as stomach pain, nausea, and bloating. Fibrosing colonopathy, a serious complication, is associated with high doses of enzymes. Several pancrelipase products have been approved by the US Food and Drug Administration in recent years. Although many double-blind, placebo-controlled trials of pancrelipase products have been conducted in recent years, these studies have enrolled relatively few patients and have often been less than a few weeks in duration. Moreover, few studies have addressed the issue of pancreatic diabetes, a type of diabetes that is characterized by frequent hypoglycemia, which is difficult to manage. In addition, it is unclear whether PERT improves morbidity and mortality in such settings."

*[Editor] One Case Report identifies a 45-year old man who was diagnosed with EPI through finding large amounts of undigested lipids in his stool. For five years he took enzymes faithfully. Diagnosed by the Editor with hypogonadism (Low-T), he reported two years later that he was able to eat without use of the enzymes. No similar report is found in the literature, however, testing every adult man for testosterone deficiency and treating is often indicated.

*[Editor] Find an over-the-counter that works well for you containing pancrease, lipase, protease.
Pancreatic enzymes of similar composition to Wobenzym® are available over-the-counter at health food stores and a similar but inexpensive product is Intenzyme® by Biotics available on-line.

Suggested Links:
*MedPage Today

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