CLINICAL | GASTROENTEROLOGY
Managing pancreatic
exocrine insufficiency Pancreatic exocrine insufficiency or exocrine Pancreatic insufficiency (EPI) is a condition characterised by deficiency of the exocrine pancreatic enzymes, resulting in the inability to digest food properly, or maldigestion.
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PI IS ASSOCIATED with certain diseases and conditions that affect the pancreas, such as cystic fibrosis, partial pancreatectomy and chronic pancreatitis.
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Patients with EPI can’t properly digest fats, proteins and carbohydrates. In addition to preventing adequate digestion, EPI produces uncomfortable gastrointestinal (GI) symptoms.
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SYMPTOMS The most common symptom of PEI is fatty stools (steatorrhoea). This occurs when the digestive system is unable to absorb dietary fats. Instead, these fats pass through the
ro t e i n PL ATE... fats | carbohydrates | p
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intestinal tract with waste products. The stools tend to be oily, large, pale, very foul-smelling, and often float in toilet water and stay in the toilet bowl, even after flushing. Individuals with steatorrhoea sometimes experience faecal incontinence or oily leakage. Intestinal gas and bloating can also occur from the fermentation of undigested food in the colon. Many individuals with PEI will experience nutritional deficiencies, since they are not taking in enough fats to help absorb vitamins. PEI can also cause weight loss, because patients do not get enough calories from the food they eat. Weight loss is more common in those who have PEI in addition to a digestive disease, such as Crohn’s disease. Some symptoms of nutrient malabsorption, and their typical causes, include fatigue, anaemia, bone disease (vitamin D deficiency), bleeding disorders, problems forming clots, bleeding under the skin, and blood in the faeces or urine (vitamin K deficiency). PEI MANAGEMENT It is important to treat the underlying cause of PEI, and these treatments will vary depending on the cause. However, lifestyle changes make it easier for the body to break down and absorb nutrients, which can help reduce the steatorrhoea and nutritional deficiencies that PEI causes.
PANCREATIC EXOCRINE INSUFFICIENCY (PEI) Improve the interdigestive “house keeper” function of gastrointestinal motility and biliopancreatic secretion1
Pancreatic exocrine insufficient patients who experience weight loss, those with daily fecal fat excretion of more than 15 g under a diet containing
CREON®, THE PANCREATIC ENZYME SUBSTITUTE2,3
100 g fat daily, and those with relevant steatorrhea related symptoms are classically and generally considered as suitable candidates for enzyme substitution therapy1
References: 1. Domínguez-Muñoz JE. Pancreatic exocrine insufficiency: diagnosis and treatment. J Gastroenterol Hepatol 2011;26 Suppl 2:12–16.2. 2. Creon® 25000. Approved package insert February 2016. 3. Creon® 10000. Approved package insert September 2005. S1 Creon® 10000. Each capsule contains enteric coated granules of Pancreatin 150 mg. Registration Numbers: Namibia: 04/11.1/1015, South Africa: 33/11.1/0340. S1 Creon® 25000. Each capsule contains enteric coated granules of Pancreatin 300 mg. Registration Numbers: Namibia: 04/11.1/1016, South Africa: 28/11.1/0645. For Full Prescribing Information Refer to the Package Insert Approved by the Medicines Regulatory Authority. Date of Publication of this Promotional Material: March 2021. Promotional Material Reference Number: SAF2183084. Abbott Laboratories S.A. (Pty) Ltd, Reg. No: 1940/014043/07. Abbott Place, 219 Golf Club Terrace, Constantia Kloof, 1709. Tel:+27 11 858 2000.
20 April 2021 | MEDICAL CHRONICLE
ENZYME THERAPY The most effective treatment for PEI is pancreatic enzyme replacement therapy (PERT), which involves taking pancrelipase to provide the body with enzymes that break down fats and proteins. Those with PEI must take PERT with each meal or snack that contains fat and/or protein. When taken with food, PERT duplicates the normal digestive process because the enzymes mix with the food and help absorption. PEI OUTLOOK With pancreatic enzyme replacement therapy and some changes to dietary adjustments, patients can manage symptoms of pancreatic exocrine insufficiency. References The National Pancreas Foundation. https:// pancreasfoundation.org/, assessed 26 March 2021. GI Society. https://badgut.org/, accessed 26 March 2021.
