Most common causes of PEI

Pancreatic Exocrine Insufficiency (PEI) may be present in patients with:1

  • acute pancreatitis
  • chronic pancreatitis
  • cystic fibrosis
  • post gastric and/or pancreatic surgery
  • pancreatic cancer
  • other conditions such as diabetes mellitus, coeliac disease, Crohn's disease

In fact, any pathology that affects the digestion of food by pancreatic enzymes – including extrapancreatic conditions – may cause PEI.

Irrespective of your patient’s primary condition, the consequences of undiagnosed or untreated PEI are both acute and long-term. Untreated PEI can lead to malnutrition and fat-soluble vitamin deficiencies,2  which are related to high morbidity and mortality secondary to an increased risk of malnutrition-related complications, including:

  • reduced quality of life3
  • reduced bone mineral density4
  • cardiovascular events2,5

Causes and consequences of untreated PEI

Goals of PERT

All patients with PEI should receive Pancreatic Enzyme Replacement Therapy (PERT), regardless of the presence or degree of steatorrhoea and associated symptoms.2,4–7 PERT facilitates the digestion of fats, proteins and carbohydrates by replacing missing digestive enzymes in patients with PEI.2

The treatment goals of PERT for PEI are to:5

  • Treat symptoms of PEI and improve nutritional status, including:
    • increase fat absorption and reduce steatorrhoea*
    • reduce stool frequency
    • improve stool consistency
  • Mimic the normal physiological conditions of a healthy pancreas in levels of dosing and timing1
*Steatorrhoea is a late-stage symptom and occurs when over 90% of normal pancreas function is lost. Hence, diagnosis should be made before the presence of steatorrhoea.

References

  1. Keller J et al. Gut 2005; 54(Suppl6): 1-28.
  2. Toouli J et al. Med J Aust. 2010; 193(8): 461-7.
  3. Ockenga J. HPB 2009; 11(3): 11-15.
  4. Sikkens ECM et al. Best Pract Res Clin Gastroenterol. 2010; 24(3): 337-47.
  5. Domínguez-Muñoz JE et al. J Gastroenterol Hepatol. 2011; 26(Suppl2): 12-16.
  6. Domínguez-Muñoz JE et al. Adv Med Sci. 2011; 56(1): 1-5.
  7. Domínguez-Muñoz JE et al. JOP J Pancreas (online) 2010; 11: 158-62.
  8. Gastroenterology and Endoscopy News. Pancreatic exocrine insufficiency. Part 1 of 2: Pathogenic and Diagnostic Considerations. Available at: www.gastroendonews.com/download/Pancreatic_CaPart1_WM.pdf. Last accessed 6th March 2016.

Early detection and optimal treatment of PEI are essential to relieve symptoms and normalise nutritional status.2,8

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