Exocrine insufficiency in pancreatic diseases and other digestive disorders: diagnosis and management
This paper reviews recent data on exocrine pancreatic insufficiency (EPI). The authors describe in detail the etiology and pathogenesis of both pancreatogenic EPI (resulting from chronic pancreatitis, pancreatic cancer, cystic fibrosis) and EPI resulting from celiac disease or diabetes. Current tests for assessing exocrine function of the pancreas are discussed. This article focuses on the available and informative test to measure pancreatic (fecal) elastase 1 levels in moderate-to-severe EPI. Its advantages are the lack of the effect of diet or fasting on test results and the possibility of performing this test in the setting of pancreatic enzyme replacement therapy. The authors also uncover the rules of correcting EPI using enzymes and management strategies in pancreatic enzyme replacement therapy non-responders involving, in particular, acid suppression therapy. Timely prescription of enzymes in adequate doses to address maldigestion and malabsorption and improvement of strategies to overcome gastric and intestinal pH barriers to guarantee proper enzyme delivery in the duodenum are important.