Frequency

It is estimated that men are affected about twice as often as women by pancreatic insufficiency (pancreatic insufficiency), the peak of frequency here is in the age group of 45-54 years.

Forms

There are basically two forms of pancreatic insufficiency (pancreatic insufficiency): an endocrine and an exocrine form. This can be explained by the fact that the pancreas performs two different functions. Firstly, it produces the hormones insulin and glucagon with some of its cells, which are important for regulating blood sugar levels.

If there is a production disorder in the area of these cells, this is known as endocrine pancreatic insufficiency (pancreatic insufficiency). On the other hand, the pancreas also produces digestive enzymes and bicarbonate, which are released into the intestine via an excretory duct. The digestive enzymes then further break down the nutrients absorbed in the intestine so that they can be optimally utilised. Bicarbonate is an alkaline substance that is responsible for neutralising the gastric acid in the food from the stomach and also ensures that the small intestine has an ideal pH value in which enzymes from the intestine can work. If there is a disorder in this area, it is called exocrine pancreatic insufficiency (pancreatic insufficiency)Depending on the form of the disease, the symptoms are quite different.

Diagnosis

The diagnosis of pancreatic insufficiency (pancreatic insufficiency), which is made by the treating doctor, is based on various diagnostic pillars. In any case, a detailed anamnesis, i.e. a conversation between doctor and patient, during which the history of the disease and the existing symptoms are discussed in detail, should take place first. If the suspicion of pancreatic insufficiency is confirmed, a physical examination and some laboratory tests should be carried out.

As a rule, these laboratory tests determine the concentration of pancreatic enzymes in a stool sample taken from the patient. These enzymes are elastase and chymotrypsin. Especially the enzyme elastase is a reliable marker for the total enzyme production of the pancreas.

If the concentration of this enzyme is reduced (<200μg per 100g of stool), the diagnosis of pancreatic insufficiency is likely. The enzyme chymotrypsin also reflects pancreatic function, but is less accurate than the enzyme elastase. This test is also known as the fluorescein dilaurate test and is used very frequently.

Therapy

Therapy for pancreatic insufficiency (pancreatic insufficiency) aims to eliminate the cause of pancreatic damage wherever possible, but this is often difficult. As long as pancreatic insufficiency cannot be cured, the aim of therapy should always be to ensure normal digestion and absorption of nutrients, to counteract a further deterioration of the condition and possibly to treat the endocrine form of pancreatic insufficiency with insulin therapy. Since the lack of digestive enzymes means that certain food components, especially fats, can no longer be processed particularly well, care should be taken to eat a diet as low in fat as possible (not fat-free), this already represents a relief for the body.

The consumption of stimulants such as alcohol should also be avoided, as these also attack the pancreas. It may also be necessary to compensate for the lack of enzyme production in the pancreas by taking enzyme-containing preparations with meals. Such enzyme replacement therapy is recommended if the patient excretes more than 15g of fat in the stool daily.

Enzymes are divided into three classes:

Amylases for the breakdown of carbohydrates
Lipases for the breakdown of fats and
Proteases for the degradation of proteins. In principle, about 30,000 units of lipase activity must be taken with meals to improve fat absorption, but of course the exact dosage depends on the extent of pancreatic insufficiency and the composition of the food: the more fatty a meal is, the more enzymes are needed. Since the enzymes in their environment need a basic pH value to be able to exert their effect, sometimes additional proton pump inhibitors or H2-receptor blockers have to be taken to reduce stomach acid. Analgesics are used for severe pain, and the administration of vitamins may also be useful. If all these options are combined in the best possible way, a considerable improvement in quality of life is possible, even if the underlying disease cannot be cured.