Pancreatic Insufficiency: Causes

Pathogenesis (development of disease)

The pancreas (pancreas) has two important functions, an exocrine function and an endocrine function. First, it produces various digestive enzymes such as trypsinogen, amylase, and lipase. These are then released into the duodenum (duodenum) (= exocrine function). In addition to this exocrine function, the pancreas produces the vital hormones insulin and glucagon, which regulate carbohydrate balance. These hormones are released directly into the blood. If the pancreas is severely damaged by conditions such as chronic pancreatitis (inflammation of the pancreas), exocrine pancreatic insufficiency (inability of the pancreas to produce enough digestive enzymes) and diabetes mellitus may result. Exocrine pancreatic insufficiency (EPI), resulting in maldigestion (“poor digestion”) with diarrhea (diarrhea), steatorrhea (fatty stools), weight loss, and micronutrient (vital substance) deficiencies, can occur after acute pancreatitis; after chronic pancreatitis, the time of onset is unpredictable. After 10 years, exocrine insufficiency occurs in more than half of patients with chronic pancreatitis and after 20 years in almost all patients (more than half of the organ must be destroyed for steatorrhea/fatty stool to occur; occurs only when lipase secretion is reduced by more than 90-95%). The incidence of diabetes mellitus in chronic pancreatitis (pancreatogenic diabetes) is reported in the literature to be between 30 and 70 percent. In endocrine pancreatic insufficiency, as in exocrine pancreatic insufficiency, the maximum incidence is expected after 10-20 years. Exocrine and endocrine pancreatic function loss do not occur in parallel. Thus, after ten years, about 20 percent of patients with exocrine pancreatic insufficiency on the floor of chronic pancreatitis still have normal glucose tolerance (ability of the organism to break down a large amount of glucose without the development of pathological blood glucose levels). More than half of the patients with severe exocrine pancreatic insufficiency requiring enzyme replacement had normal glucose tolerance or did not require insulin therapy, even if they were diabetic. Conversely, 1 in 2 or 3 diabetics requiring insulin did not require enzyme substitution for their exocrine pancreatic insufficiency.

Etiology (Causes)

Biographic Causes

  • Genetic burden from parents, grandparents
    • Genetic diseases
      • Hemochromatosis (iron storage disease) – genetic disease with autosomal recessive inheritance with increased deposition of iron as a result of increased iron concentration in the blood with tissue damage.
      • Cystic fibrosis (ZF) – genetic disease with autosomal recessive inheritance characterized by the production of secretions in various organs to be tamed.

Behavioral causes

  • Nutrition
  • Pleasure food consumption
    • Alcohol (abuse)

Causes related to disease

  • Autoimmune pancreatitis – pancreatitis caused by an autoimmune disease (directed against one’s own body).
  • Duodenal carcinoma (cancer of the duodenum).
  • Gastrinoma – hormone-producing tumor in the pancreas (pancreas).
  • Pancreatic insufficiency with bone marrow dysfunction (Shwachman syndrome) – dysfunction of the pancreas with additional disturbance of hematopoiesis.
  • Pancreatic carcinoma (pancreatic cancer).
  • Pancreatitis (inflammation of the pancreas)
  • Primary sclerosing cholangitis (PSC) – chronic inflammation of the extra- and intrahepatic (located outside and inside the liver) bile ducts; associated with ulcerative colitis in 80% of cases; long-term risk of cholangiocellular carcinoma (malignant tumor of the bile ducts of the liver) is 7-15%.
  • Traumatic pancreatitis – pancreatitis caused by an injury.

Laboratory diagnoses – laboratory parameters that are considered independent risk factors.

Operations

  • Gastrectomy (stomach removal)
  • Pancreatic resection (removal of the pancreas).

Other causes

  • Radiotherapy