Symptoms of exocrine insufficiency
In exocrine pancreatic insufficiency, digestion-associated symptoms are the main focus. In a healthy state, the pancreas produces HCO3 (bicarbonate) to buffer the remaining gastric acid that is transported further, as well as various biocatalysts (enzymes) that break down (digest) the absorbed food into its components and thus enable the intestine to absorb these components. A deficient function of the exocrine pancreas thus results in insufficient buffering of gastric acid and not all food being digested.
As a result, the patient suffers from dyspeptic symptoms such as nausea, vomiting or even pain in the upper abdomen. This is mainly due to an irritation of the mucous membranes caused by remaining, insufficiently buffered gastric acid in the stomach (gas) downstream intestinal sections (especially the duodenum). These complaints occur mainly after the intake of high-fat food, against which the affected person usually develops a pronounced aversion.
In the long term, inadequate (insufficient) digestion (also known as maldigestion) then means that the body cannot absorb sufficient food components. This then leads to a lack of them; weight loss and deficiency symptoms (especially due to a reduced absorption of the fat-soluble vitamins E, D, K and A) are the possible consequences. On the other hand, undigested food remains in the intestine and thus reaches regions of the large intestine and rectum (colon and rectum) where they are not normally found. This then leads to diarrhoea (diarrhoea), flatulence (meteorism), but also to foul-smelling fatty stools (steatorrhoea) via bacterial colonisation. As a rule, however, symptoms of maldigestion are only to be expected when the excretion capacity of the exocrine pancreas has fallen below 10% of the normal value.
Causes
Pancreatic insufficiency can have many causes. For example, in addition to permanent pancreatitis (chronic pancreatitis), pancreatic cancer (pancreatic carcinoma) can also be considered as a cause, as can genetic causes (especially the hereditary disease cystic fibrosis) or autoimmune diseases. Depending on the cause of the pancreatic insufficiency, other symptoms may occur in addition to those caused by it, such as fever, night sweats, upper abdominal and back pain, or – due to a dislocation of the bile duct – jaundice (icterus).
Therapy
In addition to treatment of the underlying disease (e.g. by abstinence from alcohol in the case of chronic pancreatitis) and dietary measures (many small, high-carbon, low-fat meals), some pancreatic products (pancreatic synthesis products) such as the digestive enzyme lipase or the hormone insulin can be supplied from the outside by replacing (substituting) them. In the case of insulin, this must be injected into the subcutaneous fatty tissue (subcutaneously) by means of a syringe. The enzyme lipase can be taken in tablet form.
For both applications, however, the dose must always be adapted to the quantity and composition of the food. If necessary, the vitamins E, D, K and A, which are fat-soluble and are therefore absorbed at a reduced rate in cases of pancreatic insufficiency, should be added. Since their absorption in the intestine is reduced, this should preferably be done “past the intestine” (parenterally).
