Pancreatic exocrine insufficiency occur due to a variety of pancreatic conditions including chronic pancreatitis, cystic fibrosis, pancreatic cancer and pancreatic surgery. Pancreatic enzymes play a vital role in the digestion of fat and when there is a deficiency fat maldigestion and malabsorption occur resulting in steatorrhoea. This a the passage of frothy, foul-smelling buoyant stools that tend to stick in the toilet bowl. Other symptoms may occur like abdominal pain, flatulence and weight loss. If untreated fat malabsorption may result in micronutrients defeciency.
Tests for Pancreatic Exocrine Insufficiency
- 3-day faecal fat test: (unpopular)
- Faecal elastase level
- Serum trypsinogen level
Pancreatic Enzyme Repalcement Therapy
- Adults: 25,000 Units of lipase per meal titrating up to a maximum of 80,000 Units per meal
- Should be taken with meals to ensure mixing with chyme
- Acid suppression therapy may be helpful in patients on high dose
- An experienced dietitian should be involved
- No dietary fat restriction
- Stop alcohol
- Have small frequent meals
- Medium-chain trigluceride have no clear advantage but can be trialed in patients who remain malnorished.