Less Common Causes of Exocrine Pancreatic Insufficiency Explored

Cystic fibrosis and chronic pancreatitis represent the most common etiologies
Cystic fibrosis and chronic pancreatitis represent the most common etiologies

While cystic fibrosis and chronic pancreatitis represent the most common etiologies of exocrine pancreatic insufficiency (EPI), less is know about other medical conditions associated with EPI, according to a new review published in World Journal of Gastroenterology.

Vikesh K. Singh, from Johns Hopkins University School of Medicine, Baltimore, MD, and coauthors aimed to review the less common conditions associated with EPI as well as the role of pancreatic enzyme replacement therapy (PERT) through a literature search of various databases.

The authors found that most patients with inoperable pancreatic cancer develop EPI (range 66% to 92%).  In addition, mild to moderate EPI occurs in patients with type 1 diabetes (26% to 57%) and type 2 diabetes (20% to 36%). Singh added that "by definition, all patients with type 3c [pancreatogenic] diabetes have EPI."

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Untreated celiac disease was also associated with EPI in 4% to 80% of cases but was resolved when patients adopted a gluten-free diet. EPI occurred in a wide range of patients with IBD (14% to 74%) and in almost all of gastrointestinal surgery patients (47% to 100%) depending on the surgery site. 

In patients with symptomatic EPI, dietary modification may help reduce symptoms. With regard to PERT, data from randomized controlled trials have shown improved fat absorption, clinical symptoms, and quality of life, as well as slowed gastric emptying in patients with EPI.  

"With the paucity of published studies on PERT use for these conditions, recommendations for or against PERT use remain ambiguous," Singh and team concluded. They call for more substantial clinical trials to better understand the associations between EPI and the less common conditions, and to assess the potential role of PERT.

For more information visit wjgnet.com.