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2017 ; 23
(39
): 7059-7076
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Less common etiologies of exocrine pancreatic insufficiency
#MMPMID29093615
Singh VK
; Haupt ME
; Geller DE
; Hall JA
; Quintana Diez PM
World J Gastroenterol
2017[Oct]; 23
(39
): 7059-7076
PMID29093615
show ga
Exocrine pancreatic insufficiency (EPI), an important cause of maldigestion and
malabsorption, results from primary pancreatic diseases or secondarily impaired
exocrine pancreatic function. Besides cystic fibrosis and chronic pancreatitis,
the most common etiologies of EPI, other causes of EPI include unresectable
pancreatic cancer, metabolic diseases (diabetes); impaired hormonal stimulation
of exocrine pancreatic secretion by cholecystokinin (CCK); celiac or inflammatory
bowel disease (IBD) due to loss of intestinal brush border proteins; and
gastrointestinal surgery (asynchrony between motor and secretory functions,
impaired enteropancreatic feedback, and inadequate mixing of pancreatic
secretions with food). This paper reviews such conditions that have less
straightforward associations with EPI and examines the role of pancreatic enzyme
replacement therapy (PERT). Relevant literature was identified by database
searches. Most patients with inoperable pancreatic cancer develop EPI (66%-92%).
EPI occurs in patients with type 1 (26%-57%) or type 2 diabetes (20%-36%) and is
typically mild to moderate; by definition, all patients with type 3c
(pancreatogenic) diabetes have EPI. EPI occurs in untreated celiac disease
(4%-80%), but typically resolves on a gluten-free diet. EPI manifests in patients
with IBD (14%-74%) and up to 100% of gastrointestinal surgery patients (47%-100%;
dependent on surgical site). With the paucity of published studies on PERT use
for these conditions, recommendations for or against PERT use remain ambiguous.
The authors conclude that there is an urgent need to conduct robust clinical
studies to understand the validity and nature of associations between EPI and
medical conditions beyond those with proven mechanisms, and examine the potential
role for PERT.
|Age Factors
[MESH]
|Celiac Disease/epidemiology/therapy
[MESH]
|Diabetes Mellitus/epidemiology/therapy
[MESH]
|Diet, Gluten-Free
[MESH]
|Digestive System Surgical Procedures/adverse effects
[MESH]
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