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Pancreatic Exocrine Deficiency


Presentation

  • Clinical teams at Royal Brompton and Harefield hospitals care for patients with a wide range of complex cardiac conditions, both congenital (present at birth), inherited and acquired.[rbht.nhs.uk]
  • Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol . 2011:4:55-73. 2. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut . 2005;54(suppl 6):vi1-vi28. 3.[identifyepi.com]
  • In the present study, the number of patients with MODY3 who had CEL mutations was low, not allowing reliable statistical evaluation.[care.diabetesjournals.org]
  • Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol . 2011. 4:55-73. [Medline] . [Full Text] . Dominguez-Munoz JE.[emedicine.medscape.com]
  • Pipeline Analysis (Phase II and I) Tabular Presentation 3.7. Competitive Analysis 4. Global Exocrine Pancreatic Insufficiency Market- By Therapeutics 2013-2023 (US Mn) 4.1. Overview 4.2. Pancreatic Enzyme Replacement Therapy (PERT) Drugs 4.2.1.[gii.co.jp]
Laboratory Technician
  • However, the odious nature of this test, for both patients and laboratory technicians, makes it an unpopular choice. Of the remaining indirect function tests, faecal elastase-1 and serum trypsinogen tests are most commonly used.[mja.com.au]
Chronic Diarrhea
  • Symptoms of PEI include: Chronic diarrhea Abdominal pain Steatorrhea (excessive fat in the feces) Flatus Azotorrhea (excessive discharge of nitrogenous substances in the feces Glucose intolerance Signs associated with certain vitamin deficiencies Anorexia[enzyme-facts.com]
  • J Med Genet 35 : 255 –257, 1998 Scire G, Magliocca FM, Cianfarani S, Scalamandre A, Petrozza V, Bonamico M: Autoimmune polyendocrine candidiasis syndrome with associated chronic diarrhea caused by intestinal infection and pancreas insufficiency.[care.diabetesjournals.org]
Osteoporosis
  • Vitamin deficiencies can also cause vision problems, osteoporosis, and muscle weakness. Weight Loss Even when you’re eating a normal amount of food, EPI can lead to weight loss.[healthline.com]
  • Duggan , SN , O'Sullivan , M , Hamilton , S et al. ( 2012 ) Patients with chronic pancreatitis are at increased risk for osteoporosis . Pancreas 41 , 1119 – 1124 . 58.[cambridge.org]
  • This study excluded patients with overt steatorrhea suggesting that mild to moderate PEI is a risk factor for development of osteoporosis (10, 15, 31, 33).[pancreapedia.org]
  • Studies show that steatorrhea is common in patients with diabetes and fecal elastase deficiency ( 6 ), suggesting clinical implications such as increased risk of osteoporosis and other diseases associated with deficiencies in fat-soluble vitamins.[care.diabetesjournals.org]
  • These nutrient deficiencies rarely result in symptoms such as tetany, glossitis, peripheral neuropathy and osteoporosis. B. History Part 2: Prevalence: Pancreatic insufficiency can develop due to: 1.[cancertherapyadvisor.com]
Peripheral Neuropathy
  • These nutrient deficiencies rarely result in symptoms such as tetany, glossitis, peripheral neuropathy and osteoporosis. B. History Part 2: Prevalence: Pancreatic insufficiency can develop due to: 1.[cancertherapyadvisor.com]

Workup

  • Diagnosis). [6] A complete laboratory evaluation (including pancreatic function testing) is required not only to diagnose EPI but also to determine the extent of the malabsorption and assess the manifestations of the underlying disease, if present (see Workup[emedicine.medscape.com]
Hypercholesterolemia
  • These are often accompanied by other minor symptoms, such as renal and intracranial vascular problems, hypercholesterolemia and growth retardation.[nature.com]

Treatment

  • Conditions, tests and treatments A-Z[rbht.nhs.uk]
  • “The goal of EPI treatment is to replace the digestive function of the pancreas,” Dr. Gardner says. Here's how the three elements of EPI treatment can help do this.[everydayhealth.com]
  • Pancreatic replacement therapy in the treatment of pancreatic steatorrhea. Gut 4:217, 1963. Google Scholar 16. Handelsman, M. B., Golden, L. A. , and Pratt, J. H.[link.springer.com]
  • What is the treatment for exocrine pancreatic insufficiency (EPI)? The treatment for exocrine pancreatic insufficiency is termed pancreatic enzyme replacement therapy (PERT).[medicinenet.com]
  • Pancreatic enzyme replacement therapy The primary treatment goal for PEI is to eliminate maldigestion and malabsorption and maintain adequate nutrition. A treatment algorithm is proposed in Box 3 . PERT is the mainstay of treatment for PEI.[mja.com.au]

Prognosis

  • What is the prognosis for a person with exocrine pancreatic insufficiency (EPI)? The prognosis of patients with exocrine pancreatic insufficiency depends upon the underlying cause.[medicinenet.com]
  • Prognosis and Patient Counseling. The prognosis is generally good with compliance of pancreatic enzyme supplementation. Patients need counselling and education about the right way to take enzymes and titration of doses according to symptoms.[cancertherapyadvisor.com]
  • Features of Alagille syndrome in 92 patients: frequency and relation to prognosis . Hepatol. Baltim. Md 29 , 822–829 (1999). 4. Golson, M. L. , Loomes, K. M. , Oakey, R. & Kaestner, K. H.[nature.com]
  • […] is a common lethal genetic disorder that is primarily diagnosed at birth through newborn screening. 2 , 65 About 85% of cystic fibrosis patients have pancreatic insufficiency by early childhood. 12 Prolonged, untreated PEI is associated with a poorer prognosis[mja.com.au]
  • The study included 227 patients. [20] Epidemiology and Prognosis Because EPI has multiple possible causes and is not usually recorded as a medical statistic, its prevalence and demographics cannot be established with certainty at present.[emedicine.medscape.com]

Etiology

  • They are organised into groups, and further divided into clinical, etiological or histopathological sub-types.[orpha.net]
  • The etiology of this deficiency includes both pancreatic and nonpancreatic causes (see Etiology). [1] The exocrine pancreas produces 3 main types of enzymes: amylase, protease, and lipase. [2] Under normal physiologic conditions, the enzymes (specifically[emedicine.medscape.com]
  • However, some of the underlying etiologies (i.e. malignancy, recent surgeries) may result in the need for skilled nursing care. F. Prognosis and Patient Counseling.[cancertherapyadvisor.com]
  • Its etiology is probably multifactorial. Insufficient caloric intake and malnutrition present important problems.[nature.com]
  • However, direct comparisons of pancreatic exocrine function in patients with varying etiologies of chronic pancreatitis have been few, so far (38).[pancreapedia.org]

Epidemiology

  • Epidemiology of chronic pancreatitis: burden of the disease and consequences. United European Gastroenterol J. 2014 Oct;2(5):345-54. Available online at . Accessed on 3/19/17. Schneider, A. et. al. (2005 May).[labtestsonline.it]
  • The epidemiology and impact of pancreatic diseases in the United States. Curr Gastroenterol Rep . 2005 May. 7(2):90-5. [Medline] . de la Iglesia D, Vallejo-Senra N, Lopez-Lopez A, et al.[emedicine.medscape.com]
  • Spanier , BWM , Dijkgraaf , MGW & Bruno , MJ ( 2008 ) Epidemiology, aetiology and outcome of acute and chronic pancreatitis: an update . Best Pract Res Clin Gastroenterol 22 , 45 – 63 . 8.[cambridge.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology involved in pancreatic exocrine insufficiency The pathophysiology involved in pancreatic exocrine insufficiency is nothing but alteration of normal physiology or the diseased pancreas per se secreting less enzymes.[ispub.com]
  • Pathophysiology The GI tract is responsible for digesting and absorbing food. [7] Lipids provide the richest source of energy for the body, with 9 calories in every gram of fat; in comparison, carbohydrate and protein contains 4 calories per gram.[emedicine.medscape.com]
  • One possible cause for these symptoms is exocrine pancreatic insufficiency, and although several hypotheses have been proposed to explain the aetiology, the precise pathophysiological mechanisms remain to be elucidated.[pancreas.imedpub.com]
  • Pathophysiology Progressive inflammatory destruction of pancreatic tissue in chronic pancreatitis leads to reduced synthesis and secretion of pancreatic enzymes in response to food intake.[pancreapedia.org]
  • Pathophysiology/Complications Abstract OBJECTIVE —Exocrine pancreas dysfunction is seen in 10–30% of patients with type 1 and 2 diabetes.[care.diabetesjournals.org]

Prevention

  • This results in the prevention of breakdown of food and its absorption leading to malnutrition.[enzyme-facts.com]
  • Cutting the fat in your diet can also help prevent abdominal pain from underlying pancreatitis.[everydayhealth.com]
  • Diet Doctors used to recommend a low-fat diet for people with EPI because it prevents fat malabsorption, which can lead to bloating and diarrhea.[everydayhealth.com]
  • Treatment involves dealing with the underlying condition, preventing further pancreatic damage and managing the symptoms. Medical therapy addresses the functional and nutritional deficiencies.[labtestsonline.org.uk]

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