Pancreatic exocrine insufficiency

Pancreatic exocrine insufficiency (PEI) is characterised by a reduction in the amount pancreatic enzymes released into the duodenum in response to a meal that is below the threshold needed to maintain normal digestive processes.(1,2)

PEI can be caused by a number of conditions, including chronic pancreatitis, acute pancreatitis, cystic fibrosis, pancreatic cancer and upper gastrointestinal surgery including pancreatectomy, gastrectomy.(1,2) 

PEI-related signs and symptoms include steatorrhea, weight loss, abdominal discomfort, and, in many cases, deficiencies of micronutrients and lipid-soluble vitamins.(1,2)

If left untreated, the symptoms of PEI significantly impacts on the patient’s quality of life, whilst other clinical consequences include weight loss and malnutrition related complications.(1,2 )

Diagnosis
If steatorrhea is present, PEI may be diagnosed clinically. However, steatorrhea may be absent in less severe cases of PEI or may be the result of other causes, such as mucosal disease or postcibal asynchrony, which may occur following gastrectomy.(3)

When PEI is suspected, a pancreatic function test should be performed. The most widely used non-invasive test is faecal elastase-1 (FE-1) level. It is reliable particularly in patients with moderate-to-severe PEI. A single stool sample is used for analysis, with concentrations of less than 200 mcg/g of stool indicating mild PEI, and less 100mcg/g indicating severe PEI.

References
1. Lindkvist B. World J Gastroenterol 2013;19:7258-66.
2. Toouli J, et al. Med J Aust 2010;193:461-7.
3. Lohr JM, et al. United European Gastroenterol J 2013;1:79-83.