Chronic pancreatitis and pancreatic cancer; the clinical aspects and treatment of pancreatic exocrine insufficiency

Abstract

In exocrine pancreatic insufficiency, the pancreas is unable to deliver a sufficient quantity of pancreatic enzymes to the small intestine to digest food. It may occur in several life threatening diseases, including chronic pancreatitis and pancreatic cancer. Due to this lack or absence of pancreatic enzymes, malabsorption of fat develops, which causes steatorrhea-related symptoms, weight loss, and malnutrition. To reduce morbidity and even mortality, patients should be treated with a sufficient amount of oral pancreatic enzymes. In clinical practice, enzyme supplementation therapy seems to be a challenge, because the optimal enzyme dose is highly variable, depending on the remaining pancreatic function, the postsurgical anatomy, and dietary fat content. Unfortunately, this seems to be an underexposed topic (as the literature overview in chapter 2 shows), and physicians are often not wel