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, 23 (39), 7059-7076

Less Common Etiologies of Exocrine Pancreatic Insufficiency


Less Common Etiologies of Exocrine Pancreatic Insufficiency

Vikesh K Singh et al. World J Gastroenterol.


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.

Keywords: Celiac disease; Epidemiology; Exocrine pancreatic insufficiency; Inflammatory bowel disease; Malabsorption; Pancreas; Pancreatic cancer; Secretion/absorption; Surgery.

Conflict of interest statement

Conflict-of-interest statement: Singh VK is a consultant for Ariel, Kowa, Novo Nordisk, and AbbVie; he has been an advisory board participant for Akcea and Nordmark; Geller DE and Hall JA are employees of AbbVie and may own AbbVie stock and/or options; Haupt ME and Quintana Diez PM are former employees of AbbVie and may own AbbVie stock and/or options.

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