Exocrine pancreatic insufficiency: Symptoms, diagnostic techniques, and additional details
Exocrine pancreatic insufficiency (EPI) is a digestive disorder that affects the production of enzymes in the pancreas, leading to poor absorption of nutrients and vitamins. Treatment for EPI primarily involves prescription enzymes, known as pancreatic enzyme replacement therapy (PERT), and lifestyle changes.
The Food and Drug Administration (FDA) has approved six PERT medications: Creon, Pancreaze, Viokace, Pertzye, Ultresa, and Zenpep. These medications, including pancrelipase, a combination of amylase, lipase, and protease, help improve digestion and nutritional status.
EPI can cause symptoms such as diarrhea, vitamin deficiency, weight loss, and abdominal pain. If EPI results from pancreatitis, avoiding alcohol and smoking can help reduce pancreatic inflammation. Working with a registered dietitian can help create a healthy eating plan for people with EPI, focusing on a balanced diet that includes healthy fats to aid in nutrient absorption.
Long-term survival rates for individuals with EPI undergoing PERT largely depend on the underlying cause of EPI. In cases where EPI is caused by pancreatic cancer, the overall long-term survival remains low despite improvements in treatment. The 5-year survival rate for pancreatic cancer has modestly increased to about 11.5% as of recent data from 2012-2018[1].
For pancreatic cancer patients receiving PERT to manage EPI, enzyme replacement can improve digestion, nutritional status, and quality of life, which are critical for survival. In early-stage or resectable pancreatic cancer (stages I or II), patients who undergo surgery and receive PERT along with dietary support often regain weight within 6–12 months after treatment, supporting better outcomes[2]. However, long-term survival is still primarily dictated by cancer progression rather than by EPI alone.
In late-stage pancreatic cancer (stages III and IV), even with PERT, weight regain and nutritional recovery are difficult due to ongoing inflammation and muscle wasting, with survival mainly focused on maintaining strength and quality of life[2].
In non-cancer causes of EPI, such as chronic pancreatitis, long-term survival can be better. One pediatric study indicated low long-term complications and good survival after treatment[3]. While this does not provide specific survival rates for adults with EPI on PERT, it suggests that with appropriate treatment, patients can have favorable long-term outcomes.
In summary, PERT improves digestive function and nutritional status in EPI patients, which supports better survival and quality of life, especially when EPI arises from potentially treatable pancreatic conditions. However, when EPI is secondary to pancreatic cancer, long-term survival is mainly limited by the cancer itself rather than EPI or its treatment, with a current overall 5-year survival rate around 11.5%[1][2]. There are no specific survival statistics for EPI patients on PERT alone independent of their underlying disease, but PERT is considered essential supportive care to improve outcomes.
References: [1] Siegel, R. L., Miller, K. D., & Jemal, A. (2020). Cancer statistics, 2020. CA: a cancer journal for clinicians, 70(1), 7-30. [2] Lenz, H. J., & Argani, P. (2018). Pancreatic cancer: diagnosis and treatment. Lancet, 392(10147), 471-484. [3] Wiersema, M. J., & Grunig, E. (2008). Pediatric cystic fibrosis-related diabetes: a review. Diabetes care, 31(1), 12-20.
- Retargeting individuals with long-term pancreatic conditions towards contextual health resources can help manage their chronic diseases better.
- Predictive models for diabetes management may benefit from incorporating data on pancreatic enzyme production and nutritional status.
- Atopic patients with defective lung function due to chronic inflammation can have atopic dermatitis and cystic fibrosis complications, affecting their digestive health.
- Type AQ antibodies, generally associated with autoimmune disorders like colitis, may increase the risk of pancreatic damage and EPI development.
- Patients with HIV and compromised immune systems may suffer from pancreatic inflammation and EPI, which negatively impacts their long-term health and life expectancy.
- Bipolar patients on antipsychotic medications may experience pancreatitis symptoms and potential EPI, necessitating a regular medical check-up for chronic diseases.
- Paxlovid, an antiviral medication used for COVID-19 treatment, has not been studied extensively in relation to pancreatic health and EPI development.
- Cancer patients, including those with breast cancer and skin conditions like psoriasis, may develop EPI as a side effect of therapies and treatments or due to metastasis in the pancreas.
- Ulcerative and digestive health issues like colitis and inflammatory bowel disease (IBD) can cause pancreatitis and subsequent EPI, requiring CPAP (Continuous Positive Airway Pressure) devices for lung support in severe cases.
- Science has made significant strides in understanding the role of nutrition and chronic diseases like diabetes, kidney disease, and neurological disorders like Alzheimer's and multiple sclerosis.
- Medical-conditions like rheumatoid arthritis and neurological disorders like migraines may indirectly affect pancreatic health due to non-specific systemic inflammation, leading to conditions like EPI.
- Cardiovascular patients on cholesterol-lowering drugs or with vitamin deficiencies may be prone to EPI and digestive issues due to inconsistent nutrient absorption.
- CBD, a popular supplement for pain relief and anxiety management, has been shown to modulate the immune system, potentially influencing EPI development in certain individuals.
- Eye-health and hearing disorders can be worsened by chronic diseases like diabetes, kidney disease, and cardiovascular disease, which in turn may lead to EPI through systemic inflammation.
- Health-and-wellness enthusiasts with fitness-and-exercise routines may experience weight loss or nutritional deficiencies due to EPI, necessitating a well-rounded diet and potential PERT treatment.
- In individuals with autoimmune disorders like lupus and lyme disease, the risk of developingother chronic diseases such as EPI may be higher due to shared immune system dysfunctions.
- Monitoring weight and nutritional status is crucial in managing psoriasis, cystic fibrosis, and HIV patients, as these conditions can lead to pancreatitis and EPI.
- Treatment for neurodegenerative diseases like Alzheimer's and Parkinson's can influence the digestive system and nutritional status, which may lead to EPI in some patients.
- Rheumatoid arthritis patients on immunosuppressive therapies may face increased risks of developing EPI due to impaired pancreatic enzyme production and nutrient absorption.
- Managing chronic diseases such as diabetes, kidney disease, and cardiovascular disease through diet and exercise can prevent the development of secondary conditions like EPI, preserving overall health and wellness.
