Every day, the body receives portions of food that must be digested and removed from them nutritional components.
Exocrine pancreatic insufficiency is a dangerous disease that entails a disruption in the production of enzymes that are responsible for the digestion of food entering the stomach.
As a result, the human body does not receive enough vitamins and other active substances. In this article, you can familiarize yourself with the pathophysiology of exocrine insufficiency (causes, mechanism and its outcome), as well as the principles of diagnosis, treatment and preventive measures.
What is the disease?
Digestion of food is considered one of the most difficult processes in the body. It begins after the product enters the mouth and is moistened with saliva. Food swallowed enters the stomach, secreting pepsin and hydrochloric acid.
After half an hour, food particles are in the initial section of the small intestine – duodenum 12. It is here that special enzymes are responsible for the assimilation of food, the breakdown of fats and proteins, and the absorption of vitamins. They are produced by the organ of the digestive system – the pancreas, which breaks down large molecules into simple particles.
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This organ performs vital functions in the human body. They are usually classified as follows:
- The exocrine function (external secretion) consists in the excretion of biologically active substances – lipase, amylase and protease into the duodenum using the branched structure of the ducts.
- Endocrine function (internal secretion) is associated with the work of the pancreatic islets, which produce hormones such as insulin, glucagon, pancreatic polypeptide, somatostatin and ghrelin (“hunger hormone”).
In a healthy person, the pancreas produces enough enzymes and hormones, so it is able to fully ensure the digestion of food and support metabolic processes.
When the organ is unable to produce the required amount of enzymes, exocrine pancreatic insufficiency develops. Due to the pathogenic process, vitamin deficiency and nutritional deficiencies occur.
The complete absence or ineffective treatment leads to a slowdown in growth in childhood, diseases of the musculoskeletal system and a significant decrease in immunity, which threatens to become infected with various infections.
According to statistics, 10% of the United States population is diagnosed with exocrine pancreatic insufficiency syndrome.
Medical studies indicate a direct relationship between alcohol abuse and the development of pathology. Patients suffering from alcohol dependence fall into a special risk group, since the disease manifests itself in 80% of cases.
The etiology of pathology includes the influence of many factors. Disruption of enzyme production occurs for congenital and acquired reasons.
Lack of pancreatic function develops as a result of the progression of such congenital diseases:
- cystic fibrosis is a genetic pathology of the respiratory and digestive system, it is characterized by the production of a viscous secretion that clogs the pancreatic ducts, small bronchi and bronchioles;
- Shwachman’s syndrome – a genetic disorder of the bone marrow and pancreas, which produces an insufficient amount of lipase;
- lipomatosis – an increase in body weight as a result of excessive deposition of adipose tissue.
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Acquired reasons include surgical removal of the pancreas and cell death in pancreatitis. Pancreatitis is a disease characterized by the replacement of normal tissue of the organ with scar tissue. As a result, the production of enzymes is reduced, and the digestive system is unable to fully digest food.
It should be noted that chronic pancreatitis is diagnosed in adult patients. In childhood, the development of such a pathology is an extremely rare occurrence. Moreover, the risk of pancreatitis increases with diabetes mellitus.
In addition, factors affecting the occurrence of exocrine organ failure can be:
- Malignant formations in the pancreas.
- Crohn’s disease is an inflammation of one of the parts of the digestive system.
- Gluten enteropathy – intolerance of the body to gluten (gluten protein in cereals).
- Dumping syndrome is a sharp increase in blood flow in the intestine due to the ingress of insufficiently digested food from the stomach.
- Zollinger-Ellison syndrome is a condition that combines such pathological processes as the presence of tumors in the duodenum or pancreas, as well as excess production of hydrochloric acid in the stomach.
Also, the onset of failure can be influenced by the transfer of surgical intervention on the digestive tract.
Signs of exocrine pancreatic insufficiency
Experimental studies have proven that with a slight lack of pancreatic secretion, food will still be digested. In this regard, at the beginning of the development of the syndrome, a person may not feel any symptoms.
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Thanks to the experimental blocking of the production of pancreatic secretions, it was found that the intestine is able to assimilate 63% of proteins and 84% of fats. Apparently, the enzymatic activity is replaced by active substances secreted by the stomach and intestinal mucosa.
The clinical picture of the disease very often resembles other pathologies of the digestive system: peptic ulcer, irritable bowel syndrome, the presence of stones in the gallbladder, etc.
The most common symptom of exocrine insufficiency is chronic diarrhea. Undigested food particles and mucus can be seen in the stool. This phenomenon is due to the fact that the body cannot fully assimilate proteins and fats. In addition, feces have a pronounced unpleasant odor.
Other signs of pathology are:
- unconditional weight loss;
- flatulence (excessive gas production);
- hypovitaminosis (hair loss and brittle nails);
- rapid fatigue and loss of strength;
- pica;
- intense thirst and polyuria (rare);
- severe girdle pain radiating to the back.
Painful sensations are sometimes so strong that the patient has to be hospitalized and injected with painkillers.
Exacerbations are observed when taking fatty foods and alcoholic beverages. In such cases, vomiting and diarrhea are possible.
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Basic diagnostic methods
First of all, the treating specialist must listen to the patient’s complaints. However, the anamnesis cannot speak exclusively of exocrine pancreatic insufficiency. In addition, diarrhea may not develop for a long time, since the organ retains its functionality, albeit not fully.
With obvious atrophy of the organ, laparoscopy or laparotomy is performed. If the patient is sick with pancreatitis, it is impossible to carry out surgical intervention for the purpose of diagnosis. This is associated with significant adhesion and fibrosis.
The main laboratory tests that a doctor can prescribe are a study of feces and blood. As a rule, an increase in ALT activity, a decrease in the production of fats, polyunsaturated acids, cholesterol, amylase, lipase, isoamylase and phospholipase A2 may indicate a malfunction of the organ.
To establish why there was a violation of the exocrine function of the pancreas, it is necessary to undergo computed tomography (CT).
Only on the basis of all the above analyzes can the doctor make a diagnosis, and based on it, develop an individual and effective treatment regimen.
Therapy and preventive measures
Treatment of the disease includes two important components – special nutrition and substitution therapy. The diet excludes the consumption of hard-to-digest fatty foods and alcoholic beverages. Instead, it is recommended to eat plant-based foods such as fresh vegetables and fruits.
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Various cereals (millet, oatmeal, buckwheat) have a beneficial effect on the digestive tract. They contain a large amount of fiber, which is not completely digested in the stomach, but is a source of nutrients. To normalize the intestinal microflora, it is advisable to add low-fat fermented milk products to the menu. But with increased acidity of the stomach, their intake is prohibited.
Substitution treatment is the gold standard in the fight against this disease. It includes taking medications containing a pancreatic enzyme. Such drugs are capable of breaking down proteins, fats and starch, making it easier for the organ to work.
The table below lists the main drugs used in the treatment of the disease.
| Name | Indications | Contraindications |
| Pancreatin | Cystic fibrosis, chronic pancreatitis, simultaneous intake of hard-to-digest food, increased gas production, preparation for ultrasound and X-ray examination. | Hypersensitivity to the components of the drug, intestinal obstruction, chronic or acute pancreatitis at the stage of exacerbation. |
| Festal | Substitution treatment for exocrine pancreatic insufficiency, diarrhea of a non-infectious nature, flatulence, impaired chewing of food during normal functioning of the gastrointestinal tract, simultaneous intake of hard-to-digest food, preparation for ultrasound and X-ray examination. | Individual intolerance to the components of the drug, intestinal obstruction, exacerbated chronic or acute pancreatitis. |
| Mezim | Substitution therapy for exocrine pancreatic insufficiency, swelling, pancreatectomy, cystic fibrosis, dyspepsia, chronic pancreatitis, non-infectious diarrhea, condition after radiation. | Hypersensitivity to drug components, chronic or acute pancreatitis in the acute stage. |
To prevent the development of a pathological process, it is recommended to adhere to the following rules:
- Give up bad habits – smoking and alcohol.
- Switch to a balanced diet that limits the intake of fatty foods.
- Take vitamin and mineral complexes.
- Eat small meals, but often (5-6 times a day).
Additionally, it is recommended to avoid severe stressful situations.
What does ineffective treatment lead to?
Ignoring the disease or ineffective therapy leads to a host of undesirable consequences and even death. A severe degree of exocrine pancreatic insufficiency leads to the development of peptic ulcer, cystic formations and gastritis.
Jaundice or malignant tumors are much less common. Also, a severe stage of pathology can cause an exacerbation of pancreatitis, which is very dangerous for the patient’s life.
During the treatment of exocrine insufficiency, blood glucose levels should be checked regularly. Since there is a violation of the secretion of the pancreas, it is likely that it will produce less human insulin – the hormone responsible for lowering the concentration of sugar. Otherwise, there is a risk of developing diabetes mellitus.
Another negative consequence of long-term therapy is the addiction of the body to painkillers, the active component of which is narcotic substances. Each time, a person needs a large dosage to eliminate pain. As you know, narcotic substances have a negative effect not only on the pancreas, but also on other internal organs.
It should be noted that self-medication and the use of folk methods will not help cure the disease. Only timely complex therapy can guarantee a positive prognosis – successful recovery and prevention of complications (diffuse organ changes and diabetes mellitus).