What is Pancreatic Exocrine Insufficiency (PEI) and Who is at Risk?

Pancreatic exocrine insufficiency (PEI) is a condition where the pancreas does not produce enough digestive enzymes to ensure normal digestion and absorption of nutrients. This can lead to symptoms such as bloating, diarrhea, steatorrhea (fatty stools), weight loss, and malnutrition. Let’s dive into what causes PEI and who may be at risk of developing it.

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What Causes PEI?

PEI occurs when the amount of enzymes secreted into the duodenum (the first part of the small intestine) in response to a meal is insufficient. This can happen due to:

1.  Atrophy or Resection of Pancreatic Tissue: Conditions like chronic pancreatitis or surgical removal of part of the pancreas reduce the gland’s ability to produce enzymes.

2.  Reduced Stimulation of Enzyme Production: This may be due to anatomical or physiological changes, such as gastric surgery or hormonal imbalances.

3.  Obstruction of the Pancreatic Duct: Stones, strictures, or tumours can block the pancreatic duct, preventing enzymes from reaching the intestine.

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Who is at Risk of Developing PEI?

Some individuals are at clear risk due to specific medical conditions or surgeries, while in others, the risk may be less obvious. Here are the most common risk groups:

1.  Cystic Fibrosis: The majority of patients with cystic fibrosis will develop PEI and require pancreatic enzyme replacement therapy (PERT).

2.  Chronic Pancreatitis: Over time, the inflammation and calcification in chronic pancreatitis lead to atrophy and loss of enzyme production, resulting in PEI.

3.  Acute Pancreatitis: Significant pancreatic necrosis during acute pancreatitis can cause PEI, though not all cases lead to this outcome.

4.  Pancreatic Cancer: Pancreatic adenocarcinoma often obstructs the main pancreatic duct, causing malabsorption. A New Zealand study in 2016 found that 68-92% of patients with advanced pancreatic cancer developed PEI, yet only 21% were on PERT. As clinicians we are working hard to raise the awareness and get all patients diagnosed with pancreatic cancer started on PERT.

5.  Pancreatic Surgery: Procedures like the Whipple’s procedure (pancreaticoduodenectomy) can lead to PEI. Postoperative PERT is now routinely recommended.

6.  Gastric Surgery: Gastrectomies reduce bicarbonate and lipase secretion and disrupt the timing of pancreatic enzyme release, leading to insufficient digestion.

7.  Bowel Resection: Extensive small bowel resections disrupt the complex interactions between the stomach, gut, and pancreas, causing PEI due to altered transit time, bacterial overgrowth, or reduced enzyme stimulation.

8.  Elderly Patients: Aging is associated with a natural decline in pancreatic volume, structure, and function. In otherwise healthy older adults, this can lead to reduced enzyme secretion and PEI.

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Why is Treating PEI Important?

Undiagnosed and untreated PEI can result in malnutrition, fat-soluble vitamin deficiencies, osteoporosis, and significant gastrointestinal symptoms. Treating PEI with Pancreatic Enzyme Replacement Therapy (PERT) not only improves digestion but also enhances the overall quality of life. PERT consists of capusles that are prescribed, and taken every time you eat. Dietitians play a crucial role in identifying at-risk patients, guiding enzyme dosing, and monitoring nutritional outcomes.

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What Should You Do If You Suspect PEI?

If you experience symptoms like unexplained weight loss, persistent diarrhea, or oily stools, consult your healthcare provider. A proper diagnosis often involves a combination of clinical history, stool tests, and imaging studies. Once diagnosed, PERT and dietary adjustments can help manage the condition effectively.

For personalised advice and support, get in touch with Kylie Russell. She's here to help you navigate your journey to better digestive health.

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