Individuals with pancreatic disease often have concurrent nutritional compromise and require specialist dietetic support. Pancreatic diseases such as cancer, acute and chronic pancreatitis and pancreatic resection all can lead to interruptions in normal enzyme production and secretion called pancreatic exocrine insufficiency (PEI), which in turn leads to malabsorption that can quickly lead to gastrointestinal symptoms, malnutrition, osteoporosis and fat soluble vitamin deficiencies. Review by a Specialist Dietitian can enable these nutrition-focused issues to be monitored and treated.
Partial pancreatectomy, pancreaticoduodenectomy (Whipples operation) and total pancreatectomy are gastrointestinal surgeries that require specialised nutrition support. Preoperative nutritional optimisation is important to ensure you are well nourished going into the operation. Pancreatic surgery alters the coordination of tightly orchestrated digestive processes. As a consequence, this can result in nutritional complications such as altered motility (gastroparesis and dumping syndrome), pancreatic exocrine insufficiency (PEI), diabetes mellitus and nutritional deficiencies. Close, regular, dietetic monitoring and attention to these issues will facilitate optimisation of nutritional status and help prevent potentially avoidable complications.
Digestion problems are common in pancreatic cancer due to pancreatic exocrine insufficiency (PEI). PEI occurs due to obstruction of the pancreatic duct resulting in the digestive enzymes not being able to be delivered into the small bowel where they are needed to break down food for absorption. This obstruction leads to malabsorption and symptoms such as abdominal pain, bloating, diarrhoea, nausea and weight loss.
PEI and the subsequent malabsorption can be treated with pancreatic enzyme replacement therapy (PERT), which eliminates the gastrointestinal symptoms, reduces weight loss, and improves nutritional status, along with quality and length of life.
Specialist Dietitian prescribers are especially well placed to prescribe PERT and to advise on administration and dosing because PERT is matched to dietary intake.
Both acute and chronic pancreatitis are common diseases of the pancreas, and are related to a significant risk of malnutrition that may require nutritional support from a Specialist Dietitian.
Acute pancreatitis is an acute inflammatory disorder characterized by oedema and when severe, necrosis of the pancreas. Research shows that pancreatic exocrine insufficiency (PEI) develops in over half of patients with pancreatitis, irrespective of the severity. This usually resolves in 6–18 months after the episode, but can persist in some cases out to 4 years. Untreated PEI can lead to gastrointestinal symptoms, maldigestion, micronutrient deficiencies and malnutrition, however treatment with pancreatic enzyme replacement therapy (PERT), which can be prescribed by a Specialist Dietitian prescriber or Doctor, eliminates these problems.
Chronic pancreatitis represents a chronic inflammation of the pancreatic gland characterised by the development of fibrosis. Abdominal pain leading to decreased oral intake, as well as pancreatic exocrine insufficiency (PEI) and endocrine failure (diabetes), are frequent complications of the disease. Anorexia, nausea and vomiting are commonly associated symptoms. All of the above represent risk factors related to malnutrition. Therefore, individuals with chronic pancreatitis should be screened and supplemented accordingly by a Specialist Dietitian.
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