Diagnosis and Treatment of Pancreatic Exocrine Insufficiency

J. Enrique Dominguez-Muñoz


Curr Opin Gastroenterol. 2018;34(5):349-354. 

In This Article

Abstract and Introduction


Purpose of review: Pancreatic exocrine insufficiency (PEI), defined as a secretion of pancreatic enzymes and bicarbonate insufficient to maintain a normal digestion, is a frequent but frequently underdiagnosed and undertreated condition. PEI may be secondary to different pancreatic diseases and extrapancreatic conditions. Recent data support the high clinical relevance of PEI and its treatment.

Recent findings: Together with symptoms of maldigestion, PEI is associated with nutritional deficiencies leading to osteoporosis, low-trauma fractures, sarcopenia and increased mortality. No single widely available test allows to diagnose PEI accurately. Diagnosis of PEI requires the evaluation of symptoms, nutritional markers and a noninvasive pancreatic function test in the appropriate clinical context. Pancreatic enzyme replacement therapy (PERT) improves digestion, symptoms, nutritional status and quality of life of patients with PEI. In addition, PERT is associated with a longer survival in patients with unresectable pancreatic cancer and after surgery for pancreatic cancer or chronic pancreatitis.

Summary: Awareness of PEI in different clinical conditions is required. Nutritional advice and appropriate PERT are mandatory to reduce the morbidity and mortality associated with PEI. Further studies on the clinical impact of PEI and its treatment are needed, especially in diseases other than chronic pancreatitis and cystic fibrosis.


Pancreatic exocrine insufficiency (PEI), defined as the inability of the exocrine pancreatic secretion to maintain a normal food digestion, is a clinical condition that develops as a consequence of reduced secretion in pancreatic diseases, of low cholecystokinin (CCK) release in celiac disease or upper gastrointestinal surgery, or as a result of anatomical changes after surgery of the upper gastrointestinal tract. PEI can be associated with symptoms of malabsorption and nutritional deficiencies that increase morbidity and mortality. Diagnosis of PEI in clinical practice is hindered by the lack of accurate tests, and it usually requires the combination of symptoms, nutritional markers and a noninvasive pancreatic function test in the appropriate clinical context. Treatment of PEI is based on a normal, nonrestrictive healthy diet together with pancreatic enzyme replacement therapy (PERT). Dose of oral pancreatic enzymes should be individualized based on symptomatic response and objective evaluation of the nutritional status.