Pancreatic Exocrine Insufficiency

The pancreas has both endocrine and exocrine functions. The endocrine function involves the synthesis and secretion of hormones and the exocrine function involves the synthesis of digestive enzymes. Diabetes mellitus is caused by abnormalities in pancreatic endocrine function. Pancreatic exocrine insufficiency is the result of damage to the acinar cells that synthesize digestive enzymes or from occlusion of the pancreatic ducts.



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Over 880,000 people worldwide are affected by pancreatic exocrine insufficiency (PEI). Pancreatic diseases, pancreatitis and cystic fibrosis primarily are the diseases that cause it. Cystic fibrosis is a hereditary disease of Europeans and Ashkenazi Jews, which is progressive and leads to death. It’s a disorder of exocrine function and is caused by a defective chloride channel in the membrane of the glandular-epithelium due to genetic mutations. Thick tenacious secretions form as a result of the defective chloride transport. It obstructs the pancreatic ducts and the small airways of the lung.



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Chronic pancreatitis involves the irreversible damage of the pancreas and is characterized by inflammation, fibrosis and destruction to the exocrine and endocrine tissue. It’s classified by etiology: alcoholic, autoimmune, metabolic, obstructive, and idiopathic. In chronic pancreatitis, PEI is the result of direct destruction of the acinar cells.



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There are a number of other pancreatic disorders that can cause exocrine deficiency. Pancreatic carcinoma (cancer) can bring about exocrine destruction. Resection (removal of part or the entire organ) for either carcinoma or pancreatitis can cause PEI due to loss of pancreatic tissue. Partial or total gastrectomy (partial or total removal of the stomach) can precipitate PEI by impairing the release of gastric hormones such as cholecystokinin that stimulate pancreatic enzyme secretion. Acute pancreatitis is a temporary condition and can be caused by gallstones, high blood triglycerides, excessive consumption of alcohol,abdominal injuries, some medications, and poison.

Certain gastrointestinal diseases may contribute to PEI. They are Crohn’s disease, stomach ulcers, and celiac disease. Certain autoimmune diseases such as systemic lupus erythematosus may also contribute.



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A deficiency or absence of the three major pancreatic enzymes, which are protease, lipase and amylase, characterizes pancreatic exocrine insufficiency. Protease digests protein, lipase digests fat and amylase digests sugar and starch. This results in the prevention of breakdown of food and its absorption leading to malnutrition.



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The enzyme deficiency also causes osmotic diarrhea because there is a presence of undigested food in the intestine. Symptoms of PEI include:

1. Chronic diarrhea
2. Abdominal pain
3. Steatorrhea (excessive fat in the feces)
4. Flatus
5. Azotorrhea (excessive discharge of nitrogenous substances in the feces
6. Glucose intolerance
7. Signs associated with certain vitamin deficiencies
8. Anorexia
9. Weight loss