The pancreas is a small glandular organ located under the stomach, which has two functions. The endocrine pancreas regulates hormones, notably insulin, and releases them into the bloodstream. The exocrine pancreas produces digestive enzymes that are necessary for digestion, particularly absorption of vitamins, fats, and proteins. Pancreatic insufficiency is a condition of the pancreas that results in its inability to produce enough digestive enzymes.
A normally functioning pancreas produces lipase, which breaks down fats; amylase, which breaks down carbohyrates; and trypsin and chymotrypsin, which break down proteins. This production is reduced in pancreatic insufficiency, and digestion is impaired. This can cause malnutrition, malabsorption of some nutrients, and an inability to gain or maintain weight.
Pancreatic insufficiency may be caused by diseases that affect the pancreas, such as chronic pancreatitis, cystic fibrosis, Shwachman-Diamond Syndrome, or pancreatic cancer. It can also occur with autoimmune diseases such as Type 1 diabetes, lupus, and possibly some others, such as celiac disease. In some cases, it might be caused by a surgery that affects the digestive system or causes inflammation around the pancreas, such as a pancreatectomy.
The first signs of pancreatic insufficiency are often weight loss, vitamin deficiency, inability to gain weight, and steatorrhea, or loose, foul-smelling stools, often with visible fat in them. Some people may experience gas, bloating, and other signs of nutrient malabsorption. If pancreatic insufficiency is suspected, a doctor will generally order a series of tests in order to make a diagnosis. Lab tests, including a fecal fat test, a fecal elastase test, and enzyme tests can confirm pancreatic insufficiency. Occasionally, it might be confirmed through endoscopic or radiological tests as well.
Treatment usually involves taking pancreatic enzymes and vitamins orally. These replace the nutrients that are not absorbed. Dietary treatment can be effective also, particularly a diet that helps a person with pancreatic insufficiency gain and maintain weight. A diet low in fat can be helpful, however, as fat absorption is an issue in pancreatic insufficiency. Occasionally, especially in children with Shwachman-Diamond Syndrome, the condition could be outgrown eventually.
Pancreatic insufficiency is also a problem for pets. Cats and dogs are susceptible to it, and might exhibit symptoms such as diarrhea, oily stools, flatulence, and a dull coat. Tests similar to the ones for humans can confirm a veterinarian's diagnosis. Treatment is similar as well; diet and pancreatic enzyme supplements are usually prescribed for the rest of the animal's life.
