30th July 2023

Pancreatic causes

The pancreas produces many enzymes essential for digestion and absorption of nutrients, as its exocrine function. Any disease affecting the pancreas can therefore impair this process and lead to malabsorption; this is globally termed as ‘pancreatic insufficiency’. Symptoms include abdominal pain, postprandial bloating, steatorrhoea and weight loss. It is often associated with diabetes, which is due to impairment of the endocrine function of the gland; as whatever disease process is impairing its exocrine function may also impair its endocrine function.

Pancreatitis and pancreatic cancer may cause pancreatic insufficiency due to the chronic inflammation in the organ. It is also associated with cystic fibrosis due to impairment of mucus production and secretion from the pancreas gland. Obstruction and strictures may also impair the secretions of enzymes, and resection will damage the gland’s function, also.

Diagnosis can be made with the faecal elastase test; samples will be deficient, as this enzyme is produced by the pancreas. Other diagnostic investigations include abdominal imaging such as x-ray, CT and MRI, and ERCP and MRCP for more focused imaging of the pancreaticobiliary tree – with these tests predominantly focused on detecting the cause.

Management involves treatment of the underlying cause and the use of pancreatic enzyme replacements. The most commonly available formulation is Creon, which contains amylase, lipase and protease. Enzymes are typically taken alongside meals and snacks, in order to enable digestion and absorption.