4. Exocrine pancreatic insufficiency

Question 1

Exocrine pancreatic insufficiency

Answer 1

When the pancreas does not make or secret enough enzymes (which break down carbohydrates, fats and protein)

Question 2

Exocrine pancreatic insufficiency symptoms

Answer 2

Symptoms:

Gastrointestinal - Diarrhoea, Abdominal cramps, steatorrhoea

Malnutrition - as the nutrients cannot be broken down to be absorbed

Question 3

Exocrine pancreatic insufficiency treatment

Answer 3

Main treatment:
Replacement therapy with vitamin supplements

Diet:
Avoid foods that are difficuult to digest such as legumes (peas, beans, lentils, chickpeas)

Avoid foods high in fibre

COMPLETELY Avoid alcohol

Avoid low fat diets as there is already a low fat absorption

Question 4

Pancreatin

Answer 4

This is a medicine which replaces the pancreatic enzymes: protease, lipase, amylase

Question 5

Pancreatin counselling

Answer 5

Pancreatin should be taken with a meal or snack, or immediately before or after

Pancreatin contains enzymes which can be inactivated by gastric acids.

Therefore if symtoms still continue despite having a high pancreatin dose, an acid suppressor should be offered.
Enteric-coated preparations can be offered as they bypass the stomach acidity

Pancreatin can be mixed with food and drinks BUT
Should NOT be mixed with EXCESSIVELY hot food and drinks, as heat can inactivate the enzymes.

Patients must also make sure they are adequately hydrated at all times

Digestive enzymes are denatured by gastric acid and heat

Question 6

Pancreatin side effects

Answer 6

• Gastro-intestinal effects - nausea, vomiting, constipation
• Can irritate the skin around the mouth and the inside of the cheeks
  Excessive doses can irritate the perineal area
• Powder formulation may cause a hypersensitivity reaction
• Fibrosing colonopathy (where the colon wall forms scar tissues)
  common in cystic fibrosis AND in high-doses