Pancreatic insufficiency

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Synonyms and keywords: Exocrine pancreatic insufficiency

## Overview

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Pancreatic insufficiency is characterized by deficiency of the exocrine pancreatic enzymes, resulting in the inability to digest food properly, or maldigestion.

## Causes

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### Common Causes

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* Chronic alcoholism
* Chronic pancreatitis
* Cystic fibrosis
* Gall stones
* Gastrectomy
* Shwachman-Diamond syndrome
* Zollinger-Ellison syndrome

### Causes by Organ System

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Cardiovascular | No underlying causes

|

Chemical/Poisoning | No underlying causes
Dental | No underlying causes
Dermatologic | No underlying causes
Drug Side Effect | No underlying causes
Ear Nose Throat | No underlying causes
Endocrine | Diabetic gastroparesis, Hyperparathyroidism
Environmental | No underlying causes
Gastroenterologic | Bowel resection, Celiac disease, Chronic pancreatitis, Cystic fibrosis, Diabetic gastroparesis, Gallstones, Hemochromatosis , Short bowel syndrome
Genetic | Alpha 1-antitrypsin deficiency, Annular pancreas, Ataxia telangiectasia, Congenital lipomatosis of pancreas, Congenital pancreatic dysfunction, Congenital partial lipodystrophy, Cystic fibrosis, Havlikova syndrome, Hemochromatosis, Hereditary pancreatitis, Homocystinuria, Johanson-Blizzard syndrome, Juvenile tropical pancreatitis syndrome, Pancreatic agenesis, Pearson syndrome, Shwachman-Diamond syndrome, Situs inversus totalis with cystic dysplasia of pancreas, Wolfram's disease
Hematologic | Acute intermittent porphyria
Iatrogenic | Bowel resection, Gastrectomy , Pancreatectomy
Infectious Disease | Mumps
Musculoskeletal/Orthopedic | No underlying causes
Neurologic | No underlying causes
Nutritional/Metabolic | Malnutrition
Obstetric/Gynecologic | Gestational diabetes
Oncologic | Pancreatic cancer, Zollinger-Ellison syndrome
Ophthalmologic | No underlying causes
Overdose/Toxicity | No underlying causes
Psychiatric | No underlying causes
Pulmonary | No underlying causes
Renal/Electrolyte | No underlying causes
Rheumatology/Immunology/Allergy | Autoimmune lymphoproliferative syndrome, Lupus, Polyglandular autoimmune syndrome, Sjogren's syndrome
Sexual | No underlying causes
Trauma | Trauma
Urologic | No underlying causes
Miscellaneous | Chronic alcoholism, Pancreatic cyst, Pancreatic duct obstruction, Pancreatic pseudocyst

### Causes in Alphabetical Order

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* Acute intermittent porphyria
* Alagille syndrome
* Alpha-1 antitrypsin deficiency
* Annular pancreas
* Ataxia telangiectasia
* Autoimmune lymphoproliferative syndrome
* Bowel resection
* Celiac disease
* Chronic alcoholism
* Chronic pancreatitis
* Congenital lipomatosis of pancreas
* Congenital pancreatic dysfunction
* Congenital partial lipodystrophy
* Cystic fibrosis
* Diabetic gastroparesis
* Gallstones
* Gastrectomy
* Gestational diabetes
* Havlikova syndrome
* Hemochromatosis
* Hereditary pancreatitis
* Homocystinuria
* Hyperparathyroidism
* Hypertriglyceridemia
* Idiopathic pancreatitis
* Johanson-Blizzard syndrome
* Juvenile tropical pancreatitis syndrome
* Lupus
* Malnutrition
* Mumps
* Pancreatectomy
* Pancreas divisum
* Pancreatic agenesis
* Pancreatic cancer
* Pancreatic cyst
* Pancreatic duct obstruction
* Pancreatic pseudocyst
* Pearson syndrome
* Polyglandular autoimmune syndrome
* Short bowel syndrome
* Shwachman-Diamond syndrome
* Situs inversus totalis with cystic dysplasia of pancreas
* Sjogren's syndrome
* Trauma
* Wolfram's disease
* Zollinger-Ellison syndrome

## Diagnosis

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### History and Symptoms

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* Fatty stools
* Muscle atrophy
* Weakness
* Weight loss

## Differential Diagnosis of Causes of Pancreatic insufficiency

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* Chronic alcoholism
* Congenital pancreatic dysfunction
* Cystic fibrosis
* Hemochromatosis
* Hyperparathyroidism
* Idiopathic pancreatitis
* Neoplasm
* Pancreatectomy
* Shwachman syndrome
* Gastrectomy
* Trauma
* Zollinger-Ellison syndrome

## Treatment

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Often pancreatic insufficiency is treated with Pancreatic Enzyme Products (PEPs), such as pancrelipase, that are used to breakdown fats (lipases), proteins (proteases) and carbohydrates (amylases) into units that can be digested by those with pancreatic insufficiency. [1]

## References

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1. ↑ FDA rulemaking history of OTC EPI drug products

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