Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-14_Buchner_Exocrine Pancreatic Insufficiency supporting digestion when pancreas fails

14_Buchner_Exocrine Pancreatic Insufficiency supporting digestion when pancreas fails

Pdf Summary

Dr. Anna M. Buchner’s presentation on Exocrine Pancreatic Insufficiency (EPI) provides a comprehensive overview of this condition, including its definition, diagnosis, and management strategies. EPI occurs when the pancreas fails to deliver adequate enzymes to the intestine, affecting digestion and leading to nutrient malabsorption. The condition is often associated with chronic pancreatitis, cystic fibrosis, and pancreatic cancer. Common symptoms include steatorrhea, diarrhea, weight loss, and deficiencies in fat-soluble vitamins.<br /><br />Diagnosis primarily involves the fecal elastase test, which measures enzyme levels in stool. While fecal fat testing and pancreatitis response trials are unreliable, proper diagnosis relies heavily on clinical context and patient symptoms. Once EPI is diagnosed, treatment includes Pancreatic Enzyme Replacement Therapy (PERT), administered during meals to aid digestion. The starting dosage generally is 40,000-50,000 USP units of lipase per meal, potentially adjusting up to 90,000 units depending on the response. <br /><br />Evaluating the effectiveness of PERT requires monitoring for symptom improvement and nutritional status, including weight and vitamin levels. Additional treatments might be necessary for osteoporosis or osteopenia associated with EPI. Dr. Buchner notes that inadequate responses to PERT are frequently due to dosage or timing issues, highlighting the cost and patient adherence as barriers. A holistic, multidisciplinary approach involving various specialists is recommended for effective management of EPI. This approach helps tailor treatment plans, address any ancillary conditions, and ensure optimal patient outcomes.<br /><br />Amidst these treatment and management protocols, it's emphasized that there is a considerable gap in the appropriate testing and treatment of EPI in clinical practice, necessitating increased awareness and systematic intervention from healthcare providers.

Keywords

Exocrine Pancreatic Insufficiency

EPI

Pancreatic Enzyme Replacement Therapy

PERT

fecal elastase test

nutrient malabsorption

steatorrhea

Dr. Anna M. Buchner

chronic pancreatitis

multidisciplinary approach