Pancreatic insufficiency (EPI)

Pancreatic insufficiency (EPI)

Pancreatic insufficiency or (EPI), i.e., it no longer works with its usual efficiency, especially as it hasn't produced enough digestive enzymes, which leads to indigestion with diarrhea and the weak ability to produce blood-sugar-regulating hormones, and then there are disorders of blood sugar and diabetes.

All this is the result of pancreatic insufficiency, and here you can read everything you need to know about pancreatic insufficiency.

What is the meaning of (EPI)?

Pancreatic insufficiency is manifested by the destruction or imbalance of the pancreas' tissue, which usually occurs due to chronic pancreatitis. This inflammation is mainly found in alcohol consumption practices in excessive quantities. It can also sometimes happen due to the destruction of the pancreas or various metabolic diseases. Pancreatic insufficiency only occurs after nearly all of its tissues have been destroyed (more than 90 percent), and no side effects are indicated in the early stages of this.

There are two types of pancreatic insufficiency:

Enzymatic pancreatic insufficiency (functional pancreatic insufficiency)

  • The pancreas produces about one to two liters of digestive secretions per day. Enzymes pass through the duct of the pancreas to the duodenum and help digest food.
  • Pancreatic secretion contributes to the equation of stomach acid throughout the intestine.
  • The secretion contains enzymes to digest proteins, fats, and carbohydrates.
  • Thus if little digestive enzymes are formed or absent in the pancreas, one suffers from indigestion and diarrhea, which is called secretory (EPI).

Hormonal pancreatic insufficiency

  • The pancreas secretes two critical hormones to control blood sugar, insulin, and glucagon.
  • Insulin is responsible for absorbing blood sugar from the body (lowers blood sugar level).
  • On the other hand, if the body needs more energy (for example, with stress or low blood sugar levels), glucagon replaces the energy reserves in the body. It boosts the release of stored glucose (raises the blood sugar level).
  • During hormonal (EPI), we find that the pancreas produces very little or no hormones at all, and from here, it either produces diabetes with insulin production or a sharp drop in blood sugar due to a lack of glucagon hormone.

Causes of (EPI)

The normal function of the pancreas ensures the secretion of enzymes essential for effective digestion and control of blood sugar levels by secreting hormones. It should noted that the pancreas is gaining full functional maturity in enzymatic production from two years of age.

On the other hand, the clinical manifestations of pancreatic insufficiency occur as part of acute or chronic inflammation of the pancreas, sometimes the cause may be a food metabolism disorder called cystic fibrosis, or Malignant tumor, or surgery to remove part or all of the pancreas, or blockage of the pancreas duct, and in rare cases, there is no cause for this disease.

Pancreatic insufficiency with pancreatitis

  • The pancreas can develop inflammation for various reasons, distinguishing between acute and chronic inflammation.
  • Acute inflammation is caused by biliary tract disorders such as gallstones, and excessive alcohol intake often the most likely cause of inflammation. In rare cases, medications (such as estrogen, cyclosporine, and HIV drugs) lead to acute pancreatitis, as well as heredity.
  • While chronic pancreatitis caused by regular and excessive alcohol consumption responsible. As well as with recurrent pancreatitis (recurrent acute pancreatitis), the inflammation turns into chronic.
  • Through infections that face the pancreas. It can lose many of its functions and become a pancreatic insufficiency.

Pancreatic insufficiency of cystic fibrosis

  • Cystic fibrosis is a genetic disorder that affects the pancreas. As well as the respiratory system, intestine, liver, and bile duct. The secretion more viscous in those affected by it than in a healthy person. Here the blockage of the pancreas channel causes inflammation of the organ, and then the pancreatic insufficiency develops.

Pancreatic insufficiency in tumors or after surgery

  • In the case of malignancies near the pancreas, part of the pancreas must sometimes be surgically removed due to anatomical proximity, for example, with some stomach tumors.
  • Pancreatic tumors (pancreatic cancer) are also partially removed. Causing pancreatic tissue to reduced, and the production of enzymes and hormones is not enough. Usually, symptoms of pancreatic insufficiency appear.

Pancreatic duct obstruction

  • The duct of the pancreas through which the digestive system secretions enter can blocked to the duodenum, then the secretions accumulate and cause pancreatitis as a result of which the pancreas tissue destroyed and the cause of the pancreas insufficiency.

Other causes related to the disease

  • Autoimmune pancreatitis.
  • Duodenal cancer.
  • Pancreas cancer.

What are the symptoms of pancreatic insufficiency?

Enzymatic pancreatic insufficiency

  • First of all, sufferers have problems digesting fats. As nutritional facts can no longer digested well, which may cause nausea and vomiting.
  • If enzymatic pancreatic insufficiency is very advanced, the fats in food will not adequately reach the intestine cells and be excreted with feces.
  • The main symptoms of this disease are seborrheic diarrhea (fatty stools) with abdominal pain. Litter then appears greasy and usually smells bad.
  • Because of indigestion disorder, people with enzymatic pancreatic insufficiency can lose a lot of weight even though they eat enough.
  • Another result of disturbed fat digestion is that it is no longer possible to properly absorb fat-soluble vitamins E, D, K, and A in the body. This is how vitamin deficiencies can develop, which causes their own complaints; for example, a strong vitamin K deficiency increases bleeding.
  • Due to insufficient digestive enzymes, much of the undigested food enters the large intestine. There are intestinal bacteria that degrade food components with a strong gas formation, and the result is very painful flatulence.
  • Enzymatic pancreatic insufficiency often arises from recurrent pancreatitis, which is why people often notice symptoms of pancreatitis and pain in the upper abdomen that extends to the back.

Hormonal pancreatic insufficiency

  • With the insufficient glandular function of the pancreas. The metabolism of sugar particularly disturbed because the pancreas does not produce enough hormones to regulate blood sugar.
  • If an insufficient amount of insulin produced in the pancreas. It is no longer possible to absorb the circulating sugar in the blood in the cells of the body. This can lead to high blood sugar levels (diabetes) and diabetes's main symptoms of diabetes: thirst, frequent urination to urinate, Fatigue, etc.
  • Insulin deficiency may also cause the brain cells don't receive enough sugar, as a result of which the body produces so-called ketone bodies, causing the blood pH to drop.
  • However, if glucagon is mostly absent in hormonal pancreatic insufficiency, the body will not be able to raise the excessively low blood sugar level if it doesn't eat for several hours. Its symptoms include shaking and sweating, and loss of consciousness.

Other symptoms

Other symptoms that may seem related to pancreatic insufficiency may affect you; for example, you may find that you suffer from night blindness, muscle cramps, and bone pain.

Diagnosis of pancreatic insufficiency

Physical examination

  • The doctor may physically examine you to do this; he will especially listen to the abdomen using a stethoscope, please tell the doctor if you have abdominal pain.
  • It is also necessary to examine the skin and eyes to indicate a possible malfunction of the pancreas, yellowing of the skin and eyes can occur in diseases of the pancreas insufficiency.

Laboratory examination of pancreatic insufficiency

  • The identification of elastase-1, lipase and amylase enzymes in the blood can provide evidence of pancreatitis as a cause of pancreatic insufficiency.
  • The activity of pancreatic enzymes (elastase and chymotrypsin) in the stool is specially analyzed to demonstrate pancreatic insufficiency. Stool examination is the most critical part of the diagnosis in cases of suspected individual pancreatic insufficiency.

Radiography of pancreatic insufficiency

  • Imaging in the pancreas insufficiency primarily explores the obvious causes of the disease (tumor and inflammation).
  • Your doctor can recognize pancreatic calcification exceptionally well during pancreatic CT scans.
  • The pancreas can also be examined in detail using MRI.
  • Endoscopy examination can be used to assess pancreatic stones, and it was done by a thin tube that is pushed through the mouth into the mouth of the pancreatic duct in the duodenum and a careful examination of the pancreatic insufficiency.
  • Another way to assess the pancreas is ultrasound; however, since the pancreas lies completely deep inside the abdomen, and is often covered with intestinal gases, it is relatively difficult to see with ultrasound.

Complications of pancreatic insufficiency

Complications appear at various stages from the onset of the disease and in most cases require endoscopic or surgical treatment:

  • Narrowing or blockage of the bile duct leading to jaundice or yellowing on the skin or eyes.
  • Pancreatic edema: as a result of the rupture or blockage of the pancreatic duct.
  • The spleen veins clot with the risk of gastrointestinal bleeding.
  • Pancreatic cancer: Chronic pancreatic insufficiency can cause pancreatic cancer but in sporadic cases.
  • A sharp drop in blood sugar, which causes human death.
  • Chronic high blood sugar, which causes diabetes.
  • Night blindness.
  • Pancreatic insufficiency is associated with a significant increase in mortality because most patients don't receive treatment or do so at lower doses than recommended.

(EPI) Pancreatic insufficiency in children

Pancreatic insufficiency is rare in children, and (EPI) causes very severe pain, chronic inflammation can develop from acute inflammation of the pancreas. The most common cause of pancreatic insufficiency is acute pancreatitis, or an accident, after falling on a bike or scooter. The child can injured severe pancreatic insufficiency, or there may be other triggers:

  • Take a medication that contributes to (EPI).
  • Gallstones.
  • Viruses.
  • Digestive disorders.
  • DNA.
  • It isn’t possible to find an adequate explanation for pancreatic insufficiency in some children, which called idiopathic pancreatitis.

Diagnosis in children

  • In adults, symptoms of pancreatic insufficiency aren't very different from children, and sudden severe pain in the abdominal area can be an indication of pancreatic insufficiency by scanning the affected area and listening to intestinal sounds using a stethoscope will confirm his suspicions.
  • During an ultrasound examination, he can see and evaluate the gland.
  • If the blood test is evaluated to reveal an increase in the digestive system enzyme and an expression of infections in the body, the doctor has another indication of pancreatic insufficiency.
  • As more tests, he can then order a CT scan or take a tissue sample to confirm this.

Symptoms in children

  • Pancreatic insufficiency is usually accompanied by severe and sudden pain, stretching like a belt across the abdomen, and pain appears in the back.
  • High temperature.
  • Bleeding from the stomach and intestine.
  • Nausea.
  • Vomiting.
  • Difficulty breathing.
  • Symptoms can be very severe, and a life-threatening condition can arise.
  • Children develop diabetes or bile as complications of (EPI).
  • Lack of digestive juice production can also limit food intake in a way that causes children to lose weight and develop poorly.

Treatment of pancreatic insufficiency

If the cause of the pancreas insufficiency is a specific cause, it must eliminated first. Such as the treatment of gallstones or contractions in the pancreas duct by the endoscope. Where the stones removed or crushed and rinsed.

The narrowing of the pancreatic duct expanded by the use of a small balloon or stent, and if pancreatic insufficiency continued despite this intervention and an attempt made to relieve symptoms through the following therapeutic measures:

1. Pain control

Pain control is the most challenging task in treating patients with chronic pancreatic insufficiency(EPI). First, vigorous efforts and appropriate referrals must made to encourage smoking cessation and alcohol withdrawal in patients with addiction, in an attempt to slow disease progression as soon as possible.

2. Correct nutrition

People with pancreatic insufficiency should divide their food into five to seven small meals a day, and avoid fatty foods as much as possible. Besides, affected people should avoid alcohol altogether. These nutritional measures will reduce digestion and thus reduce symptoms if symptoms persist. Fatty stools despite this diet, the fat content of the food should further reduce.

3. Substitution of Enzymes

  • If changing the diet alone doesn’t improve symptoms, then enzymes can replaced in the secretion of the pancreas. These special-purpose capsules taken several times a day, working to stimulate digestive enzymes. Most of the digestive enzymes present in the drug come from the slaughtered pig pancreas. Some preparations contain fungal enzymes.
  • Some digestive enzymes in the body can also produced by other organs such as the salivary gland, so they don’t necessarily need to be replaced from outside the body.

4. Take vitamins

Vitamins E, D, K, A are fat-soluble; this means that they cannot absorbed in the intestine unless they are dissolved in fat. So fat-soluble vitamins taken in a compound that not rejected by the intestinal wall.

5. Insulin therapy

With pancreatic insufficiency, the blood sugar level must checked regularly, and if there is an absolute insulin deficiency referred to as diabetes, those affected must inject insulin daily.

6. Pancreatectomy

  • Surgical treatment can be useful in relieving pain, and this should be among the surgical options for patients who have stopped using alcohol and who can control diabetes.
  • Many procedures have led to a better quality of life for patients with (EPI) after surgical removal of the pancreas. They have concluded that despite its serious impact after surgery. It can significantly improve (EPI) and even compared with the general population of patients who have not performed surgery and rely on treatment.

Treatment should carried out by specialized doctors (gastroenterologists and endocrinologists respectively), to reduce the consequences of the pancreatic function deficit, which can have long-term effects.

Advice for patients with pancreatic insufficiency

  • In the case of pancreatic insufficiency, the person with the disease has little time and options and often severely restricted so that the person with this disease relies mainly on diagnosis and prompt treatment so that there are no severe complications. So you should contact the doctor when the first symptoms and signs of the disease appear to prevent complications or other symptoms.
  • Most patients with this disease rely on the use of several medications to relieve symptoms permanently. The person concerned should always pay attention to the correct dose and take it regularly if something isn't clear then you should consult a doctor first.
  • Moreover, a healthy lifestyle with a healthy diet, in general, has a positive effect on the course of chronic pancreatic insufficiency and can alleviate symptoms.
  • Most patients depend on the help and support of friends and family in their daily lives. Contacting people with (EPI) can be very logical, as this can often lead to the exchange of information.
  • The patient must referred to an endocrinologist to treat diabetes. Insulin must given wisely because the current deficiency of glucagon secretion by alpha cells indicates that the effects of excess insulin in the blood not addressed. This may lead to hypoglycemia for a long time; rarely, Oral hypoglycemic medications are useful in treating type 2 diabetes with chronic(EPI).

Prevention of pancreatic insufficiency

  • Prevention is only possible indirectly by avoiding harmful causes such as alcohol and eating a balanced diet.
  • If symptoms appear on the digestive system, gallbladder, or duodenum. As well as the liver, a specialist should consult to eliminate the current risks of pancreatic disease on time. Hence the matter doesn't progress to pancreatic insufficiency.
  • When taking medicine before taking it, it is essential to consider its side effects regarding the risk of (EPI).
  • Constant malnutrition should avoided preventing pancreatic insufficiency.

Is pancreatic insufficiency chronic?

  • The current (EPI) isn't curable, but with the appropriate treatment, you can influence it positively, and its painful symptoms usually decrease to an acceptable level. Predicting the results and improving an individual's life mainly depends on:
  • Whether only one function (enzymatic or hormonal insufficiency) has lost in the pancreas or both functions have lost during impairment.
  • Knowing the cause of the pancreas insufficiency and whether several causes come together or one cause.
  • However, factors that cause pancreatic insufficiencies, such as alcohol and fatty food, should avoided because it exacerbates pancreatic insufficiency.

Lack of digestive juice

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