Pancreatic Insufficiency

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Pancreatic Insufficiency
Pancreatic Insufficiency

Video: Pancreatic Insufficiency

Video: Pancreatic Insufficiency
Video: Exocrine Pancreatic Insufficiency 2023, December

Pancreatic insufficiency

The pancreas is the only organ in the body that has a double function. In the case of pancreatic insufficiency, it can no longer adequately fulfill its functions. In the case of so-called endocrine pancreatic insufficiency, there is a lack of hormones that regulate blood sugar levels. In the case of exocrine pancreatic insufficiency, not enough digestive secretions are formed - this leads to problems in particular with fat digestion. Both forms can also occur together.


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  • What is endocrine pancreatic insufficiency?
  • What is Exocrine Pancreatic Insufficiency (EPI)
  • What are the causes of EPI?
  • What are the symptoms of EPI?
  • ">How is the diagnosis of an EPI made?


  • How is the EPI treated?
  • Whom can I ask?
  • How are the costs going to be covered?


What is endocrine pancreatic insufficiency?

The endocrine part of the pancreas - the so-called islet apparatus, which consists of the islets of Langerhans - normally produces the hormones insulin and glucagon, which regulate the sugar level. In the case of endocrine pancreatic insufficiency, these hormones can no longer be produced in sufficient quantities. The result is usually diabetes. For more information, see Diabetes mellitus.

What is Exocrine Pancreatic Insufficiency (EPI)

The exocrine part of the pancreas produces an average of 1.5 liters of fluid with important digestive enzymes every day. They break down the proteins, fats and carbohydrates contained in food into the smallest building blocks. These get from the intestines into the blood and are distributed throughout the body. Pancreatic exocrine insufficiency occurs when the pancreas does not produce enough digestive enzymes.

What are the causes of EPI?

Exocrine pancreatic insufficiency (EPI) can have a number of causes, including:

  • Cystic fibrosis: The inherited metabolic disease damages the bronchial system as well as the digestive system, especially the pancreas. It becomes clogged with thick mucus. As a result, the digestive enzymes can no longer be released into the small intestine in sufficient quantities.
  • Chronic pancreatitis: The pancreatic cells are slowly destroyed by recurring inflammation. As the disease progresses, the damaged tissue becomes scarred.
  • Pancreatic cancer,
  • Surgical removal of the stomach (gastrectomy), for example due to stomach cancer: After the operation, the chyme gets into the intestine too quickly. As a result, the pancreas is often unable to deliver its digestive enzymes to the small intestine in time. You can therefore not mix sufficiently with the chyme. In addition, there is no communication from the stomach via the intestines to the pancreas, so that the gland is not sufficiently stimulated to produce enzymes.
  • Smoking and alcohol can make pancreatic insufficiency worse.

What are the symptoms of EPI?

Disorders of the pancreas often go undetected for a long time. The symptoms usually appear in phases and sometimes only after years in their entirety. Many symptoms are only clearly noticeable when 90 percent of the digestive function has been lost.

Classic symptoms of exocrine pancreatic insufficiency are mainly:

  • violent belt-shaped radiating epigastric pain,
  • Nausea,
  • Vomit,
  • Flatulence,
  • Diarrhea or constipation
  • disturbed fat digestion: typical is sometimes very light, foul-smelling, voluminous stool (so-called fatty stool, steatorrhea),
  • Malnutrition,
  • severe weight loss.

Furthermore, sequelae such as a lack of fat-soluble vitamins are possible. Bacterial colonization of the intestine often makes things more difficult.

How is the diagnosis of an EPI made?

After discussing anamnesis, the doctor will conduct a physical examination. This is followed by pancreatic function tests (e.g. elastase-1 concentration, fluorescein dilaurate test, secretin-pancreozymin test) and stool examinations. If necessary, imaging procedures such as endoscopic examination of the bile and pancreatic ducts (endoscopic retrograde cholangiopancreatography, ERCP), x-rays of the bile ducts (cholangiogram), ultrasound, magnetic resonance tomography, computed tomography and endosonography are used.

How is the EPI treated?

The treatment of exocrine pancreatic insufficiency consists of several components that are individually tailored to the patient depending on the clinical picture:

  • Painkiller,
  • balanced nutrition,
  • Replacement of pancreatic enzymes in the form of capsules and granules with meals: the dose depends on the symptoms with the aim of being free of symptoms,
  • possibly intake of fat-soluble vitamins (A, D, E, K).

Note It is helpful to have nutritional advice to estimate the amount of fat in food as well as possible and to prevent deficiencies.

With proper treatment - a balanced diet and adequate intake of digestive enzymes - people with exocrine pancreatic insufficiency can lead normal, unimpaired lives.

Whom can I ask?

For clarification of complaints of the pancreas, the first point of contact should be:

  • a general practitioner.

    A visit to the following doctors may be necessary for further clarification and therapy:

  • Specialist in internal medicine (gastroenterology and hepatology),
  • Specialist in surgery.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. However, you may have to pay a deductible with certain health insurance providers (BVAEB, SVS, SVS, BVAEB).

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

When hospitalization is required

Sometimes hospitalization is required for pancreatic insufficiency. Here, the hospital costs are billed. The patient has to pay a daily contribution to the costs.

For more information, see What does a hospital stay cost?