Pancreatic Failure

When the pancreas cannot produce enough digestive enzymes, the body struggles to absorb nutrients from food, leading to serious health consequences that require careful management and treatment.

Table of contents

• What is Pancreatic Insufficiency?
• Associated Anatomy
• Causes of Pancreatic Insufficiency
• Symptoms and Warning Signs
• Diagnosis and Testing
• Treatment and Management
• Lifestyle Changes and Dietary Recommendations

What is Pancreatic Insufficiency?

Pancreatic insufficiency, also known as exocrine pancreatic insufficiency or EPI, occurs when the pancreas does not make enough digestive enzymes to properly break down food^[3][4]. The condition is characterized by the inadequate delivery of pancreatic enzymes and bicarbonate to the duodenum, resulting in maldigestion (incomplete breakdown of food) and malabsorption (poor absorption of nutrients)^[3].

This condition typically develops slowly, taking years to finally manifest^[4]. As a result of insufficient enzyme production, the body cannot absorb all the nutrients it needs from food because the small intestine is unable to completely digest what you eat^[4].

Associated Anatomy

• Pancreas
• Small intestine
• Duodenum
• Gallbladder
• Bile duct
• Pancreatic duct

The pancreas is a long, flat gland located behind the stomach and in front of the spine in the upper abdomen^[2][7]. It is about 22 centimeters (9 inches) long and salmon pink in color^[7]. The pancreas has two main functions: it produces digestive enzymes to help break down food (called the exocrine function) and it creates hormones like insulin to regulate blood sugar (called the endocrine function)^[7].

Causes of Pancreatic Insufficiency

Many diseases that affect pancreatic tissue can cause EPI^[7]. The most common causes differ between children and adults.

In adults, chronic pancreatitis is the main cause of exocrine pancreatic insufficiency. As many as 8 in 10 adults with chronic pancreatitis will eventually develop EPI^[7][19]. Chronic pancreatitis is a long-term, progressive condition where constant inflammation causes scarring of pancreatic tissues, which stops them from making enzymes and hormones^[2].

In children, cystic fibrosis is the top cause of EPI. This inherited condition causes thick mucus to build up in the pancreas, which keeps digestive enzymes from reaching the small intestine^[19]. Nearly 9 in 10 infants with cystic fibrosis develop EPI within the first year of life^[19].

Other causes of pancreatic insufficiency in adults include^[7][19]:

• Pancreatic cancer
• Acute pancreatitis with tissue death
• Pancreas surgery
• Celiac disease
• Inflammatory bowel disease
• Diabetes (both type 1 and type 2)
• Upper digestive tract surgery, including weight loss surgery

Rarer causes include Shwachman-Diamond syndrome, Johanson-Blizzard syndrome, and pancreatic hemochromatosis^[7].

Symptoms and Warning Signs

Because the body has particular difficulty absorbing fats from foods when digestive enzymes are lacking, EPI leads to uncomfortable digestive problems^[19].

Common symptoms of pancreatic insufficiency include^[4][19]:

• Abdominal pain, gas, and bloating
• Diarrhea
• Constipation
• Steatorrhea (fatty, oily stools that are pale in color, have a foul smell, and float in the toilet)
• Unintended weight loss or failure to thrive in infants and children
• Excess gas

When long-term chronic pancreatitis begins to affect pancreatic function, you will notice it in your digestive system first. When the pancreas can no longer make and deliver its digestive enzymes, the body cannot break down and absorb all the nutrients from food^[2]. You may feel discomfort after eating, experience indigestion and pain after eating, loss of appetite, and see fatty stools that leave an oily film in the toilet^[2].

Over time, the consequences of nutrient malabsorption can include deficiencies in vitamins and minerals (especially fat-soluble vitamins A, D, E, and K), low bone mineral density, sarcopenia (muscle loss), and impaired quality of life^[3]. When untreated, these complications lead to increased illness and death^[3].

Diagnosis and Testing

Healthcare providers may suspect EPI if you have a condition that affects your pancreas^[19]. Many digestive problems cause symptoms similar to EPI, so proper testing is important^[19].

Several tests can help diagnose pancreatic insufficiency^[19]:

• Fecal elastase test (FE-1): This test checks stool for the presence of the elastase enzyme that helps digest proteins. Little or no elastase can indicate EPI.
• Fecal fat test: This test measures the amount of fat in stool. A high fat volume may be a sign of EPI.
• Secretin pancreatic function test: This test measures how the pancreas responds to secretin, a hormone that triggers the release of digestive enzymes.

Imaging tests such as CT scans, abdominal ultrasound, MRI, or endoscopic ultrasound may also be used to spot pancreas problems that can lead to EPI^[19][15].

Treatment and Management

Unfortunately, there is no cure for pancreatic insufficiency^[4]. However, several approaches can help manage the condition and reduce troublesome symptoms.

Pancreatic Enzyme Replacement Therapy (PERT)

The main treatment for EPI is pancreatic enzyme replacement therapy or PERT^[4][19]. This involves taking medication that contains pancreatic enzymes with meals and snacks. The enzymes help your body digest food and prevent malnutrition, and they also provide relief from symptoms^[4].

When taking enzyme supplements, it is important to take them at the beginning of your meal or snack, and to take the right amount^[16]. Healthcare providers typically prescribe enzymes at appropriate weight-based doses, and the dose may need to be adjusted to achieve symptom control and normal stool patterns^[3].

Different types of pancreatic enzymes include^[19]:

• Amylase, which breaks down carbohydrates
• Lipase, which breaks down fats
• Protease and elastase, which break down proteins

Because fat malabsorption happens early in the disease, lipase is particularly important^[3].

Treating Underlying Conditions

If pancreatic insufficiency is caused by another disease or condition—such as cystic fibrosis, pancreatitis, or pancreatic cancer—treatments to control and manage these illnesses can also improve pancreatic function^[4].

Nutritional Support

Ensuring the body gets enough nutrition is critical when managing EPI^[4]. Healthcare providers work closely with patients to monitor progress and make any necessary adjustments to health care plans. Ongoing care includes tracking weight, body mass index, bone density, and vitamin and mineral levels^[3].

If needed, you may be given vitamin supplements, particularly fat-soluble vitamins A, D, E, and K, or vitamin B-12 injections^[12].

Lifestyle Changes and Dietary Recommendations

In addition to medical treatment, certain lifestyle habits and dietary changes can help manage the symptoms of EPI and support overall health^[20].

Dietary Guidelines

Working with a registered dietitian is strongly recommended for people with pancreatic insufficiency^[16]. General dietary recommendations include:

• Eat small, frequent meals and snacks throughout the day instead of 3 large meals^[16][21]
• Choose lean meats and remove all visible fat^[21]
• Bake, broil, or grill foods instead of frying them^[21]
• Eat nutrient-dense meals including lean protein, fruits and vegetables, and whole grains^[18]
• Limit fats and oils to no more than 1 tablespoon per meal^[21]
• Eat food with minimal fluids, then wait 20-30 minutes after eating before drinking to help retain food in your digestive system longer^[16]

One common misconception is that people with pancreatic problems should avoid all fat. In reality, fat is important and needed, but patients need to take enzymes to help digest it properly^[18].

Additional Healthy Habits

Beyond diet, other lifestyle changes can help manage EPI^[20]:

• Don’t smoke: Smoking tobacco can damage your pancreas, which could be very harmful if your pancreas is already challenged^[20]
• Limit or avoid alcohol: Drinking heavily can cause or contribute to chronic pancreatitis. Limit alcohol to one to two drinks per day or avoid it altogether^[20]
• Stay hydrated: Drinking plenty of plain water helps the pancreas function more properly. Limit sugary drinks, fruit juices, and caffeinated beverages^[20]
• Exercise regularly: Activities like yoga and walking can help with overall digestive health^[16]
• Know where bathrooms are located when away from home, as digestive symptoms can occur unpredictably^[16]

Building a support system of positive people and working with healthcare professionals can help patients get through tougher days^[16]. It is possible to have a good quality of life with pancreatic insufficiency when properly managed^[7].