Fast Five Quiz: Exocrine Pancreatic Insufficiency Management

Romesh Khardori, MD, PhD


March 08, 2021

Exocrine pancreatic insufficiency (EPI) is characterized by maldigestion — an inability to digest food properly. Causes of EPI can be either pancreatic or nonpancreatic in origin. The cornerstone of EPI management is pancreatic enzyme replacement therapy (PERT). The typical indications for starting enzyme replacement therapy are progressive weight loss and steatorrhea, defined as at least 7-15 g of fecal fat per day. The primary goal of PERT is normalizing gut absorption and thereby correcting nutritional deficiencies. In addition to improving the digestion and absorption of nutrients, PERT aims to reduce morbidity and prevent complications. Treatment of causative diseases, when applicable, is also crucial.

EPI is treated with pancreatic enzyme products (PEPs), a combination of porcine-derived amylases, lipases, and proteases that mimic digestive enzymes secreted by the pancreas and act in the duodenum and proximal small intestine. These agents catalyze the hydrolysis of starches into dextrins and short-chain sugars such as maltose and maltotriose; fats into monoglycerides, glycerol, and free fatty acids; and proteins into peptides and amino acids.

How much do you know about managing pancreatic insufficiency? Test your knowledge with this quick quiz.


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