Digestive Problems
Diseases: Pancreas and Biliary Tree: Pancreatic Insufficiency
One of the functions of the pancreas is to produce digestive enzymes which are released into the small intestine and play an important role in breaking down food products for absorption. When the pancreas becomes damaged, usually by chronic inflammation or rarely cancer, pancreatic enzymes are not produced and malabsorption results.
Risk Factors
Chronic pancreatitis has many causes but chronic alcohol abuse is the commonest one in western countries. Chronic pancreatitis and subsequent insufficiency can also run in families (hereditary pancreatitis and cystic fibrosis).
Clinical features
Patients with chronic pancreatitis may not have any symptoms. However, with ongoing destruction of the gland and loss of its function, symptoms of malabsorption may develop. Chronic pancreatitis can also manifest with abdominal pain, and diabetes.
Diagnosis
Pancreatic insufficiency is suspected in a patient who develops diabetes, upper abdominal pain and features of malabsorption. Bowel movements classically are bulky, loose and foul smelling; because of their oily nature, they may float in the toilet bowl, and are difficult to flush.
Simple investigations used to diagnose chronic pancreatitis include an abdominal X-ray (which can show calcifications in the pancreas) and stools collected for fat content. Other studies such as CT scan, MRI scan, and endoscopic ultrasound can also show typical features of chronic pancreatitis. Occasionally the pancreas becomes so chronically inflamed that a scarred mass may develop, which can be difficult to distinguish from cancer.
Treatment
When chronic pancreatitis is discovered, attempts are made to remove causative factors. Causes of ongoing inflammation should be removed, such as high blood fat (triglyceride) levels and intake of alcohol. Problems with drainage of the pancreatic duct can be treated endoscopically with stents, dilatation and sometimes surgery. There are reports of the use of antioxidants (selenium, vitamin A, vitamin C, and vitamin E) to reduce ongoing inflammation. In terms of maldigestion from chronic pancreatitis, enzyme supplements are usually prescribed. These supplements are in the form or pills which contain pancreatic enzymes. The pills are taken before and during each meal. Depending on the type of supplements an antacid may be prescribed also, as some pancreatic supplements are broken down by gastric acid. Dietary changes are also suggested; a low fat diet (30g fat per day) will reduce the amount of steatorrhea and sometimes abdominal pain associated with chronic pancreatitis. Since fat can be so significantly malabsorbed, supplements of fat soluble vitamins (vitamin D, A, E, and K) may be prescribed.