Exocrine pancreatic insufficiency in systemic diseases: unravelling the complex interplay – a comprehensive review

Abstract

Exocrine pancreatic insufficiency (EPI) is characterised by the pancreas’s inadequate synthesis or release of digestive enzymes, which impairs digestion and causes nutritional malabsorption. To effectively manage concomitant systemic disorders and provide personalised therapy, early identification is essential. The production of digestive enzymes is a key component in the processes of EPI, which is linked to several conditions such as pancreatic cancer, cystic fibrosis, chronic pancreatitis, and diabetes-related fibrosis. Other causes include aging, smoking, inflammatory bowel disease (IBD), and stomach removal. Exocrine pancreatic insufficiency causes prolonged diarrhoea in celiac disease, perhaps resulting in pancreatitis and autoimmune processes. With mechanisms involving inflammation, bile duct scarring, pancreatic autoantibodies, and extraintestinal manifestations, EPI prevalence in IBD is noteworthy. Both indirect and direct tests are used in the diagnosis of EPI, and secretin-induced magnetic resonance cholangiopancreatography imaging provides a thorough evaluation. Modifications to lifestyle, therapy modalities such as pancreatic enzyme replacement therapy, and innovative therapies for genetic disorders are all part of the management. Pancreatic enzyme replacement treatment is important because micronutrient deficits, including calcium, magnesium, zinc, and vitamins, are present in EPI patients. Innovative treatments investigate machine learning and PARP enzymes for prophylactic and diagnostic purposes, advancing more accurate EPI diagnosis and treatment in systemic disorders.

Keywords

• exocrine pancreatic insufficiency
• systemic diseases
• pancreatic dysfunction
• digestive enzyme deficiency
• gastrointestinal disorders
• multiorgan dysfunction