Digestion and the Pancreas

Stimulation of enzyme secretion1,2

The major hormonal stimulus that causes pancreatic digestive enzyme secretion is the release of cholecystokinin from the duodenum.

Prevention of inactivation1,2

Bicarbonate alkalinizes intraluminal duodenal pH and prevents inactivation of digestive pancreatic enzymes.

Normal enzyme secretion3

“Normal” amount of pancreatic enzyme secretion varies with content and volume of meal ingested.

Normal pancreatic enzyme secretion varies3

  • 480,000Lipase units per meal

  • 720,000Lipase units per meal (Average)

  • 960,000Lipase units per meal

EPI occurs when prandial enzyme output is ≤10% of normal4

EPI may result in:

  • Maldigestion1,4

    Digestion is not clearly impaired until enzyme output has been decreased to ≤10% of normal. EPI impairs the breakdown of nutrients. In EPI, the digestion of fat is the most impaired.

  • Malabsorption1

    Malabsorption of nutrients including fat-soluble vitamins (A, D, E, and K) may accompany EPI.

  • Symptoms1,2,4

    Symptoms of EPI are mostly related to insufficient pancreatic enzymes leading to undigested and unabsorbed fat reaching the colon and being excreted in feces (steatorrhea). Other symptoms of EPI include frequent diarrhea, unexplained weight loss, flatulence and bloating, and abdominal pain.

Could your patient's symptoms be due to EPI?

See how symptoms overlap with
other GI conditions

References: 1. Ferrone M, Raimondo M, Scolapio JS. Pancreatic enzyme pharmacotherapy. Pharmacotherapy. 2007;27(6):910-920. 2. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122. 3. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl 6):1-28. 4. DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973;288(16):813-815.