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The major hormonal stimulus that causes pancreatic digestive enzyme secretion is the release of cholecystokinin (CCK) from the duodenum.6-8
The pancreatic enzymes are comprised of7:
Bicarbonate alkalinizes intraluminal duodenal pH and prevents inactivation of the enzymes. When nutrients arrive in the proximal small bowel, the pancreatic enzymes begin to break them down.6,7
EPI may result in:
EPI leads to an inability to digest food properly, with fat maldigestion being the most profound.
Malabsorption of fat soluble vitamins A, D, E, and K may accompany EPI.
EPI-related maldigestion and malabsorption can lead to malnutrition and weight loss.
GASTROINTESTINAL (GI) SYMPTOMS7
EPI can lead to GI symptoms due to undigested and unabsorbed food. Steatorrhea, the most common clinical manifestation of EPI, may not occur until the disease is advanced. Yet, there may be significant maldigestion and malabsorption without overt steatorrhea.
This can result from a defect in the pancreatic parenchyma or a decrease in enzyme activity despite intact parenchyma.1
Loss of functional pancreatic parenchyma or reduced endogenous stimulation of the pancreas can result in decreased production of enzymes
Ultrasound of pancreatic cancer
An obstruction in the duct can cause a decrease in the delivery of pancreatic enzymes to the duodenum
Gastric bypass surgery
Activity of enzymes can be reduced due to postcibal asynchrony or intraluminal inactivation
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