Digestion and the Pancreas

Stimulation of enzyme secretion1

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

Prevention of inactivation2,3

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 pancreatic enzyme output is ≤10% of normal4

EPI may result in:

  • Maldigestion2,4

    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.

  • Malabsorption2

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

  • Symptoms2,5

    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. Fieker AP, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73. 2. Ferrone M, Raimondo M, Scolapio JS. Pancreatic enzyme pharmacotherapy. Pharmacotherapy. 2007;27(6):910-920. 3. Keller J. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl_6):1-28. 4. DiMagno MJ, DiMagno EP. Chronic pancreatitis. Curr Opin Gastroenterol. 2006;22(5):487-497. 5. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122.