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Other conditions are associated with EPI1-13

PANCREATIC CANCER:
Obstruction of the pancreatic duct by tumors from the head of pancreas, destruction of the pancreas by tumor growth, and loss of pancreatic tissue from surgery often lead to pancreatic exocrine insufficiency.

PANCREATECTOMY:
Partial or complete removal of the pancreas is very likely to cause EPI and the patient will need lifelong use of pancreatic enzyme replacement therapy (PERT). EPI has been diagnosed after partial resection of the pancreas including duodenopancreatectomy (Whipple procedure), a procedure that involves removal of the head of the pancreas and the encircling duodenum. The risk of EPI depends upon the type of surgery and extent of pancreatic tissue removed.

GASTRIC SURGERY:
Gastric surgical procedures can result in asynchrony between gastric emptying and discharge of bile and pancreatic enzymes.

OBSTRUCTION OF THE BILIARY OR PANCREATIC DUCT:
Descending gall stones, biliary sludge from common bile duct as well as tumors of the pancreas can lead to obstruction of pancreatic duct and ampulla of Vater, leading to pancreatic inflammation/autodigestion.

DIABETES MELLITUS (TYPE I AND TYPE IIIC):
EPI is associated with type I and type IIIC diabetes. Type I diabetes is characterized by chronic inflammation in both the endocrine and exocrine pancreas from autoimmunity against pancreatic islets, leading to insulin deficiency, pancreatic fibrosis, and atrophy. Type IIIC diabetes, or pancreatogenic diabetes, is a form of secondary diabetes that follows the disease of the exocrine pancreas, such as chronic pancreatitis.

Patients with pancreatic cancer may have duct obstruction, atrophy of pancreatic tissue, or surgery that may cause EPI
Patients with pancreatic cancer may have duct obstruction, atrophy of pancreatic tissue, or surgery that may cause EPI
Partial or complete removal of the pancreas is very likely to cause EPI and the patient will need lifelong use of pancreatic enzyme replacement therapy (PERT)
Partial or complete removal of the pancreas is very likely to cause EPI and the patient will need lifelong use of pancreatic enzyme replacement therapy (PERT)
While there may be an association between EPI and diabetes, the true incidence of EPI in diabetes is unknown, and the pathophysiology remains unclear
While there may be an association between EPI and diabetes, the true incidence of EPI in diabetes is unknown, and the pathophysiology remains unclear

Learn about EPI
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References: 1. Bures J. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978. 2. Cavalot F, Bonomo K, Fiora E, et al. Does pancreatic elastase-1 in stools predict steatorrhea in type 1 diabetes? Diabetes Care. 2006;29(3):719-721. 3. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001;120(3):682-707. 4. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26 Suppl 1:S5-S20. 5. Hahn J-U, Kerner W, Maisonneuve P, Lowenfels AB, Lankisch PG. Low fecal elastase 1 levels do not indicate exocrine pancreatic insufficiency in type-1 diabetes mellitus. Pancreas. 2008;36(3):274-278. 6. Hardt PD, Hauenschild A, Jaeger C, et al. High prevalence of steatorrhea in 101 diabetic patients likely to suffer from exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations: a prospective multicenter study. Dig Dis Sci. 2003;48(9):1688-1692. 7. Keller J. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl_6):1-28. 8. Matsumoto J, Traverso LW. Exocrine function following the whipple operation as assessed by stool elastase. J Gastrointest Surg. 2006;10(9):1225-1229. 9. Witt H, Apte MV, Keim V, Wilson JS. Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology. 2007;132(4):1557-1573. 10. Yuasa Y, Murakami Y, Nakamura H, et al. Histological loss of pancreatic exocrine cells correlates with pancreatic exocrine function after pancreatic surgery. Pancreas. 2012;41(6):928-933. 11. Czakó L, Hegyi P, Rakonczay Z, Wittmann T, Otsuki M. Interactions between the endocrine and exocrine pancreas and their clinical relevance. Pancreatology. 2009;9(4):351-359. 12. Ewald N, Bretzel RG. Diabetes mellitus secondary to pancreatic diseases (Type 3c) – are we neglecting an important disease? Eur J Intern Med. 2013;24(3):203-206. 13. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2014;37(Supplement 1):S81-S90.
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