The pancreas and EPI

The role of the exocrine pancreas2-4

The exocrine pancreas produces 3 main types of enzymes, which begin to digest macronutrients in the duodenum.

Lipase

breaks down fats into free fatty acids and glycerol

Ham bone icon.

Protease

breaks down proteins into amino acids

Amylase

breaks down carbohydrates into monosaccharides and disaccharides

Normal pancreatic enzyme secretion range 720,000, with 960,000 being the high end of Lipase units per meal and 480,00 being the low end.

Normal pancreatic enzyme secretion

Under normal physiological conditions, the pancreas secretes anywhere from 480,000 to 960,000 lipase units per meal—with an average of about 720,000. Steatorrhea* is observed when pancreatic enzyme output drops below ~10% of the normal range.5,6

*Steatorrhea: ≥7 g of fecal fat per day while consuming 100 g of dietary fat per day in the context of a 72-hour stool test.2

EPI (exocrine pancreatic insufficiency) is a condition caused by inadequate production, delivery, or activity of pancreatic enzymes needed for normal digestion.7,8

The consequences of EPI

When the exocrine function of the pancreas is compromised, it can result in maldigestion and malabsorption, which can lead to malnutrition.

  • Maldigestion—the inability of the small intestine to properly digest fats, proteins, and carbohydrates, which may lead to malabsorption3,8,9
  • Malabsorption—the failure of the small intestine to achieve maximal absorption of essential vitamins and nutrients, especially the fat-soluble vitamins A, D, E, and K3,9-11
  • Malnutrition—a result of maldigestion and malabsorption, which can lead to a variety of consequences, like vitamin deficiencies and unintended weight loss9,11,12

Interested in attending an educational presentation about CREON and EPI?

Patients with EPI may present with signs and symptoms similar to those of other GI disorders, so it’s important to assess specific clinical features.3