Pancreatic insufficiency – causes, symptoms & therapy

The pancreas (pancreas) is located in the upper abdomen and has two tasks to fulfill: On the one hand, it is responsible for the production of digestive enzymes, on the other hand, it produces hormones such as glucagon or insulin, which regulate blood sugar. If pancreatic insufficiency occurs, these functions can be reduced or even completely absent.

A distinction is made between exocrine and endocrine pancreatic insufficiency. One speaks of exocrine pancreatic insufficiency when the pancreas produces no or too few digestive enzymes. If patients suffer from endocrine pancreatic insufficiency, little or no insulin is produced, which usually manifests itself in diabetes mellitus.

causes

Pancreatic insufficiency very often occurs as part of an inflammation of the pancreas. Inflammation of the pancreas can have a wide variety of reasons, with a distinction being made between an acute and a chronic form. Acute inflammation is often caused by diseases of the bile duct, excessive alcohol consumption or, in rarer cases, medication such as estrogen or cyclosparin.Chronic inflammation is mainly caused by the regular consumption of alcohol. Pancreatic insufficiency can also be caused by the hereditary disease cystic fibrosis. In this disease, a cell channel is not properly formed, so that important transport processes can be impaired.

symptoms and course

Typical symptoms of pancreatic insufficiency:

• Vomit

• nausea

• fatty stool

• weight loss

• Vitamin deficiency

• gas

• stomach pain

• back pain

• exhaustion

• hypoglycaemia

The symptoms of pancreatic insufficiency vary and depend on which region of the pancreas is affected. Exocrine insufficiency only causes symptoms when around 90 percent of the organ is no longer functioning. The main problems then are the fat in the food, which is not properly digested and leads to vomiting and nausea.

So-called fatty stools are also typical. Since digestion is disturbed, those affected lose weight even though they eat enough food. A vitamin deficiency can also occur because vitamins E, D, K and A cannot be absorbed in sufficient quantities.

Painful flatulence also occurs because the food reaches the large intestine undigested, and there can also be pain in the upper abdomen, which radiates to the back. An endocrine pancreatic insufficiency is expressed by exhaustion, frequent urge to urinate and a great feeling of thirst .

In addition, a very high blood sugar level can be measured in the blood because the pancreas does not produce enough insulin. If the production of glucagon is mainly affected, severe hypoglycaemia occurs, which is accompanied by symptoms such as cold sweats, tremors or loss of consciousness .

Diagnose

After an anamnesis by the family doctor or a specialist in internal medicine, a physical examination follows, during which the abdomen is palpated. In addition, the skin and eyes are inspected, as these can often be discolored yellow in pancreatic insufficiency. However, yellowing can also indicate a disease of the bile ducts or the liver. Blood and stool are then analyzed, and computer tomography , ultrasound or magnetic resonance imaging provide further information . In rarer cases, a test is used to determine the secretion production of the pancreas.

treatment and therapy

In the case of exocrine pancreatic insufficiency, the specific cause is first eliminated. For example, stones that are in the excretory duct of the pancreas are crushed or flushed out. If the exocrine pancreatic insufficiency still persists, three therapeutic measures are used.

Diet plays an important role in this . Patients should divide their food into about seven servings per day and avoid fatty foods. Normally, the patients are advised by a dietitian, who optimally adapts the diet to the individual stage of the disease. Alcohol consumption is completely discouraged. Cigarettes are also an absolute taboo, because they also have a damaging effect on the pancreas.

Symptoms can also be improved by taking capsules that contain digestive enzymes and have an enteric-coated shell. The enzymes are taken whole with liquid during meals and then dissolve in the stomach . This releases the enzymes and the fat can be broken down in this way. Since vitamin absorption may also be disrupted in the case of exocrine pancreatic insufficiency, these are often supplied artificially.

If patients suffer from endocrine pancreatic insufficiency, it is important to check the blood sugar level regularly or to support it artificially. If insulin and glucagon are completely absent, blood sugar control is often very difficult. If necessary, a so-called insulin pen is used in these patients.

prevention

Existing pancreatic insufficiency cannot be cured, but with appropriate therapy it is possible to reduce the symptoms and positively influence the disease. The prognosis also depends on the cause of the disease or which function of the pancreas is impaired. Alcohol should be avoided in any case, as it can further aggravate pancreatic insufficiency.By doing without harmful stimulants or by eating a balanced diet, pancreatic insufficiency can be indirectly prevented. In the case of problems with the gallbladder , the duodenum or the gastrointestinal tract , a specialist should be consulted in good time in order to eliminate any secondary diseases. If medication is taken, it is advisable to pay attention to side effects related to pancreatic insufficiency.