When to Consider the Pancreas

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1Gastrointestinal Upset? Nutritional Deficiencies? Consider the Pancreas
Exocrine Pancreatic Insufficiency (EPI)—Decreased Production, Delivery, or Activity of Pancreatic Enzymes Needed for Proper Digestion
2EPI Is Caused by Various Pancreatic and Extrapancreatic Conditions1,2*
*This list is not all-inclusive of EPI etiologies.
3EPI Signs and Symptoms1,2
  • Flatulence
  • Bloating
  • Abdominal discomfort
  • Fatty food intolerance
  • Diarrhea
  • Malodorous stool
  • Steatorrhea
MIMIC THAT OF OTHER GI CONDITIONS, CONFOUNDING DIAGNOSIS5
4EPI Can Have Nutritional Consequences and Impact Quality of Life1,2
  • Micronutrient and fat-soluble vitamin deficiencies
  • Malnutrition
  • Weight loss
OBSERVED IN PATIENTS WITH CHRONIC PANCREATITIS
  • Impaired quality of life3
  • Increased mortality4
5EPI Is Largely a Clinical Diagnosis Considerations in the diagnosis of EPI
PRESENCE OF EPI-PREDISPOSING CONDITION5,6
  • Cystic fibrosis
  • Chronic pancreatitis
  • Acute pancreatitis
  • Pancreatic/gastric surgery
  • Pancreatic cancer
  • Inflammatory bowel disease
  • Celiac disease
SIGNS & SYMPTOMS5,6
  • Flatulence
  • Bloating
  • Abdominal discomfort
  • Fatty food intolerance
  • Diarrhea
  • Malodorous stool
  • Steatorrhea
  • Micronutrient deficiencies
  • Fat soluble vitamin deficiencies
  • Malnutrition
  • Weight loss
SUPPLEMENTAL TESTS5,6
  • Fecal elastase-1 test
  • Fecal fat tests
  • Biochemical markers of nutritional status
  • Direct pancreatic function test
PATIENT FACTORS THAT MAY DELAY DIAGNOSIS7,8
  • Accustomed to symptoms
  • Restricting fat intake to avoid symptoms
  • Embarrassment
6PERT Is the Cornerstone of EPI Treatment

Pancreatic enzyme replacement therapy (PERT)—a combination of porcine-derived lipases, proteases, and amylases to aid digestion9

  • PERT must be taken orally with each meal and snack
  • Dosing options are based on
Patient
weight
Fat content
of the diet
Underlying
condition*
  • Dose should be individualized based on
Clinical
symptoms
Fat content
of the diet
Degree of
steatorrhea
  • If symptoms and signs of steatorrhea persist, dosage can be increased
GENERAL SAFETY
  • To avoid irritation of oral mucosa, patients should not chew PERT or retain in the mouth
  • Exercise caution when prescribing PERT to patients with gout, renal impairment, or hyperuricemia
  • Exercise caution when administering pancrelipase to a patient with a known allergy to proteins of porcine origin
  • Fibrosing colonopathy has been reported in patients with cystic fibrosis taking high-dose PERT
*According to individual PERT label.
References: 1. Domínguez-Muñoz JE. Curr Gastroenterol Rep. 2007;9(2):116-122. 2. Lindkvist B. World J Gastroenterol. 2013;19(42):7258-7266. 3. Olesen SS, et al. Pancreatology. 2014;14(6):497-502. 4. de la Iglesia-Garcia D, et al. J Clin Gastroenterol. 2018;52(8):e63-e72. 5. Othman MO, et al. Int J Clin Pract. 2018;72(2). 6. Durie P, et al. Curr Med Res Opin. 2018;34(1):25-33. 7. Hart PA, Conwell DL. Curr Treat Options Gastroenterol. 2015;13(3):347-353. 8. American Gastroenterological Association website. http://www.gastro.org/ press_releases/largest-analysis-examining-barriers-to-epi-diagnosis-finds-patients-with-digestive-health-issuesoverlook- their-symptoms. Accessed December 18, 2019. 9. MICROMEDEX [database]. Accessed August 20, 2019.
ABBV-US-00206-MC | Approved: 09/2020