D., Ph.D.* †, * Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, † Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium, ‡ INSERM U6988, Université Paris 13, Bobigny, France, § Service de Biochimie, Hŏpital Jean Verdier, AP-HP, Bondy, France, ¶ Service d’Hépatologie, Hŏpital Jean Verdier, AP-HP, Bondy, France, ** INSERM U773, Centre de Recherche Bichat

Beaujon CRB3, Université Paris 7, Paris, France. selleck compound “
“Pancreatic insufficiency is a major consequence of pancreatic diseases leading to a loss of pancreatic parenchyma, obstruction of the main pancreatic duct, decreased pancreatic stimulation, or acid-mediated inactivation of pancreatic enzymes. In addition, gastrointestinal and pancreatic surgical resections are frequent causes. Clinical manifestations include abdominal cramps, steatorrhea and malnutrition. Malnutrition, the main contributing factor of weight loss, has been related to a high morbidity and mortality secondary to an increased risk of BTK signaling inhibitor malnutrition-related complications and cardiovascular events. Assessments of exocrine pancreatic function, such as fecal fat quantification and 13C-triglyceride breath test, are the method of choice for diagnosis. In clinical practice, high-risk patient populations include those with severe necrotizing pancreatitis, gastrointestinal and pancreatic surgery,

cancer of pancreas head, and those with pancreatic calcifications. Apart from relief of maldigestion-related symptoms, the main goal of pancreatic enzyme substitution therapy is to ensure a normal nutritional status. Therapy of pancreatic

insufficiency is based on the oral administration of exogenous pancreatic enzymes. Restriction of fat intake, though traditionally important in conventional treatment, should be reconsidered. Enzyme substitution therapy should ideally mimic the physiological pattern of pancreatic exocrine secretion, and pancreatic enzymes in the form of enteric-coated minimicrospheres are considered Montelukast Sodium as the most elaborated commercially available enzyme preparations. In general, pancreatic exocrine insufficiency in patients after surgery may be managed similarly to patients with chronic pancreatitis. This review focuses on current perspectives in diagnosis and treatment of pancreatic exocrine insufficiency and practical suggestions on its clinical management. Pancreatic exocrine insufficiency is a major consequence of diseases leading to a loss of pancreatic parenchyma (e.g. chronic pancreatitis, cystic fibrosis), obstruction of the main pancreatic duct (e.g. pancreatic and ampullary tumors), decreased pancreatic stimulation (e.g. celiac disease), or acid-mediated inactivation of pancreatic enzymes (e.g. Zollinger-Ellison syndrome). In addition, gastrointestinal and pancreatic surgical resections (e.g.