Do I Have IBS?
Melissa G. Hunt, Aaron T. Beck in Reclaim Your Life From IBS, 2022
Exocrine pancreatic insufficiency (EPI) is a condition in which the pancreas doesn’t produce enough of the enzymes that help with certain aspects of digestion. Most people know that the pancreas makes insulin, which is crucial to managing glucose or blood sugar. But few people know that the pancreas also makes a number of digestive enzymes, including amylase (which breaks down carbohydrates), lipase (which breaks down fats), and protease and elastase (which break down proteins). If you can’t break down food, it passes through the intestines partially undigested, which can result in abdominal pain, gas, bloating, diarrhea (typically), or constipation, and, if it’s severe, weird poop that looks pale and oily, and can smell bad and sometimes floats (because there’s too much fat in it). One of the main causes of EPI is chronic pancreatitis, so if you’ve ever experienced even one incident of pancreatitis, it’s worth being tested for EPI. The easiest test for EPI is a stool test called the fecal elastase test (FE-1). Elastase is one of the digestive enzymes. If there is little or no elastase in your stool, that can indicate EPI.
Companion Animals Models of Human Disease
Rebecca A. Krimins in Learning from Disease in Pets, 2020
Exocrine pancreatic insufficiency (EPI) is a disorder wherein the pancreas fails to secrete adequate amounts of digestive enzymes. In dogs, EPI is usually the consequence of an autoimmune disease known as pancreatic acinar atrophy. Originally believed to be a simple autosomal recessive disorder, a test-breeding recently revealed that EPI has a more complex mode of inheritance(92). The contributions of multiple genes, combined with environmental factors, may explain observed variability in clinical presentation and progression of this disease. Research efforts aim to identify genetic variations underlying EPI to assist breeders in their efforts to eliminate this disease from their breed and provide clinicians with new targets for therapeutic intervention and/or disease prevention. Genome-wide linkage, global gene expression, and candidate gene analyses have failed to identify a major locus or genetic variations in German Shepherd dogs with EPI. Recently, genome-wide association studies revealed numerous genomic regions associated with EPI. Current studies are focused on alleles of the canine major histocompatibility complex(92).
Irritable Bowel Syndrome
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Exocrine pancreatic insufficiency (EPI) is a differential diagnosis that has been little investigated in relation to IBS. This is partly explained by the paucity of readily available tests for exocrine pancreatic function. However, the development of the faecal elastase-1 test has facilitated the detection of patients with EPI. A single study from the UK investigated 314 patients with IBS-D and found faecal elastase-1 levels <100 μg/g in 19 (6.1%) of these.34 The authors reported a clinical response to enzyme supplementation in 18/19 patients and improvement of abdominal pain in 11/19 patients. The mean age of the patients who had low levels of faecal elastase-1 was 58 years, and this indicates that EPI can be of particular relevance in older patients with IBS-D-like symptoms.
Exocrine pancreatic insufficiency is common in people living with HIV on effective antiretroviral therapy
Published in Infectious Diseases, 2018
Pancreas is the only gland in the human body with both exocrine and endocrine functions. Dysfunction of the endocrine part results in diabetes and exocrine dysfunction results in pancreatic insufficiency [1]. Exocrine pancreatic insufficiency (EPI) results from a progressive loss of acinar pancreatic cells, which leads to secretion of an insufficient quantity of digestive enzymes into the duodenum. Maldigestion results when exocrine pancreatic function is reduced by more than 90% [2]. Symptoms of EPI include steatorrhoea, diarrhoea, flatulence, bloating and abdominal discomfort [3]. The most common cause of EPI is chronic pancreatitis, but EPI can also be caused by several other conditions, such as diabetes, celiac disease, inflammatory bowel diseases, cystic fibrosis, partial or total surgical resection of pancreas, loss of function of pancreatic tissue or obstruction of the main pancreatic duct and gastrectomy [4]. EPI has also been associated with HIV and it has been proposed as an underdiagnosed and important cause of diarrhoea and fat malabsorption in adults and children living with HIV [5–7].
Trypsinogen and chymotrypsinogen: potent anti-tumor agents
Published in Expert Opinion on Biological Therapy, 2021
Aitor González-Titos, Pablo Hernández-Camarero, Shivan Barungi, Juan Antonio Marchal, Julian Kenyon, Macarena Perán
The pancreas plays a very important role in the digestive function through the secretion of several enzymes necessary for the degradation of nutrients. These enzymes are secreted by acinar cells as zymogens (inactive forms also known as (pro)enzymes) [3]. Once secreted, they are transferred to the small intestine where they are activated. The most studied zymogens are Trypsinogen and Chymotrypsinogen. In the case of Trypsinogen, it is activated to Trypsin in the small intestine by enterokinase. Once activated, it is capable of activating the rest of the pancreatic zymogens, including Chymotrypsinogen into Chymotrypsin [4]. A failure in the production of these proteins can cause poor absorption of nutrients, the most common diseases that lead to exocrine pancreatic insufficiency are chronic pancreatitis and cystic fibrosis [5].
Importance of Pancreatic Enzyme Replacement Therapy after Surgery of Cancer of the Esophagus or the Esophagogastric Junction
Published in Nutrition and Cancer, 2018
Thomas Kiefer, Dorothea Krahl, Kathrin Osthoff, Peter Thuss-Patience, Jörg Bunse, Ulrich Adam, Marc H. Jansen, Rudolf Ott, Robert Pfitzmann, Matthias Pross, Thomas Kohlmann, Georg Daeschlein, Hermann Buhlert, Heinz Völler, Carsten Hirt
Many patients who were admitted to our rehabilitation clinic with cancer of the esophagus or the esophagogastric junction after surgery with or without chemotherapy/irradiation report flatulence, diarrhea, weight loss and signs of steatorrhea (pale color, foul smell, stool is lose, bulky, and floats in the toilet bowl). Symptoms of exocrine pancreatic insufficiency like steatorrhea, are a well-known problem in patients following surgical treatment of gastric cancer, and significantly affect quality of life as well as professional and social rehabilitation (5). In contrast, there are only very few reports on pancreatic exocrine insufficiency in patients after esophagectomy (6). Here we report retrospective data of patients after surgery of cancer of the esophagus or the esophagogastric junction, who were treated during 4 years in our rehabilitation clinic.
Related Knowledge Centers
- Digestive Enzyme
- Malabsorption
- Pancreas
- Protease
- Type 1 Diabetes
- Type 2 Diabetes
- Digestion
- Cystic Fibrosis
- Shwachman–Diamond Syndrome
- Pancreatitis