Diéguez-Castillo Carmelo, Jiménez-Luna Cristina, Prados Jose, Martín-Ruiz José Luis, Caba Octavio
Department of Gastroenterology, San Cecilio University Hospital, 18012 Granada, Spain.
Institute of Biopathology and Regenerative Medicine (IBIMER), University of Granada, 18100 Granada, Spain.
Medicina (Kaunas). 2020 Oct 7;56(10):523. doi: 10.3390/medicina56100523.
Exocrine pancreatic insufficiency (EPI) is defined as the maldigestion of foods due to inadequate pancreatic secretion, which can be caused by alterations in its stimulation, production, transport, or interaction with nutrients at duodenal level. The most frequent causes are chronic pancreatitis in adults and cystic fibrosis in children. The prevalence of EPI is high, varying according to its etiology, but it is considered to be underdiagnosed and undertreated. Its importance lies in the quality of life impairment that results from the malabsorption and malnutrition and in the increased morbidity and mortality, being associated with osteoporosis and cardiovascular events. The diagnosis is based on a set of symptoms, indicators of malnutrition, and an indirect non-invasive test in at-risk patients. The treatment of choice combines non-restrictive dietary measures with pancreatic enzyme replacement therapy to correct the associated symptoms and improve the nutritional status of patients. Non-responders require the adjustment of pancreatic enzyme therapy, the association of proton pump inhibitors, and/or the evaluation of alternative diagnoses such as bacterial overgrowth. This review offers an in-depth overview of EPI in order to support the proper management of this entity based on updated and integrated knowledge of its etiopathogenesis, prevalence, diagnosis, and treatment.
外分泌性胰腺功能不全（EPI）被定义为由于胰腺分泌不足导致食物消化不良，这可能由胰腺刺激、分泌、运输或在十二指肠水平与营养物质相互作用的改变引起。最常见的原因是成人的慢性胰腺炎和儿童的囊性纤维化。EPI的患病率很高，因病因不同而有所差异，但被认为存在诊断不足和治疗不足的情况。其重要性在于吸收不良和营养不良导致的生活质量受损，以及发病率和死亡率的增加，还与骨质疏松症和心血管事件有关。诊断基于一组症状、营养不良指标以及对高危患者进行的间接非侵入性检查。治疗选择是将非限制性饮食措施与胰腺酶替代疗法相结合，以纠正相关症状并改善患者的营养状况。无反应者需要调整胰腺酶疗法、联合使用质子泵抑制剂和/或评估其他诊断，如细菌过度生长。本综述对外分泌性胰腺功能不全进行了深入概述，以便基于对其病因发病机制、患病率、诊断和治疗的最新综合知识，支持对该疾病的合理管理。
