Kusztos Victoria, Pogorelova Mariya
Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Am J Case Rep. 2025 Jul 17;26:e948283. doi: 10.12659/AJCR.948283.
BACKGROUND Exocrine pancreatic insufficiency (EPI) is characterized by inadequate delivery of pancreatic digestive enzymes to the small intestine, and can result in steatorrhea, weight loss, and fat-soluble vitamin deficiencies without treatment. We present a case of EPI attributed to longstanding type 2 diabetes mellitus. CASE REPORT A 71-year-old man with type 2 diabetes mellitus and remote history of Roux-en-Y bypass surgery 35 years ago and cholecystectomy 50 years ago presented with an 8-month history of steatorrhea and 41-kg weight loss despite increased caloric intake. Workup was notable for fecal elastase less than 40 µg/g and significant steatorrhea with total fat 277 g over 24 hours. Computed tomography (CT) enterography revealed marked pancreatic atrophy without any sign of pancreatic tumor. He was diagnosed with EPI, and with initiation of pancreatic enzyme replacement therapy (PERT), his diarrhea improved, allowing him to regain weight to his prior baseline and to reduce caloric intake. CONCLUSIONS Although exocrine pancreatic insufficiency affects close to one-third of patients with type 2 diabetes mellitus, it remains under-recognized due to the nonspecific nature of presenting symptoms and their frequent attribution to the effects of diabetes mellitus itself or diabetes medications. EPI can lead to marked malabsorption, reduced quality of life, and increased morbidity and mortality, and therefore should be included in the differential diagnosis for steatorrhea, weight loss, and vitamin deficiencies in patients with diabetes during initial assessment by internal medicine providers. A high index of suspicion and assessment with fecal elastase testing can allow for early recognition and timely initiation of PERT, helping mitigate long-term complications.
背景 外分泌性胰腺功能不全（EPI）的特征是胰腺消化酶向小肠的输送不足，未经治疗可导致脂肪泻、体重减轻和脂溶性维生素缺乏。我们报告一例归因于长期2型糖尿病的EPI病例。病例报告 一名71岁男性，患有2型糖尿病，35年前有Roux-en-Y胃旁路手术史，50年前有胆囊切除术史，尽管热量摄入增加，但仍有8个月的脂肪泻病史和体重减轻41千克。检查发现粪便弹性蛋白酶低于40μg/g，24小时内总脂肪量达277g，有明显脂肪泻。计算机断层扫描（CT）小肠造影显示胰腺明显萎缩，无胰腺肿瘤迹象。他被诊断为EPI，开始胰腺酶替代疗法（PERT）后，腹泻改善，体重恢复到先前基线水平，热量摄入减少。结论 尽管外分泌性胰腺功能不全影响近三分之一的2型糖尿病患者，但由于症状表现不具特异性且常归因于糖尿病本身或糖尿病药物的影响，该病仍未得到充分认识。EPI可导致明显的吸收不良、生活质量下降以及发病率和死亡率增加，因此在内科医生对糖尿病患者进行初始评估时，应将其纳入脂肪泻、体重减轻和维生素缺乏的鉴别诊断中。高度的怀疑指数和粪便弹性蛋白酶检测有助于早期识别并及时启动PERT，从而减轻长期并发症。
