Pancreatic Enzyme Deficiency – Causes and Symptoms

A deficiency of the pancreatic enzymes for digestion can result in a number of malabsorption syndromes. These enzymes play a major role in digesting carbohydrates, proteins and fats as well as certain fat-soluble vitamins. The pancreatic enzymes are also dependent and assisted by other digestive enzymes in the mouth, stomach and small intestine, as well as the action of additional substances like bile. Therefore a deficiency or the absence of pancreatic enzymes, as a result of impaired production, secretion or activity, will not result in a total disruption of nutrient absorption.

Causes of Pancreatic Enzyme Deficiency

Exocrine pancreatic insufficiency may be due to :

  • Chronic pancreatitis, and acute pancreatitis
  • Cystic fibrosis
  • Pancreatic resection (surgical removal)
  • Pancreatic cancer
  • Schwachman-Diamond syndrome
  • John-Blizzard syndrome
  • Pearson syndrome

However, the cause of the enzyme deficiency may not be rooted in the pancreas’ impaired production of digestive enzymes. The conditions below affects the release of all of the pancreatic digestive enzymes :

  • Obstruction of the pancreatic duct in the event of pancreatic cancer may prevent the outflow of pancreatic enzymes from the pancreas.
  • Gallstones (bile duct stones) may also impair the flow of pancreatic enzymes and often affects the outflow of bile as well.
  • Less frequently, certain conditions may affect the factors that regulate the production and secretion of digestive enzymes – this include nerve disorders and diseases that affect the digestive hormones cholecystokinin (CCK) and secretin.

Certain conditions may only affect a few of the pancreatic digestive enzymes. The enzymes are still present but are either not able to act or remain inactivated.

  • The lack of or reduced secretion of bile as seen in cirrhosis may affect the action of the pancreatic enzymes that digest lipids. This can lead to vitamin deficiencies due to a malabsorption of the fat-soluble vitamins A, D, E and K.
  • Excessive amounts of acid in the duodenum or increased duodenal acidity as seen in Zollinger-Ellison syndrome can impair the action of pancreatic lipase and also contribute to fat malabsorption.
  • A congenital deficiency of the enzyme enterokinase which is responsible for activating trypsinogen into trypsin can lead to a protein malabsorption.

Signs and Symptoms of Pancreatic Enzyme Deficiency

A deficiency or inactivity of the pancreatic enzymes should be confirmed with appropriate laboratory tests. – refer ro pancreas enzyme tests. Certain signs and symptoms may be present but should not be used to conclusively diagnose this disorder.

Other signs and symptom may be related to the causes of the pancreatic enzyme deficiency or inactivity.

Related Articles

  1. Pancreatic Function Tests
  2. Pancreatic Enzymes
  3. Digestive Enzymes
  4. What is Malabsorption?

References

  1. Malabsorption Syndromes. Emedicine
  2. Malabsorption Syndromes. Merck
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  • bonnie

    i had gastric by pass surj and had blood work and an mri, tells me my bile ducts are enlaged and my ca is coming back elevated. had a scope of my bile ducts and pancreas. no tumors or cancer present, could this be an enzyme issue? dr. sugest enzyme therapy.

  • Dr. Chris

    Hi Bonnie

    Bile duct enlargement is not a concern but since your doctor did recommends enzyme therapy then there is obviously some disturbance in the digestion as may be evident by a stool sample. Remember that small amounts of the CA pancreatic tumor marker ( I assume this is what you are referring to although there are other CA antigens) is present in the blood of even healthy people. You should direct your questions at your doctor who is more familiar with your case. Wait till all investigations are completed.