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.
- Steatorrhea – fats in the stool
- Creatorrhea – protein in the stool
- Bloating and gas
- Unintentional weight loss in addition to the signs and symptoms associated with the specific vitamin deficiencies associated with the malabsorption of fat-soluble vitamins.
Other signs and symptom may be related to the causes of the pancreatic enzyme deficiency or inactivity.