home Audience 2 Endocrine pancreatic insufficiency. Exocrine pancreatic insufficiency. Signs of exocrine pancreatic insufficiency

Endocrine pancreatic insufficiency. Exocrine pancreatic insufficiency. Signs of exocrine pancreatic insufficiency

The pancreas is responsible for the production of enzymes. These components help in digesting food and breaking it down into proteins, fats and carbohydrates. If this process is disrupted, a person begins to experience unpleasant symptoms such as bloating, pain in the left side, and nausea. Thus, pancreatic insufficiency manifests itself.

Any type of disease does not occur on its own. This process is always preceded by the influence of unfavorable factors in the form of:

Any reason from the above list can lead to organ failure. If the gland begins to produce a small amount of pancreatic juice, the food bolus will begin to be poorly digested. This will lead to the fact that each cell of the body will not receive enough building material in the form of protein compounds.

It is worth remembering that the pancreas is responsible for the production of two important hormones in the form of insulin and glucagon. They are needed to process sugar and maintain glucose at normal levels. If this process is disrupted, the patient will develop a serious disease such as diabetes.

Types of pancreatic insufficiency

In medicine, pancreatic enzyme deficiency is usually divided into 4 main groups. Each of them has its own characteristics and clinical picture.

These include:

exocrine form;
exocrine form;
enzyme form;
endocrine form.

Before starting treatment, it is necessary to understand the patient’s complaints and compare them with symptoms.

Exocrine insufficiency

Exocrine pancreatic insufficiency was previously diagnosed in people over 50 years of age. But nowadays, this form of the disease can also be found in patients aged 20-30 years. This develops against the background of the fact that the number of cellular structures for secretion production has greatly decreased.

The causes of the pathological phenomenon lie in the following:

decrease in the mass of pancreatic parenchyma due to endocrine diseases;
disruption of the outflow of contents into the lumen of the small intestine;
sluggish nutrient processing.

Symptoms of pancreatic insufficiency are accompanied by:

soreness in the abdomen;
rejection of fatty and salty foods;
feeling of heaviness in the gastric cavity;
diarrhea;
bloating;
the appearance of colic and aching, painful feeling in bone tissue;
increased heart rate;
development of convulsive syndrome;
shortness of breath;
blood clotting disorder;
dryness and itching of the skin;
nausea and vomiting.

Such symptoms signal a fat deficiency.

To restore external secretory function, it is necessary to begin treatment as soon as possible. It is based on compliance with certain recommendations.

Eat properly. Portions should be small, and you should eat as often as possible.
Fatty and fried foods are excluded from the menu.
The last meal is at 6-7 pm. Night snacks are completely excluded.
Alcohol-containing drinks are prohibited.
The list of permitted products is prescribed only by a doctor based on individual indications.

An important point in case of exocrine insufficiency is that food of animal origin must be replaced with plant food. It should make up 70-80% of the entire menu.

Since the body cannot produce the required amount of enzymes and does not receive fats, carbohydrates will quickly leave it. Products rich in their content include confectionery and flour products. But they are banned. Therefore, it is recommended to replace them with vegetables and fruits. But such a menu also adversely affects the functioning of the body - it reacts with increased formation of gases. But bran helps reduce it.

Enzyme deficiency of the pancreas is compensated by taking medications:

Mezim,
Creon,
Pancreatin,
Festal.

The first sign of proper treatment is the normalization of stool and the disappearance of other unpleasant symptoms.

Exocrine pancreatic insufficiency is characterized by a violation of the production of digestive juice for the complete processing of the food bolus.

Doctors identify several main reasons for this phenomenon:

Symptoms of pancreatic enzyme deficiency are characterized by:

poor absorption of food;
increased formation of gases;
difficulties with bowel movements;
nausea and vomiting;
heaviness in the stomach.

The exocrine type of disorder can only be confirmed using laboratory diagnostics. A mandatory test for this pathology is checking blood sugar, since there is a high probability of diabetes mellitus.

Treatment is based on eliminating the root cause. If alcohol or diet has disrupted the production of pancreatic juice, the patient should reconsider his life principles. Mono-diets and prolonged fasting lead to a lack of important elements: proteins, fats and carbohydrates. This process adversely affects not only the pancreas, but also the entire body as a whole.

The diet should be rich in vitamins in the form of ascorbic acid, alpha-tocopherol, retinol. They have a positive effect on the digestive organs. In some cases, the doctor prescribes enzymes.

Enzyme deficiency

Enzyme deficiency is accompanied by constant pain. In this case, there is a serious enzyme deficiency.

The causes of the pathological process are:

excessive use of medications;
infectious diseases;
injury to the pancreatic duct;
the presence of congenital pathologies in the pancreas;
intestinal dysbiosis.

Often, enzyme deficiency manifests itself as acute or chronic pancreatitis. The clinical picture of these diseases is the same and is accompanied by:

irregular bowel movements. Patients often complain of diarrhea. Feces have a fetid odor;
lack or worsening of appetite;
general weakness;
bloating due to a large amount of gas;
weight loss;
painful sensations in the abdomen.

This process has the worst impact on children. It is difficult for a child to adhere to a diet regimen. Weight loss can lead to serious developmental problems. To avoid this, you need to take care of your diet. It must be high in calories. Another treatment involves taking artificial enzymes.

Endocrine insufficiency

The pancreas is responsible not only for the functioning of the digestive tract, but also helps the endocrine system. Inside this organ, insulin, glucagon and lipocaine are produced. Such components are responsible for blood sugar levels.

Insulin lowers glucose levels.
Glucagon is necessary to increase blood sugar.
Lipocaine. Inhibits the occurrence of fatty infiltration in the liver and stimulates the effect of lipotropic substances.

If the production process is disrupted, adverse consequences may develop. The problem primarily concerns the islets of Langerhans, as they are responsible for the production of hormones.

A disorder of the endocrine function of the pancreas is characterized by some symptoms such as:

release of gases and unpleasant odor;
nausea and vomiting;
foul-smelling, loose stools;
increasing the number of bowel movements per day;
bloating;
abnormalities in blood counts. They can be lower or higher depending on the work of a particular hormone;
weaknesses;
dehydration of the body.

Treatment is based on following certain recommendations.

Adhering to a strict diet. Fatty and fried, spicy and salty foods are excluded from the diet. Various sweets, sugar, coffee, smoked foods, and marinades are prohibited.
Constantly monitoring blood sugar. The patient needs to purchase a special device that will help measure sugar levels. It's called a glucometer. Manipulations must be carried out in the morning on an empty stomach and after meals.
Taking pills to normalize blood sugar.

If it is not possible to normalize the functioning of the pancreas, it means that diabetes mellitus will occur. This is one of the serious and dangerous diseases. But you can learn to live with it. In severe cases, the patient is prescribed insulin injections, otherwise everything will end in death.

Recovery prognosis

Treatment is based on the use of medications and a strict diet. In the first days, when pain is observed, it is better to completely stop eating. You are allowed to drink only purified water.

As soon as the pain subsides (this will take 1-2 days), you can expand your diet. The menu includes low-fat soups and broths, compotes, green and black tea without sugar, and water porridge. It is better to eat often, but little by little. Portions should be small - 100-150 g.

The emphasis is on vegetables and fruits. Only it is better to eat them not fresh, but stewed, steamed or boiled. It is strictly forbidden to eat before going to bed. You can drink a glass of kefir or yogurt to normalize the microflora.

After another 3-4 days, the diet expands to the usual diet. To help the pancreas produce enzymes, doctors recommend taking special medications based on pancreatin. The treatment course lasts no more than 1 month. If the condition does not improve, then you need to undergo examination and tests.

If all recommendations are followed, the prognosis will be only positive. In 80% of cases, relapses and progression of the disease to a severe form can be avoided. Other cases end sadly. But it all depends on the patient himself and his lifestyle. At the first signs, you should immediately visit a doctor.

Diseases that can result from pancreatic insufficiency

In the absence of therapeutic measures, the patient will develop serious complications.

With a lack of enzymes, the following develops:

pancreatitis. It comes in two types: acute and chronic. Characterized by an inflammatory process in the pancreas;
formation of pseudocysts. There may be infected contents inside. If the cyst bursts, the patient cannot avoid serious complications;
pancreatic necrosis. Characterized by tissue necrosis. It is a complication of acute pancreatitis. Leads to multiple organ failure;
diabetes. There is a violation of glucose absorption. It is a serious pathology and poses a danger to the patient’s life;
formation of fistulas in the pancreas, gastric cavity and intestinal canal.

Diseases can be prevented if symptoms are identified early and treatment is started.

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Pancreatic insufficiency is an endocrine disease caused by a failure in the production of hormones necessary for the normal functioning of the body. The pancreas (PG) is the main organ that stimulates digestion, and without its proper functioning the entire body suffers.

The essence of the problem

The pancreas performs 2 main functions:

Exocrine.
Endocrine.

The first is the production by the gland of substances involved in the process of digesting food (pancreatic juice and more than 20 types of enzymes). This part of the pancreas consists of acini (gland cells) that synthesize enzymes (trypsin, lipase, chymotrypsin, amylase, etc.) that break down proteins, fats and carbohydrates that enter the body with food in the duodenum.

Lipase ensures the breakdown of fats into fatty acids in the bile environment of the intestine.

The endocrine part of the gland is the islets of Langerhans, which are located between the acini and consist of insulinocytes that produce insulin, glucagon, somostatin and various polypeptides involved in glucose metabolism and regulating blood sugar levels. Islets consist of A, B and D cells. Glucagon is produced in type A cells (25% of all cells); B cells (60% of all cells) produce insulin, and type D cells (15%) synthesize other polypeptides.

Pancreatic failure is caused by the destruction of normal tissues and cells in the organ and their gradual replacement with connective tissue (fibrosis), which subsequently leads to a decrease in the functional activity of the gland in the production of necessary enzymes and hormones. Thus, pathology can lead to malfunctions in all body systems.

Types of pancreatic insufficiency and their signs

Pancreatic diseases are classified into 4 main types:

The pancreas performs important functions in the body that ensure the normal functioning of the body. Like any intraorganic structure, the pancreas can be subject to some pathological influences, causing its functionality to decrease. One of these pathological conditions is pancreatic insufficiency.

Reason for development

The pancreas produces specific digestive enzymes, in the absence of which the normal course of food digestion processes is impossible.

When disruptions occur in the production of these substances and the gland begins to function inadequately, this condition is called pancreatic insufficiency.

There are several causes of pancreatic insufficiency. These include:

Vitamin deficiency;
Damage to pancreatic tissue
Lack of hemoglobin;
Lack of protein in the blood;
Unhealthy diet, abuse of salty foods, fatty foods, unusual seasonings, spices, etc.;
Heredity;
Pathologies such as lipomatosis, cystic fibrosis, Shwachman syndrome;
Death of gland cells due to pancreatitis or surgical removal of part of the organ.

Sometimes there are several factors that provoke the development of pathology. Or it may be that the patient seems to be healthy, follows a healthy lifestyle, eats right, but pancreatic insufficiency is still detected. In such situations, the reasons usually lie in hereditary predisposition.

Types of disease: causes, symptoms, diagnosis and treatment methods

Experts distinguish four types of functional pancreatic insufficiency, and each of them has its own individual characteristics, including etiology or treatment method.

Pancreatic insufficiency can be:

Exocrine;
Exocrine;
Enzymatic;
Endocrine.

Since each of the varieties has serious differences, they must be considered separately.

Exocrine pancreatic insufficiency

Exocrine pancreatic insufficiency is a pathology in which there is a lack of juices for the stable flow of digestive processes. Characteristic signs of such pancreatic insufficiency are:

Nausea reactions;
Bloating;
Feeling of heaviness in the epigastrium;
Problems with stool;
Poor digestion of food.

This pathological condition is preceded by various types of gastric problems and pancreatic pathologies caused by changes in glandular tissues. In addition, exocrine insufficiency can develop against the background of gall bladder or intestinal diseases, excessive fasting or abuse of mono-diets.

Exocrine insufficiency can be identified only through comprehensive laboratory diagnostics. With such pancreatic insufficiency, the risk of developing diabetes increases, so such patients need to regularly check their blood sugar levels.

The success of treatment directly depends on the accurate establishment of the etiology of the pathological process. If there is a dietary or alcohol factor, you will need to change your lifestyle, giving up strict diets and drinking alcohol.

Vitamins such as ascorbic acid, tocopherol and retinol must be present in the diet for this form of pancreatic insufficiency. In addition, patients are prescribed enzymatic preparations that help the gland to fully perform secretory functions.

Exocrine

Today, even relatively young patients suffer from secretory insufficiency. This form is closely related to the exocrine form, because insufficient production of enzyme components leads to disturbances in the digestion processes in the intestine.

The reason for the lack of secretion is a variety of factors, under the influence of which the pancreas loses some of the cells that produce the most important pancreatic secretion.

The development of pathology is also facilitated by the use of certain medications, an excessively active outflow of pancreatic secretions into the duodenum, poor participation of enzyme substances in the processing of food masses, or a decrease in the parenchyma of the organ.

Exocrine pancreatic insufficiency has specific symptoms, including manifestations such as:

Heaviness in the abdominal area that occurs after eating foods with high fat content;
Intolerance to spicy or overly fatty foods;
Pasty, greasy stools;
Painful sensations in bone tissue;
Colic;
Flatulence.

Patients with such a deficiency often complain of shortness of breath, dry skin, rapid heartbeat, bleeding disorders, etc. Such complaints are due to the fact that the body lacks fats, which are practically not absorbed from food.

Treatment involves a proper diet, in which you need to reduce single meals to a minimum, but eat up to 5-6 times a day. It is necessary to somewhat limit the intake of fatty foods, which will not be digested anyway. You should also avoid eating at night and late in the evening.

Alcoholic products are absolutely prohibited. The list of permitted foods should be checked with your doctor.

The diet should be enriched with plant foods such as vegetables, grains and fruits rich in complex carbohydrates. Against the background of a plant-based diet, gas formation may increase, which bran will help to cope with.

Drug therapy for exocrine pancreatic insufficiency involves taking drugs that help the gland to function fully. Such medications include Pancreatin, Creon, etc. The first sign of correctness of treatment will be the elimination of diarrhea and normalization of the results of laboratory tests of stool.

Enzymatic

Enzyme deficiency is called food intolerance, which develops against the background of insufficient exocrine pancreatic functionality.

Enzymes are present in pancreatic juice, their purpose is to help digest food masses.

If at least one enzymatic component is not enough, then the entire digestive process will go astray and be disrupted.

Typically, such pancreatic insufficiency is provoked by factors such as:

Infectious processes;
Taking medications that lead to damage to glandular cellular structures;
Lesions of the pancreatic duct channels;
Congenital structural pathologies of the organ, etc.

Characteristic clinical manifestations of pancreatic enzyme deficiency are problems with appetite and pain in the abdomen, nausea or excessive gas formation, loose stools and chronic fatigue, poor physical activity and weight loss.

One of the characteristic signs of enzyme-type deficiency is the dilution of stool, which has a greasy consistency and a foul odor.

For diagnosis, the patient is prescribed studies, and. Based on the data obtained, the exact form of deficiency is revealed.

For enzyme deficiency, a high-calorie diet and medication to help the digestion process are indicated.

Endocrine

Another form of insufficient functionality of the pancreas is considered endocrine or intrasecretory.

The main tasks of endocrine function are the production of hormonal substances such as glucagon, lipocaine or insulin. If this function fails, the consequences for the body will be irreparable.

This form of deficiency usually develops against the background of lesions in those glandular areas (islets of Langerhans), which are responsible for the production of a certain hormonal substance. With such lesions, the patient faces an almost inevitable threat of developing diabetes.

Endocrine insufficiency of the pancreas manifests itself in the following ways:

Fetid odor of gases released;
Nausea and vomiting reactions;
Bloating and diarrhea with foul-smelling stool;
Increased frequency of bowel movements;
Laboratory blood tests will show any abnormalities.

In addition, there are also symptoms of a concomitant nature, such as the patient’s general malaise, which occurs against the background of dehydration due to diarrhea.

Diagnosis is similar to other forms of pancreatic failure.

After an accurate diagnosis has been established, the patient is prescribed strict dietary therapy aimed at minimizing glucose in the blood. If dietary nutrition is useless, treatment with insulin injections is prescribed.

It is quite possible to live with this form of deficiency, but the strictest dietary diet should become the norm of life without any exceptions or concessions.

Forecasts

According to statistics, more than 30% of the population have some form of pancreatic insufficiency. Some people know about their pathology and have already taken measures to eliminate it, while others remain ignorant, which only aggravates the situation.

The main thing is that in the presence of any pancreatic insufficiency, strictly follow dietary recommendations and take prescribed medications according to the prescribed regimen.

Of course, such a disease for any person is associated with very unpleasant sensations, but if the patient gives up unhealthy habits and unhealthy diet, then the quality of life improves and the disease stops.

If a patient develops pancreatic insufficiency due to alcohol addiction, then if he completely abstains from drinking alcohol, he can live for about another 10 years.

If the patient continues to abuse alcohol and eat prohibited foods, then in a few years he will die. Therefore, a healthy lifestyle and diet for such a diagnosis are not just a doctor’s whim, but a guarantee of preserving life.

Video about exocrine pancreatic insufficiency:

Questions regarding the diagnosis of exocrine pancreatic insufficiency (PIN), assessment of the severity of this condition and methods for its correction quite often arise before pediatricians, therapists, gastroenterologists, and surgeons.

Although congenital diseases with isolated loss of lipase, amylase or protease functions of the pancreas are currently known, in clinical practice we often have to deal with mixed deficiency with a predominance of lipase dysfunction.

Significant exocrine insufficiency of the pancreas with loss of predominantly lipase activity is manifested by undigested frequent, sometimes copious, stools with a characteristic greasy sheen and a peculiar odor. The described clinical picture is typical for such severe diseases as cystic fibrosis, Shwachman-Diamond syndrome and congenital lipase deficiency. At the same time, moderate or minor pancreatic insufficiency, often detected only during a special examination, can accompany many gastroenterological diseases (for example, celiac disease) and be a symptom of chronic pancreatitis.

Cystic fibrosis is an autosomal recessive disease caused by a mutation in the transmembrane chloride channel regulator gene; characterized by damage to almost all exocrine glands, severe course and fatal outcome. The degree of damage to the respiratory system and the severity of exocrine pancreatic insufficiency determine the prognosis of the disease. Rational pancreatic replacement therapy with pancreatic drugs, which is vital for patients with cystic fibrosis, helps to increase the patient’s life expectancy and improve its quality.

Shwachman-Diamond syndrome is a congenital condition that is characterized by pancreatic insufficiency (mainly lipase) against the background of pancreatic hypoplasia, hematological changes, growth retardation, and bone abnormalities. The clinical picture is polymorphic and depends on the predominant syndrome. In the case of dominance of pancreatic insufficiency, the disease is manifested by fatty stools and malnutrition of varying degrees of severity, which requires replacement therapy with highly active drugs of pancreatic enzymes. The prognosis of the disease is determined to a greater extent by the severity of hematological changes, especially neutropenia, and, as a consequence, the frequency of infectious complications.

Congenital lipase deficiency is manifested from birth by frequent, fatty stools and the presence of corresponding laboratory signs. Previously, the difficulty of diagnosing this disease was associated with the need to exclude all other diseases manifested by pancreatic insufficiency. With the advent of the test for pancreatic elastase-1 in stool, solving this problem has become much easier. In the case of adequate correction of impaired pancreatic function with highly active pancreatic enzyme preparations, the prognosis can be considered relatively favorable.

Among the acquired forms of pancreatic insufficiency, one should note pancreatic insufficiency in chronic pancreatitis, as well as pancreatic insufficiency due to resection of the pancreas, for example, with nisidioblastosis or a tumor. In this case, in addition to correcting the exocrine function of the pancreas, replacement therapy with insulin preparations under the supervision of an endocrinologist is also required.

To assess the exocrine function of the pancreas, direct (usually probe) and indirect (probeless) methods are used. Direct methods are associated with the direct determination of enzyme activity in the duodenal contents, and indirect methods are associated with the assessment of the processes of digestion of standard substrates.

The simplest indirect method is scatological research. An increase in the amount of neutral fat, connective tissue, muscle fibers and/or starch indicates a decrease in the exocrine function of the pancreas. The accuracy of this method is influenced by a large number of factors, sometimes not directly related to the exocrine function of the pancreas, in particular the volume of bile secreted into the intestinal lumen, its qualitative composition, the state of intestinal motility, the presence of inflammatory processes in the small intestine, therapy with enzyme preparations, etc. Based on this, the method can be considered only indicative. Nevertheless, a scatological examination is recommended for all patients with gastroenterological pathology at the initial stage of examination.

A more accurate (quantitative) assessment of lipolytic processes in the intestine is provided by a stool lipid profile with determination of the amount of triglycerides in the stool using thin layer chromatography. The method can be recommended to clarify the nature of steatorrhea and to assess the effectiveness of replacement therapy.

An indirect test, the so-called BT-PAVA test, is widely used abroad. The synthetic peptide N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA), which is cleaved mainly by chymotrypsin, is used as a substrate. The released para-aminobenzoic acid is absorbed into the blood and excreted by the kidneys. In urine collected over 8 hours, 61% of the ingested para-aminobenzoic acid is normally determined. A decrease in excretion indicates a violation of proteolysis in the small intestine.

The fluorescein dilaurate test is based on the breakdown of the above substrate by pancreatic esterase to free lauric acid and fluorescein, which is absorbed and excreted in the urine. Determination of fluorescein concentration in urine reflects the activity of pancreatic enzymes. Tests with labeled 14C-triolein and 3H-butyric acid have also been proposed, but due to the specific nature of working with radioisotope preparations, they have not become widespread.

The technique of pancreatic intubation is similar to that used for conventional duodenal intubation. A 33% solution of magnesium sulfate can be used as a stimulant. Portions of duodenal contents are collected before and after stimulation, followed by determination of the activity of pancreatic enzymes.

A more specific stimulant is a 0.5% solution of hydrochloric acid (hydrochloric acid test). After acid stimulation, secretion volume and bicarbonate alkalinity increase and enzyme activity decreases. The test characterizes the production of pancreatic bicarbonates in response to acidification of the duodenal contents.

Food products can be used as secretion stimulants to assess the enzymatic function of the pancreas. The most commonly used test is the Lundh test: stimulation of the pancreas with a mixture consisting of milk powder, vegetable oil and glucose dissolved in 300-500 ml of warm water. A mixture of 18 g of vegetable oil, 16 g of cazillac and 40 g of glucose, dissolved in 300 ml of water, contains approximately 6% fat, 5% protein and 15% carbohydrates. After administration of the stimulant, four consecutive 30-minute samples of duodenal contents are collected (that is, collection is carried out within 2 hours), in which the activity of trypsin, lipase, and amylase is determined.

However, the “gold standard” for assessing the exocrine function of the pancreas for many years has been and remains the secretin and pancreasimin (cholecystokinin) tests developed in 1960. Secretin stimulates the release of bicarbonates from the pancreas, and pancreazimin (cholecystokinin) stimulates the release of enzymes. The tests can be performed individually or together. After inserting the probe and obtaining basal portions of the duodenal contents, secretin is injected intravenously, after which three portions of the secretion are collected at an interval of 10 minutes to determine the dynamics of volume and bicarbonate alkalinity. When conducting the secretin-pancreazimin test, after receiving the indicated portions, pancreazimin is administered intravenously and three more portions of duodenal contents are collected to determine enzyme activity.

There is a normosecretory response to the introduction of stimulants, as well as a hypersecretory response (excessive increase in enzyme activity), characteristic of the initial stages of pancreatic damage, a hyposecretory response (decreased enzyme activity), observed with profound changes in the pancreas, and an obstructive response (decreased secretion volume), reflecting blockage of the ducts. .

Secretin and pancreasimin tests are highly accurate, but their widespread use is impossible due to the extremely high cost of secretin and pancreasimin. Disadvantages of the method are also the need to probe the patient, the duration of the procedure and the possibility of adverse reactions associated with intravenous administration of drugs.

The method for determining elastase-1 in feces, which has appeared in recent years and has become widely practiced, is a real alternative to the expensive and invasive secretin-pancreasimin test. The pancreatic enzyme elastase-1 is not metabolized in the intestine, and its activity in feces objectively reflects the exocrine function of the pancreas. Since elastase-1 is organ specific, its determination eliminates the possibility of error associated with the function of intestinal enzymes. Moreover, unlike indirect tests, such as fecal lipid profiles, elastase-1 determination can be performed without discontinuing pancreatic enzyme medications.

The level of elastase-1 in stool is determined by enzyme immunoassay using monoclonal antibodies (Elastase 1 stool test®, ScheBo Biotech, Germany) and is normally at least 200 μg/g of feces. Lower values indicate the presence of exocrine pancreatic insufficiency.

Determination of elastase-1 in stool is indicated in all cases where there is a suspicion of exocrine pancreatic insufficiency and the use of pancreatic enzyme preparations is being discussed, since the use of this method avoids their unreasonable prescription.

With the advent of an accessible and highly accurate test for assessing exocrine pancreatic secretion, doctors have the opportunity to make a reasonable diagnosis of isolated pancreatic insufficiency: until recently, this diagnosis was made by exclusion. A normal level of elastase-1 in the stool along with severe steatorrhea due to neutral fat clearly indicates isolated lipase deficiency. Determination of elastase-1 in patients with severe pancreatic insufficiency (cystic fibrosis, Shwachman syndrome, isolated lipase deficiency) makes it possible, without canceling enzyme therapy, to monitor the condition of the pancreas. Finally, the introduction of this test into everyday practice will dispel the myth about the harmful effects of long-term enzyme therapy on the exocrine apparatus of the pancreas.

At the same time, the appearance of a test for elastase-1 in stool does not exclude the possibility of using indirect methods for studying exocrine pancreatic function, since only they (a coprogram or, preferably, a stool lipid profile) make it possible to assess the degree of adequacy of replacement therapy and select the dose of the drug (Table 1).

The algorithm for studying the exocrine function of the pancreas, as it is seen today, is presented in Table. 2 and on.

Correction of exocrine pancreatic insufficiency should be carried out with highly active preparations of pancreatic enzymes. The dose of the drug is selected individually under the control of the nature of the stool, coprogram and stool lipid profile.

The most effective are microspherical and microtablet preparations of pancreatic enzymes with a pH-sensitive shell. The high activity of these drugs is determined by several factors. Firstly, the high degree of activity of the initial substrate (pancreatin) used for their production. Secondly, thanks to the special form of these drugs (microspheres 1-1.2 mm in size), they are evenly mixed with gastric contents and synchronously penetrate into the duodenum. Studies have shown that a microsphere diameter of 1-1.2 mm is optimal in this regard, while spheres with a diameter of 2 mm or more linger in the stomach for at least 2 hours. Third, the pH-sensitive shell of the microspheres protects the enzyme from destruction in the stomach and releases it in the duodenum. In addition, the microspheres themselves are placed in capsules (also pH-sensitive), which protect the microspheres from premature activation in the oral cavity and esophagus, where, as in the duodenum, there is an alkaline environment. In addition, this form makes it easier to take the drug. Thus, the drug in the capsules reaches the stomach, where the capsules dissolve and the microspheres are released and mixed with the gastric contents. In the duodenum, at a pH value of about 5.5, the pH-sensitive shell of the microspheres dissolves and highly active enzymes begin to act.

The microspherical encapsulated preparation of pancreatic enzymes (Creon) is characterized by a rapid and uniform distribution of the active substance in the stomach with complete protection of this substance from inactivation by gastric acid, which is achieved by filling the gelatin capsule with a known amount of microspheres with the pancreatin preparation (diameter 1-1.2 mm) , coated with an enteric coating. Dissolving in the stomach in a few minutes, the capsule releases microspheres that remain resistant to the action of highly acidic gastric juice (pH = 1). The need to protect pancreatic enzymes in the stomach is beyond doubt. It has been shown that only 10% of the lipolytic activity of an unprotected drug persists after passage through the stomach. Due to the fact that Creon microspheres are covered with an enteric protective coating, after passing through the stomach, 98.6% of enzymatic activity is retained. Microspheres are evenly mixed with gastric chyme and evacuated into the small intestine, where they quickly dissolve in an alkaline environment, releasing enzymes. At an environmental pH of 5.5, 90% of the drug is released in 45 minutes, and at pH = 6 - in 15 minutes, which ensures adequate digestive processes. This ensures the possibility of rapid and highly effective action of the drug.

One capsule of the drug Creon 10,000 contains 150 mg of highly purified pancreatin, obtained from porcine pancreas and consisting of lipase (10,000 U), amylase (8000 U) and proteases (600 U) (E - Ph. Eur. units). The drug Creon 25,000 contains 300 mg of highly purified pancreatin with high activity of lipase (25,000 U), amylase (18,000 U) and proteases (1000 U). The dose of the drug is selected individually. Initially, the patient is prescribed one or two capsules of the drug, which should be taken with food, and then the dose is adjusted depending on individual needs. The daily dose of the drug depends on the severity of exocrine pancreatic insufficiency. In pediatric practice, to facilitate administration of the drug, the capsule can be carefully opened, and the microspheres can be taken without chewing and washed down with a small amount of water or juice. If microspheres are mixed with food, they should be taken immediately; otherwise, damage to the enteric coating may occur.

The drug has a wide range of indications for which its effectiveness has been demonstrated. The main area of its use is conditions with exocrine pancreatic insufficiency. Numerous studies have shown the high effectiveness of microspheres in patients with malabsorption, in the broad sense of the word. In particular, the feasibility of using the drug as an adjuvant therapy for malabsorption in children with celiac disease, as well as with acute intestinal infections, has been shown. Thus, the administration of Creon during the period of convalescence of an acute intestinal infection made it possible to significantly reduce the number of bowel movements, the stool becomes more formed, and the phenomena of flatulence, steatorrhea, creatorrhoea, and amilorrhea decrease. In general, when correcting malabsorption in patients with acute intestinal infection, a good effect is achieved in 87% of sick children, satisfactory in 10%, and no effect is observed in only 3% of patients. Using radioimmune methods, it was shown that Creon significantly improves nutrient absorption (compared to the control group, where treatment was carried out with regular pancreatin).

Among the advantages of modern pancreatic enzyme preparations, it should be noted the absence of side effects and good tolerability, due to which these drugs can be used in all age groups. If necessary, drugs are prescribed for a long time, without fear that any negative consequences will arise. Patients with cystic fibrosis, Shwachman-Diamond syndrome, and congenital lipase deficiency receive replacement therapy for life. For patients with transient pancreatic insufficiency, pancreatic enzyme preparations are prescribed for a period of several weeks to several months under the supervision of appropriate research methods. At the same time, the unreasonable prescription of enzyme preparations, which has been quite widely practiced in recent years, should also be avoided. The use of modern methods for diagnosing exocrine pancreatic insufficiency makes it possible to really narrow the range of patients who require expensive replacement therapy.

In conclusion, I would like to note that a rational approach to the selection of methods for diagnosing and correcting exocrine pancreatic insufficiency ensures the greatest effectiveness of treatment at an optimal cost.

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Note. The frequency of control studies of elastase-1 and fecal lipidogram is determined individually, however, approximately in case of severe exocrine insufficiency of the pancreas, the fecal lipidogram should be repeated at least once every 3 months, and determination of elastase-1 in stool should be carried out at least once a year.

- This is a very important organ in humans. It performs many functions that ensure the normal functioning of the body. Like any other organ, the pancreas can fail. One of the most common diseases is pancreatic insufficiency.

There are several types of pancreatic insufficiency

Like all other diseases, this one also has reasons due to which this deficiency develops. The pancreas produces special enzymes, without which the digestion process is simply impossible.

he can live it for about 10 years If there is a failure in the production of these enzymes and substances, then such a failure is called deficiency. Among the reasons that can cause this failure are:

Tissue damage
Lack of vitamins in the body
Decreased protein levels in the blood
Reduced hemoglobin
Poor nutrition, in particular the consumption of fatty and salty foods, the use of unusual spices, etc.

Of course, these are not all the reasons why deficiency can occur. There are a lot of factors. Sometimes heredity (predisposition) can play a significant role. It seems that the person leads a normal lifestyle, eats right, etc., but still suffers from this illness.

Types of deficiency

Today there are four types of functional pancreatic insufficiency. Each of these types has its own characteristics, ranging from the causes of its appearance to symptoms and treatment. So, they distinguish:

Exocrine insufficiency
Exocrine insufficiency
Enzyme deficiency
Endocrine insufficiency

As mentioned above, each of them has its own characteristics. Therefore, in order to fully understand what the differences are and whether there are similarities in the manifestation of symptoms, it is necessary to get to know each one better. Glandular insufficiency is not a very pleasant circumstance. But in order to establish what kind of deficiency is taking place, it is necessary to consult with a doctor who, based on the symptoms, will make an accurate diagnosis and prescribe the necessary treatment.

Exocrine insufficiency

Unfortunately, today more and more people are suffering from sectoral failure. And if earlier the age category began at about 50 years old, today the bar has moved much lower, and younger people suffer from it.

Exocrine insufficiency is a lack of enzymes (secrets), due to which the breakdown of all useful substances in the body occurs. This happens because over time, under the strong influence of certain factors, the number of cells in the gland that produce this very important secretion decreases.

Symptoms

Like any other disease, exocrine insufficiency has a number of specific manifestations, by which it can be determined that it is this particular type. Among the main symptoms are:

Intolerance to fatty and spicy foods. People with this deficiency find it very difficult to eat fatty foods, since they are either difficult to digest or are not accepted by the body at all.
Heaviness in the stomach. It is formed mainly after a person has consumed fatty foods, which, as mentioned above, are not absorbed by the body
Fat stool. And it's mushy
Colic
Bone pain

In addition, symptoms of exocrine insufficiency can also include rapid heartbeat, convulsions, shortness of breath, abnormalities in blood clotting, dry skin, etc. These symptoms appear as a result of a lack of fat in the body, which is also very important. Due to their poor absorption, associated problems arise that bring more discomfort than the direct symptoms of the disease.

Causes

There are several specific reasons why a person may develop this type of deficiency. These include:

Reduction in exocrine parenchyma mass
Outflow of secretions into the duodenum
Insufficient participation of enzymes in the processing of substances

Treatment

In fact, the most important treatment will be to follow a proper diet, the basic principles of which are as follows:

It is necessary to increase the number of meals, while reducing its quantity
Limit the consumption of fatty foods, which also includes all fatty meats.
Limit food consumption in the late evening and night hours
Must be completely abandoned

Products that are allowed for consumption are discussed with the attending physician, who in turn must fully control the patient’s diet. If we talk about limiting the intake of fatty and animal foods, then it is necessary to replace them with plant foods, that is, eat more vegetables and fruits. For people suffering from this disease, carbohydrates come to the fore, which must be consumed in the right quantity in order to help the body. But the main thing to remember is that you need to look for carbohydrates in healthy foods, and not in sweets, which contain large quantities of carbohydrates.

But there is one caveat to all this, this whole diet. Many patients who completely switch to a plant-based diet begin to experience problems associated with increased gas formation. If this happens, patients are advised to eat bran.

In addition to diet, patients are prescribed medications that will directly help the pancreas. Such drugs include Creon, Pancreatin, Mezim, etc. Typically, these medications are prescribed with every meal in order to eliminate possible digestive problems.

The main indicator of the correctness of the prescribed treatment is the disappearance of diarrhea, as well as normal indicators in the patient’s stool tests. Exocrine gland insufficiency is a serious problem, but you can live with it. You just need to watch your diet and follow all the doctor’s instructions.

Exocrine insufficiency

This is another type of deficiency, which means a lack of juices for normal and stable digestion. Like all diseases, it has its own characteristics of manifestation.

Symptoms

There are several specific symptoms on the basis of which we can conclude that a person has this type of deficiency:

Poor digestibility of food
Flatulence
Abnormal stool
Feeling of heaviness

Of course, this is not all the symptom of this disease. Like other deficiencies, this one has other associated symptoms that are very similar to exocrine ones.

Causes

Exocrine insufficiency will never develop just like that. It is preceded by some disorders in the body, which give impetus to its development. Thus, among the causes of exocrine insufficiency there are:

Irregularities associated with irreversible changes in its tissues
Stomach problems
Problems with the duodenum
Gallbladder problems
Poor nutrition, which includes diets based on eating the same product for a long period of time
Alcohol abuse
Starvation

Diagnosis and treatment

This type of deficiency can be determined only by the results of laboratory tests. The list of tests is prescribed by the attending physician, who will subsequently monitor the entire treatment process. Among other things, if a person has been diagnosed with exocrine glandular insufficiency, then he will constantly need to check his blood sugar levels, since in this case there is a high risk of developing diabetes mellitus.

One of the main principles of successful treatment is to determine the true cause of the development of such deficiency. If the cause is alcohol abuse or diet, then you need to change your view on these things and eliminate alcohol, and also start eating right. The key to proper nutrition in the presence of such a disease is the presence of vitamins such as A, C and E, which have a positive effect on the pancreas. In addition to diet, the patient is prescribed medications that help in the production of necessary enzymes.

Very often a person does not even understand that he has such a problem, since the symptoms of this deficiency are not so obvious and only a doctor can make an accurate diagnosis after receiving the results of laboratory tests of stool.

Enzyme deficiency

Pain is one of the symptoms of pancreatic insufficiency

The pancreas performs a number of specific functions, and any one of them can trigger the development of insufficiency. One of the most common pancreatic insufficiencies is enzyme deficiency. contained in gastric juice and help food digest. If it happens that at least one enzyme is present in insufficient quantities, the digestion process will be disrupted.

Causes

Among the reasons for the development of enzyme deficiency are:

Cell damage caused by certain drugs
Infections
Damage to the duct
Pathologies in the structure of the organ (congenital)
Dysbacteriosis

Symptoms

Among the symptoms that are characteristic of enzyme deficiency are the following:

Abnormal bowel movements, particularly loose stools
General weakness
Appetite disturbance
Increased gas formation
Reducing weight and physical activity of a person
Nausea
Strong

One of the most important symptoms of enzyme deficiency is a change in stool. This disease is characterized by fatty stools with a very unpleasant and foul odor.

Diagnosis and treatment

In order to make an accurate diagnosis, the patient needs to undergo some tests. These include:

Blood sugar test
Analysis of urine
Stool analysis
Ultrasonography
Tomography

After all these tests have been taken and the procedures have been completed, the doctor will make an accurate diagnosis based on the results obtained. If the patient has been diagnosed with enzyme deficiency, then he will have to undergo treatment, which will consist of:

Prescriptions of a high-calorie diet
Prescription of medications that will help food digestion

The diet and medications are selected for each patient individually, taking into account his physiological characteristics, as well as the tolerability or intolerance of certain components in the prescribed medications.

Endocrine insufficiency

Endocrine insufficiency is also called intrasecretory. This function includes the production of hormones such as insulin, lipocaine, glucagon. Violation of this function can lead to irreparable consequences for the human body as a whole.

Causes

The main reason for the development of this deficiency is damage to those places that are responsible for the production of hormones. These places are also called the islets of Langerhans. If these places are damaged, then there is a high probability of developing diabetes.

Symptoms

Symptoms of endocrine insufficiency include:

Unpleasant smell of gases
Diarrhea. And the smell will be very foul
Increased number of bowel movements per day
Flatulence
Abnormalities in blood tests

Of course, these are not all the symptoms. Among the accompanying symptoms, one can highlight a person’s general malaise due to loss of fluid (it is lost during frequent bowel movements, when a person has diarrhea).

Diagnosis and treatment

Very often, the diagnosis can be made after collecting the entire medical history, that is, after a conversation with the patient. This happens because in other deficiencies, compared to this one, the symptoms are not as pronounced. But still, for an accurate diagnosis, a person will need to do:

After the attending physician receives all the results of the studies, he will be able to make an accurate diagnosis, based on which treatment will be prescribed. Treatment usually involves following a strict diet, the main goal of which will be to control blood sugar levels. If the diet does not help, then the person will be prescribed insulin therapy. If you follow all the doctor’s recommendations, you can completely return to a normal lifestyle. The main thing to remember is that a diet is necessary, and there should be no deviations from it.

Forecasts

Today, almost every third person suffers from some type of deficiency. Of course, everyone's degrees are different. Someone accidentally discovered this quite early and managed to prevent the situation from getting worse; someone did not know about it until the very last moment, until all the symptoms manifested themselves so strongly that it forced them to consult a specialist.

In any case, every patient can hope that his life will become easier if he follows all the doctors’ recommendations.

If a person follows the diet suggested to him and takes all the necessary enzyme replacement drugs, then in 80 percent of cases he manages to avoid further development of the disease and transition to a more severe stage.

Pancreatic insufficiency is a difficult ordeal for every person. In most cases, when a person completely gives up alcohol, fatty and spicy foods, and follows all the recommendations, his survival rate becomes much higher than if he continued to lead his previous lifestyle.

So, for example, if a person has developed pancreatic insufficiency, then if he completely gives up this bad habit (abandoning alcohol in general), he can live quite a long time and even be healthy. In any case, a person’s life is always in his hands. He has the power to both fix it and destroy it. The main thing to remember is that doctors are helpers, not enemies.