Pancreatic insufficiency is a condition in which the pancreas is not able to produce and/or transport enough digestive enzymes to break down food in the intestine. This condition is also known as exocrine pancreatic insufficiency or EPI.
The pancreas is a narrow, flat gland about six inches long located deep in your abdominal cavity, behind the stomach and below the liver. It has head, middle, and tail sections. Its head section connects to the first part of the small intestine (duodenum).
- Inside the pancreas, small ducts (tubes) feed digestive enzymes and bicarbonate produced by the pancreas into the pancreatic duct. This large duct carries the digestive enzymes and bicarbonate down the length of the pancreas, from the tail to the head section, and into the duodenum.
- The common bile duct also runs through the head section of the pancreas, carrying bile from the liver and gallbladder into the small intestine.
- The bile duct and pancreatic duct usually join just before entering the duodenum and share a common opening into the small intestine.
The pancreas consists of two kinds of tissues that perform different functions:
- The exocrine pancreas makes, stores and releases powerful enzymes to digest fats, proteins, and carbohydrates in the small intestine. The enzymes normally are produced and carried in an inactive form to the small intestine, where the enzymes are activated as needed. Exocrine tissues also make and release bicarbonate that neutralizes stomach acids and allows for the activation of pancreatic enzymes.
- The endocrine pancreas produces hormones, including insulin and glucagon, and releases them into the blood. These hormones regulate sugar (glucose) transport into the body's cells, where it is used for energy and to help maintain normal blood sugar levels.
In adults, pancreatic insufficiency typically occurs as a result of ongoing (progressive) pancreatic damage that may be caused by repeated bouts of acute pancreatitis or by chronic pancreatitis due to a variety of conditions.
In children, it is most frequently associated with cystic fibrosis (CF) or Shwachman-Diamond Syndrome (SDS). SDS is the second most common cause of inherited pancreatic insufficiency, after CF. All those with SDS have some degree of pancreatic insufficiency that begins when they are infants.
People with the following conditions may also develop EPI:
- Crohn disease
- Celiac disease
- Pancreatic Cancer
- Autoimmune pancreatitis (immunoglobulin G4-related disease)
Zollinger-Ellison syndrome is a rare condition caused by a tumor of the pancreas that stimulates the cells of the stomach to release excess acid. This excess acid may cause temporary pancreatic insufficiency. Once the excess acid is treated, the pancreatic insufficiency usually goes away.
Some surgical procedures that affect the function of the digestive tract or the pancreas can lead to EPI.