Why are there not enough enzymes?
The pancreas secretes juice containing lipase, amylase and proteases into the duodenum. Lipase is the most vulnerable: it is destroyed first, so fat digestion is the first to suffer. Deficiency occurs through three mechanisms. The first is the death of the working tissue of the gland during chronic inflammation or after removal of part of it. The second is a mechanical obstacle to the outflow of juice: a stone, a narrowing of the duct, a tumor. The third is a mismatch: enzymes are released, but do not meet food in time, which happens after gastric surgery.
- Chronic pancreatitis of any origin
- Previous severe acute pancreatitis
- Surgeries on the pancreas and stomach
- Tumor of the head of the gland or duct
- Cystic fibrosis
- Celiac disease and Crohn's disease
- Long-term diabetes mellitus
Symptoms
Complaints appear when lipase production drops significantly, so the early stage is easy to miss. The most characteristic symptom is steatorrhea: voluminous, soft, light and shiny stool with a pungent odor, leaving a greasy residue. Bloating, rumbling and discomfort after eating, especially fatty foods, are often bothersome. A person begins to intuitively avoid fats and eat less, which accelerates weight loss. Over time, signs of vitamin deficiency appear: dry skin, brittle nails, deterioration of twilight vision, bone pain, and a tendency to bruise.
- Copious, greasy, shiny stools
- Bloating and rumbling after eating
- Heaviness and discomfort in the abdomen
- Weight loss while maintaining appetite
- Weakness and fatigue
- Dry skin, brittle nails and hair
- Bone pain, decreased bone density
- Deterioration of vision at dusk
What examinations are needed
The key test is the determination of pancreatic elastase in the stool: it is simple, does not require enzyme withdrawal and well reflects the function of the gland. It is complemented by a coprogram, where drops of neutral fat and undigested muscle fibers are visible. Blood amylase and lipase levels are not useful for assessing function: they indicate inflammation, not enzyme storage. Be sure to look for the cause: do an ultrasound, if necessary, CT or MRI with assessment of the duct. Nutritional status is also checked: vitamin D, iron, albumin, glucose.
- Pancreatic fecal elastase
- Coprogram with assessment of neutral fat
- Ultrasound of the pancreas and abdominal cavity
- CT or MRI of the gland for an unknown reason
- Blood glucose and glycated hemoglobin
- Vitamin D, iron, ferritin, albumin
- Tests for celiac disease if suspected
- Long-term densitometry
Enzyme therapy
The basis of treatment is pancreatic enzyme replacement therapy in capsules with minimicrospheres coated with an acid-resistant shell. It is important not only the purpose, but also the technique of administration: the capsules are taken with food, distributing the dose at the beginning and middle of the meal, and not before or after. The dose is calculated based on lipase content and adjusted based on stool and weight. If there is no effect, the doctor checks the correct intake, increases the dose or adds a drug that reduces acidity. There is no need to starve and remove fats from the diet - on the contrary, nutrition should be complete.
- Enzymes in capsules with acid-resistant mini-microspheres
- Take with meals, the dose is distributed throughout the meal
- Smaller dose for snacks
- Evaluation of the effect by stool, weight and well-being
- Proton pump inhibitors for insufficient response
- Do not chew the contents of the capsules
- Dose adjustment is carried out by a doctor
Nutrition and prevention of complications
A nutritious diet with enough protein and calories is more important than any restrictions. It is recommended to eat more often and in smaller portions, not to give up fats completely, since they are needed for the absorption of vitamins, and be sure to avoid alcohol and smoking - they accelerate the destruction of the gland. Monitor the level of vitamin D, iron and bone density, and if there is a deficiency, the doctor will prescribe supplements. If diabetes associated with pancreatic disease has developed, it is treated taking into account the risk of low sugar, usually in conjunction with an endocrinologist.
- Small meals 5–6 times a day
- Adequate calories and protein
- Do not eliminate fats completely, distribute them among meals
- Complete cessation of alcohol and smoking
- Control and replenishment of vitamins A, D, E and K
- Bone Density Monitoring
- Glucose control and observation by an endocrinologist for diabetes