Lipase
breaks down fats into free fatty acids and glycerol
The pancreas and EPI
The role of the exocrine pancreas2-4
The exocrine pancreas produces 3 main types of enzymes, which begin to digest macronutrients in the duodenum.
Protease
breaks down proteins into amino acids
Amylase
breaks down carbohydrates into monosaccharides and disaccharides
Normal pancreatic enzyme secretion
Under normal physiological conditions, the pancreas secretes anywhere from 480,000 to 960,000 lipase units per meal—with an average of about 720,000. Steatorrhea* is observed when pancreatic enzyme output drops below ~10% of the normal range.5,6
*Steatorrhea: ≥7 g of fecal fat per day while consuming 100 g of dietary fat per day in the context of a 72-hour stool test.2
EPI (exocrine pancreatic insufficiency) is a condition caused by inadequate production, delivery, or activity of pancreatic enzymes needed for normal digestion.7,8
The consequences of EPI
When the exocrine function of the pancreas is compromised, it can result in maldigestion and malabsorption, which can lead to malnutrition.
- Maldigestion—the inability of the small intestine to properly digest fats, proteins, and carbohydrates, which may lead to malabsorption3,8,9
- Malabsorption—the failure of the small intestine to achieve maximal absorption of essential vitamins and nutrients, especially the fat-soluble vitamins A, D, E, and K3,9-11
- Malnutrition—a result of maldigestion and malabsorption, which can lead to a variety of consequences, like vitamin deficiencies and unintended weight loss9,11,12
Patients with EPI may present with signs and symptoms similar to those of other GI disorders, so it’s important to assess specific clinical features.3