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Exocrine Pancreatic Insufficiency

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A malabsorption condition resulting from greater than 10% reduction in the secretion of pancreatic digestive enzymes (LIPASE; PROTEASES; and AMYLASE) by the EXOCRINE PANCREAS into the DUODENUM. This condition is often associated with CYSTIC FIBROSIS and with chronic PANCREATITIS.

Also Known As:

Exocrine Pancreatic Insufficiencies; Insufficiencies, Exocrine Pancreatic; Insufficiencies, Pancreatic; Insufficiency, Exocrine Pancreatic; Insufficiency, Pancreatic; Pancreatic Insufficiencies; Pancreatic Insufficiencies, Exocrine; Pancreatic Insufficiency, Exocrine; Pancreatic Insufficiency

Networked: 1009 relevant articles (41 outcomes, 78 trials/studies)

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Disease Context: Research Results

Digestive System Diseases: 46
- Pancreatic Diseases: 1085
  - Exocrine Pancreatic Insufficiency: 1009
    - Shwachman syndrome: 238

Related Diseases

1.	Cystic Fibrosis (Mucoviscidosis)
2.	Chronic Pancreatitis
3.	Steatorrhea
4.	Exocrine Pancreatic Insufficiency
5.	Pain (Aches)

Experts

1.	Schall, Joan I: 12 articles (08/2015 - 04/2005)
2.	Stallings, Virginia A: 11 articles (08/2015 - 04/2005)
3.	Zenker, Martin: 7 articles (10/2015 - 12/2005)
4.	Steiner, Jörg M: 7 articles (01/2015 - 09/2004)
5.	Borowitz, Drucy: 7 articles (04/2013 - 11/2005)
6.	Hardt, Philip D: 6 articles (11/2013 - 09/2003)
7.	Zemel, Babette S: 6 articles (11/2012 - 04/2005)
8.	Maqbool, Asim: 5 articles (06/2014 - 07/2006)
9.	Chang, Anne B: 5 articles (01/2014 - 01/2009)
10.	Sukalo, Maja: 4 articles (10/2015 - 01/2011)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Exocrine Pancreatic Insufficiency:

1.	Pancreatic Elastase (Elastase)IBA 11/01/2001 - "The detection of pancreatic elastase 1 in stool samples has become the noninvasive gold standard for the diagnosis of pancreatic insufficiency in humans. " 04/01/2013 - "Twenty-six of 29 infants with a fecal elastase value <50 μg/g at study entry had a fecal elastase value <200 μg/g (the accepted cutoff value for pancreatic insufficiency) on all measurements during the year; all 29 had a value <200 μg/g at the end of the study. " 10/01/2014 - "Fecal elastase is a noninvasive test for pancreatic insufficiency diagnosis. " 09/01/2013 - "Exocrine pancreatic insufficiency was confirmed by low levels of fecal elastase. " 01/01/2012 - "Faecal elastase has been demonstrated to be of use in the diagnosis of pancreatic insufficiency. "
2.	Secretin FDA Link 01/01/2007 - "The secretin-induced pancreatic T2 signal intensity changes are significantly reduced in patients with a mild exocrine pancreatic insufficiency as compared with healthy volunteers. " 10/01/2006 - "Data on magnetic resonance cholangiopancreatography with secretin stimulation (S-MRCP) for the assessment of exocrine pancreatic insufficiency (EPI) are limited. " 10/01/2006 - "Does secretin-stimulated MRCP predict exocrine pancreatic insufficiency?: A comparison with noninvasive exocrine pancreatic function tests." 03/01/2005 - "The duodenal mucosa in chronic pancreas patients with pancreatic insufficiency has a normal concentration of s-cells and, therefore, the production of secretin is preserved. " 10/01/2000 - "The accuracy of synthetic porcine secretin in diagnosing pancreatic insufficiency was 100% when compared with biologic porcine secretin. "
3.	EnzymesIBA 04/15/2005 - "To evaluate, in a prospective, randomized, open, comparative, three-way, crossover study, the effect of the administration schedule on the efficacy of oral pancreatic enzymes for the treatment of exocrine pancreatic insufficiency. " 12/01/2012 - "The present study investigated behavioral changes in exocrine pancreatic insufficiency (EPI) pigs when their feed was supplemented with pancreatic-like enzymes of microbial origin. " 08/01/2015 - "Exocrine pancreatic insufficiency (EPI) is a digestive disorder resulting from the insufficient secretion of enzymes from the pancreas. " 01/01/2014 - "There is also no evidence on the relative dosages of enzymes needed for people with different levels of severity of pancreatic insufficiency, optimum time to start treatment and variations based on differences in meals and meal sizes. " 07/01/2013 - "Exocrine pancreatic insufficiency (EPI) is a disease wherein pancreatic acinar cells fail to synthesize and secrete sufficient amounts of digestive enzymes for normal digestion of food. "
4.	Lipase (Acid Lipase)FDA Link 07/01/1994 - "Clinical studies indicate that as little as 10% of pancreatic secretory capacity is needed to ensure normal digestion; but we found previously that supplying lipase to the postcibal duodenum at > or = 10% of normal rates did not normalize fat absorption in pancreatic insufficiency. " 12/01/2010 - "Yarrowia lipolytica lipase has been assumed to be a good candidate for the treatment of fat malabsorption in patients with pancreatic insufficiency. " 12/01/2008 - "The MTG-BT estimates the hydrolysis of triacyl-glycerols by pancreatic lipase, and appears attractive for monitoring exogenous lipase requirements in patients with exocrine pancreatic insufficiency. " 01/01/2006 - "To determine serum lipase activities and pancreatic lipase immunoreactivity (PLI) concentrations in dogs with exocrine pancreatic insufficiency (EPI). " 01/01/2006 - "Serum lipase activities and pancreatic lipase immunoreactivity concentrations in dogs with exocrine pancreatic insufficiency."
5.	Chymotrypsin FDA Link 08/01/2005 - "To study fecal elastase-1 (E1F) and chymotrypsin (ChT) in stools for the diagnosis of pancreatic insufficiency in pediatric practice. " 10/01/2001 - "The aim of our study was to re-evaluate the sensitivity and specificity of elastase-1 and chymotrypsin in stool in the assessment of exocrine pancreatic insufficiency. " 01/01/1976 - "[Determination of fecal chymotrypsin as a screening test for exocrine pancreatic insufficiency: studies on the reliability of various methods]." 09/01/2004 - "For several years, indirect noninvasive tests of pancreatic insufficiency have been developed, such as fecal chymotrypsin (FChT) and fecal elastase-1 (FEL-1) measurements. " 11/01/1997 - "Pancreatic insufficiency was confirmed by the low level of faecal chymotrypsin found in 85% of cases. "
6.	Caerulein (Ceruletide)IBA 07/01/1995 - "The decrease of plasma amino acid levels in response to cerulein does not reflect pancreatic function and does not permit the diagnosis of pancreatic insufficiency." 07/01/1995 - "Cerulein-induced changes in plasma amino acid concentrations are not a valid test for pancreatic insufficiency." 01/01/1987 - "Cerulein induces hyperplasia of the pancreas in a rat model of chronic pancreatic insufficiency." 10/01/2001 - "Exocrine pancreatic insufficiency was graded, according to the results of the secretin-caerulein test, into mild, moderate and severe. " 10/01/1998 - "In coeliac disease it has been demonstrated that the indirect pancreatic function tests detect a greater percentage of subjects with exocrine pancreatic insufficiency than the secretin-caerulein test. "
7.	Cholecystokinin (Pancreozymin)IBA 06/01/1989 - "The present study was undertaken to examine the intestinal phase of cholecystokinin (CCK) secretion and gall bladder contraction in patients with severe pancreatic insufficiency. " 01/01/1997 - "A failure of cholecystokinin (CCK) release after a meal has been shown among patients with exocrine pancreatic insufficiency. " 06/01/1989 - "Effect of pancreatic enzyme supplementation on postprandial plasma cholecystokinin secretion in patients with pancreatic insufficiency." 12/01/1984 - "It has been claimed that plasma cholecystokinin (CCK) concentrations are raised in patients with pancreatic insufficiency. " 12/01/1984 - "Plasma cholecystokinin concentrations in patients with pancreatic insufficiency measured by sequence-specific radioimmunoassays."
8.	Pancrelipase (Creon)FDA Link 01/01/2009 - "The aim of the study was to evaluate efficiency of creon substitution therapy of severe primary pancreatic insufficiency in the 13C-breath test. " 11/01/1993 - "Comparative in vitro and in vivo studies of enteric-coated pancrelipase preparations for pancreatic insufficiency." 04/01/2011 - "Pancrelipase delayed-release capsules for the treatment of pancreatic insufficiency." 12/01/2010 - "CREON (Pancrelipase Delayed-Release Capsules) for the treatment of exocrine pancreatic insufficiency." 10/01/1997 - "Lack of dose-response with Pancrease MT for the treatment of exocrine pancreatic insufficiency in adults."
9.	PancreatinIBA 01/01/2002 - "[Use of Panzytrat in the replacement therapy of exocrine pancreatic insufficiency (an analytical review)]." 05/01/1997 - "After oroileal multilumen intubation for duodeno-jejuno-ileal sampling, marker perfusion, and motility recording, 14 normal subjects and 12 patients with severe pancreatic insufficiency received a labeled liquid meal twice, either with placebo or pancreatin. " 11/01/1990 - "The cholesteryl-14C-octanoate breath test was used to monitor the intraluminal enzymatic activity of pancreatin preparations in six patients with severe pancreatic insufficiency. " 12/01/1986 - "Since both regimens are equally potent in overcoming gastric acid-induced enzyme inactivation, it is concluded that therapy with acid-protected pancreatin may simplify and improve treatment of exocrine pancreatic insufficiency in the presence of gastric hyper- or normo-acidity." 07/01/1976 - "Forty-three patients had evidence of pancreatic insufficiency; in all but one patient the symptoms were mild and five patients abandoned dietary restriction and pancreatin without ill effect. "
10.	TrypsinIBA 12/01/2003 - "The serum trypsin-like immunoreactivity test remains the gold standard technique for the diagnosis of exocrine pancreatic insufficiency. " 04/01/2014 - "A diagnosis of exocrine pancreatic insufficiency (EPI) was made based on clinical signs and serum feline trypsin-like immunoreactivity (0.1 μg/l; RI: 12-82 μg/l). " 05/01/2011 - "Decreased serum trypsin-like immunoreactivity is a very sensitive and specific test for the diagnosis of exocrine pancreatic insufficiency in dogs and cats. " 03/01/2009 - "The dog was diagnosed with exocrine pancreatic insufficiency based on markedly decreased serum levels of trypsin-like immunoreactivity. " 03/01/2007 - "Among symptomatic dogs tested for exocrine pancreatic insufficiency (EPI) by canine trypsin-like immunoreactivity (cTLI) assay, EPI is common in certain breeds and rare in others. "

Therapies and Procedures

1.	Enzyme Replacement Therapy 01/01/2011 - "Pancreatic enzyme replacement therapy is currently the mainstay of treatment for nutrient malabsorption secondary to pancreatic insufficiency. " 12/01/2011 - "The standard measure of pancreatic enzyme replacement therapy (PERT) efficacy in treating exocrine pancreatic insufficiency (EPI) is the coefficient of fat absorption (CFA). " 11/01/2010 - "The efficacy of the treatment of exocrine pancreatic insufficiency is dependent on adequate meal-time enzyme replacement therapy. " 01/01/1993 - "Up to now, only few tests exist to judge the efficacy of enzyme replacement therapy in pancreatic insufficiency. " 11/01/2014 - "To clarify and to understand the potential for misinterpretation of change in fecal fat quantitation during pancreatic enzyme replacement therapy (PERT) trials for treatment of exocrine pancreatic insufficiency. "
2.	Microspheres (Microsphere) 12/01/1995 - "Recent scientific developments, as the characterization of an acid-stable bacterial lipase, the cloning of human acid-stable lipase, the transfection of human lipase genes by virus-mediated gene transfer as well as the development of very small acid-stable mini microspheres, present interesting new perspectives to further optimize the efficacy of the therapy of exocrine pancreatic insufficiency in the near future." 09/01/1993 - "Significant benefits in pancreatic insufficiency therapy have derived from the introduction of enteric coated microspheres which ensure a consistent level of enzymes to reach the duodenum mixed with the meal and which are resistant to gastric acid inactivation as well." 03/01/1981 - "In 23 adult patients with pancreatic insufficiency, we evaluated the efficacy of a pancreatic enzyme delivered as pH-sensitive enteric-coated pancreatic lipase microspheres, and compared it with placebo and other available enzyme supplements. " 07/01/1999 - "A double-blind, randomized, multicentre, crossover study to prove equivalence of pancreatin minimicrospheres versus microspheres in exocrine pancreatic insufficiency." 10/01/1996 - "For the treatment of exocrine pancreatic insufficiency conventional strength enteric-coated microsphere/microtablet pancreatin preparations do not have an optimal dissolution profile. "
3.	Decompression 01/01/1991 - "Long term results were excellent or improved in 93.4% what pain relief concern, but the progression of exocrine or endocrine pancreatic insufficiency indicates that decompression of the dilated pancreatic duct does not prevent continuing destruction of pancreatic glandular tissue. " 11/01/1983 - "Those results indicated that patients who had an internal decompression had lower mortality, less morbidity, less postoperative pancreatic insufficiency, and better relief of pain (88% vs 76% improved). " 11/01/1983 - "These preliminary results indicate that internal decompression in properly selected patients can provide superior relief of pain, with lower mortality, less morbidity, and less pancreatic insufficiency." 08/01/1980 - "This progression of exocrine or endorine pancreatic insufficiency indicates that decompression of the dilated pancreatic duct, although an effective means for relief of pain in chronic pancreatitis, does not prevent continuing destruction of pancreatic glandular tissue."
4.	Pancreaticoduodenectomy 10/01/1999 - "All 11 pancreatoduodenectomy patients have only mild pancreatic insufficiency relieved by daily enzyme replacement. " 07/01/2009 - "The aim of this study was to determine risk factors for exocrine pancreatic insufficiency after pancreatoduodenectomy (PD) with pancreaticogastrostomy (PG). " 07/01/2009 - "Predictive factors for exocrine pancreatic insufficiency after pancreatoduodenectomy with pancreaticogastrostomy." 01/01/2008 - "The majority of patients develop severe exocrine pancreatic insufficiency after pancreatoduodenectomy. " 07/01/1997 - "A comparative study was performed between patients with exocrine pancreatic insufficiency after conventional pancreatoduodenectomy (Whipple's procedure) and pylorus-preserving pancreatoduodenectomy (PPPD). "
5.	Enzyme Therapy 03/01/1983 - "Comparative evaluation of the therapeutic efficacy of a pH-sensitive enteric coated pancreatic enzyme preparation with conventional pancreatic enzyme therapy in the treatment of exocrine pancreatic insufficiency." 01/01/2006 - "[Modern principles of the diagnostics and enzyme therapy of exocrine pancreatic insufficiency]." 01/01/1994 - "Enzyme therapy for pancreatic insufficiency: present status and future needs." 02/01/1990 - "These children (median age, four years) had growth that was close to normal and comparable to growth in children with severe pancreatic insufficiency who received oral enzyme therapy. " 01/01/1989 - "Enzyme therapy for malabsorption in exocrine pancreatic insufficiency."