Pancreatic exocrine insufficiency

Pancreatic exocrine insufficiency refers to a reduced ability of the pancreas to produce digestive enzymes, resulting in malnutrition. The pancreas has two main functions:

  • Digestion of food.
  • Control of blood glucose levels by the secretion of hormones (insulin and glucagon).

When the function of the pancreas to digest food is disturbed, there can be maldigestion and malabsoprtion of food, particularly fats. Manifestations include malnutrition and greasy, loose stools. The main causes of pancreatic exocrine insufficiency (PEI) are:

  • Inadequate production of pancreatic juice and enzymes e.g. chronic pancreatitis.
  • Structural abnormailities of the pancreatic duct system preventing delivery of pancreatic juice to the gut.
  • Surgical procedures which disrupt the normal mixing of pancreatic juice and food.


Diagnosis involves demonstration of malnutrition (loss of weight and/or nutrient deficiencies) combined with low pancreatic enzyme levels in the stools. There may or may not be abnormalities on imaging of the pancreas structure. A cause for the pancreatic insufficiency should be sought.


The condition is treated primarily with pancreatic enzyme replacement therapy. Adequate doses of enzyme replacement should be administered to achieve the desired response. In addition, measures should be taken to ensure adequate nutritional intake. Consultation with a dietician is recommended. It is also important to address the underlying cause of the PEI, if possible.