Digestive weakness of the pancreas

(exocrine pancreatic insufficiency)

The pancreas produces more than 20 enzymes that help digest the components of our food. At the same time it produces the antagonistic hormones insulin and glucagon, which together regulate blood sugar levels.

While insulin and glucagon are produced in the islets of Langerhans and from there released directly into the blood, the enzymes are secreted in a highly alkaline fluid (pH 8.3 to 9.0) through a special pancreatic duct into the duodenum. Together with the bile duct, the pancreatic duct empties into the duodenum. Only here in particular the protein-digesting enzymes are activated. Otherwise the pancreas would digest itself.  
In the absence of enzymes the body can no longer completely absorb the nutrients. They reach the lower intestine in largely undigested form, where bacteria normally encounter only so-called dietary fibre. If now abundant nutrients are thus provided for this bacterial flora, flatulence and abdominal cramps will result. The bacteria can proliferate and spread into areas of the intestine (overgrowth syndrome) in which they are normally not to be found.

However, diarrhoea with steady weight loss may also result. This likewise has the consequence that the intestinal flora changes and the intestinal mucosa shows atrophied villi. Poor digestion of fat may lead to fatty stools.

In protracted pancreatic hypofunction there is a shortage of essential vitamins – especially of the fat-soluble ones, such as vitamin A (night blindness), vitamin D (bone metabolism), Vitamin E (skin), vitamin K (coagulation disorders) – leading to other complaints (malabsorption). Trace elements such as zinc cannot be sufficiently absorbed anymore.

The causes of pancreatic hypofunction are very diverse.
Often an acute pancreatic inflammation has preceded, brought about e.g. by a biliary tract condition, which obstructs the outflow of pancreatic fluid. Viral infections can also cause acute inflammation.

The course of chronic pancreatitis is mostly gradual, and here excessive consumption of alcohol is the most common cause. Much more rarely, the inflammation is caused by medications or diseases such as cystic fibrosis.

A tumour may limit the function of the pancreas, and unfortunately surgery may too.

But there are far more subtle reasons why enzyme production of the pancreas may not work suffi-ciently, e.g. insufficiency of gastric secretion: the highly acidic chyme from the stomach enters the duodenum where it triggers enzyme release from the pancreas. If, however, the chyme is only slightly acidic, only low amounts of enzyme are released.

Finally, with increasing age production of digestive enzymes decreases.