Exocrine pancreas insufficiency: clinical significance and approaches to correction from evidence medicine

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Abstract

Exocrine pancreatic insufficiency (EPI) is a common complication of both benign and malignant diseases of the pancreas, as well as a consequence of radical surgical operations on the pancreas and a whole range of other variable extra-pancreatic causes. In clinical practice in the adult population, most cases of EPI are associated with chronic pancreatitis, while in the pediatric population – with cystic fibrosis. The regression of the production of digestive enzymes in EPI mediates the development of the syndrome of maldigestion and malabsorption, leading to the progressive development of malnutrition, the importance of which is often underestimated by practitioners. At the same time, the development of nutritional deficiency is not just a complication of EPI, but also has an important effect on the course of the underlying causative disease, worsening the prognosis and quality of life of the patient, and is also a proven risk factor for osteoporosis and sarcopenia. To date, compensation for the absolute deficiency of pancreatic enzymes using enzyme replacement therapy is the only possible way to correct the EPI and prevent nutritional deficiency.

About the authors

Igor V. Maev

Yevdokimov Moscow State University of Medicine and Dentistry

Email: dna-mit8@mail.ru
ORCID iD: 0000-0001-6114-564X

акад. РАН, д.м.н., проф., зав. каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова», засл. врач РФ, засл. деят. науки РФ

Russian Federation, Moscow

Yury A. Kucheryavyy

Ilyinskaya Hospital

Email: dna-mit8@mail.ru
ORCID iD: 0000-0001-7760-2091

к.м.н., доц., зав. гастроэнтерологическим отд-нием

Russian Federation, Krasnogorsk, village Glukhovo

Dmitry N. Andreev

Yevdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: dna-mit8@mail.ru
ORCID iD: 0000-0002-4007-7112

к.м.н., доц. каф. пропедевтики внутренних болезней и гастроэнтерологии

Russian Federation, Moscow

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2. Fig. 1. Particle size (μm) of pancreatin capsule preparations available in Russia / CIS, expressed in Ferret max × 50. The solid line at 2000 level represents the largest particle size recommended by HaPanEU, 2017 [57]

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3. Fig. 2. Lipase activity of different drugs [57]

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