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Pancreatic insufficiency, also known as pancreatic exocrine insufficiency (PEI), is a condition where the pancreas does not produce or secrete enough digestive enzymes to adequately break down food. These enzymes, primarily lipase, amylase, and proteases, are crucial for digesting fats, carbohydrates, and proteins, respectively. Without sufficient enzymes, nutrients are not properly absorbed, leading to various digestive symptoms.

The most common cause of pancreatic insufficiency is chronic pancreatitis, an inflammation of the pancreas that leads to irreversible damage. Cystic fibrosis, a genetic disorder affecting multiple organs, can also cause PEI due to blockages in the pancreatic ducts. Pancreatic surgery, particularly pancreatectomy, and pancreatic cancer can also lead to impaired pancreatic function. Less common causes include autoimmune pancreatitis and certain medications.

Symptoms of pancreatic insufficiency often include steatorrhea, characterized by greasy, foul-smelling, bulky stools due to undigested fat. Other symptoms can include bloating, abdominal pain, gas, unintended weight loss, and deficiencies in fat-soluble vitamins (A, D, E, and K). In children, PEI can impair growth and development.

Diagnosis typically involves assessing fecal elastase levels, a substance produced by the pancreas that is excreted in stool. Blood tests may also be used to evaluate pancreatic function and identify underlying causes. Imaging studies like CT scans or MRI can help visualize pancreatic damage.

Treatment focuses on enzyme replacement therapy (PERT), where patients take oral pancreatic enzyme supplements with meals to aid digestion. Dietary modifications, such as reducing fat intake and ensuring adequate caloric and nutrient intake, are also important. Management of the underlying cause, such as treating chronic pancreatitis or cystic fibrosis, is also essential.