AGA-PancreasFest Joint Symposium on Exocrine Pancreatic Insufficiency

Whitcomb, David C.; Duggan, Sinead; Martindale, Robert G.; Lowe, Mark E.; Stallings, Virginia A.; Conwell, Darwin L.; Barkin, Jodie A.; Papachristou, Georgios I.; Husain, Sohail Z.; Forsmark, Christopher E.; Kaul, Vivek

doi:10.1016/j.gastha.2022.11.008

Cited by 7 publications

(13 citation statements)

References 112 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 However, multiple studies since then have shown inconsistencies with this initial assertion, including a German study from 1986 in which patients with severe EPI (lipase <10%) were found to have normal fat excretion whereas other patients with moderate disease had steatorrhea. 7 Regardless of the severity of EPI, reduction of pancreatic enzyme secretion in an individual can result in malabsorption of nutrients, which subsequently requires intervention to restore effective nutrient digestion and absorption. There are a multitude of etiologies of EPI that can result via inadequate synthesis and secretion of pancreatic enzymes, decreased pancreatic stimulation, pancreatic ductal obstruction, and decreased pancreatic enzyme activity in the small bowel.…”

Section: Defects In Lipolysismentioning

confidence: 99%

“…In general, the routine supplementation of vitamins without known deficiencies is not indicated because of the risk of hypervitaminosis, which can occur in patients with chronic pancreatitis. 7 As discussed, fat digestion and absorption are crucial processes for generating energy and nutrition for the body. Defects in luminal processing, absorption into the intestinal mucosa, and transport into the circulation can lead to a multitude of malabsorptive conditions.…”

Section: Clinical Diagnosis and Managementmentioning

confidence: 99%

“…Initially, EPI was thought to occur after >90% of pancreatic exocrine function is lost, as noted in a frequently cited study conducted in 1973 6 . However, multiple studies since then have shown inconsistencies with this initial assertion, including a German study from 1986 in which patients with severe EPI (lipase <10%) were found to have normal fat excretion whereas other patients with moderate disease had steatorrhea 7 . Regardless of the severity of EPI, reduction of pancreatic enzyme secretion in an individual can result in malabsorption of nutrients, which subsequently requires intervention to restore effective nutrient digestion and absorption.…”

Section: Defects In Lipolysismentioning

confidence: 99%

“…Additionally, patients after bariatric surgical intervention can develop EPI, likely in the setting of inadequate stimulation of pancreatic enzymes or alteration in anatomy distorting the overall synchronization of the digestive process. Bariatric interventions that involve loss of pylorus commonly lead to EPI because of the development of dumping syndrome and motility changes that result in asynchronous delivery of meal to the upper intestine and pancreatic enzymes 9 …”

Section: Defects In Lipolysismentioning

confidence: 99%

“…Patients may also note abdominal pain, bloating, and unintentional weight loss. EPI should be suspected in patients with high‐risk clinical conditions, such as chronic pancreatitis, pancreatic adenocarcinoma, cystic fibrosis, or prior pancreatic surgical intervention, who are presenting with chronic diarrhea or nutrition deficiencies 9 . In patients without any underlying pancreatic disease, many other diseases of the GI tract may overlap or mimic EPI and should be considered in a differential of diagnoses.…”

Section: Clinical Diagnosis and Managementmentioning

confidence: 99%

See 4 more Smart Citations

Fat digestion and absorption: Normal physiology and pathophysiology of malabsorption, including diagnostic testing

Omer,

Chiodi

2024

Nut in Clin Prac

View full text Add to dashboard Cite

Fat digestion and absorption play crucial roles in maintaining energy homeostasis and supporting essential physiological functions. The initial stage of fat digestion occurs in the stomach, where gastric lipase begins the hydrolysis of triglycerides. However, most fat digestion takes place in the small intestine via pancreatic enzymes and bile salts. Emulsification of fat by bile acids facilitates enzymatic action, breaking down triglycerides into free fatty acids and monoglycerides, which are then able to be absorbed by enterocytes. Fat malabsorption can result from various underlying conditions, such as exocrine pancreatic insufficiency, bile acid disorders, or intestinal diseases. The clinical manifestations of fat malabsorption include steatorrhea, malnutrition, and deficiencies of fat‐soluble vitamins. Diagnostic approaches involve assessing fecal fat levels, imaging studies, and various functional tests to identify the specific etiology. This review article will describe the normal physiologic process of fat digestion and absorption and discuss various pathophysiology that can lead to fat malabsorption within the gastrointestinal tract as well as their respective diagnostic testing modalities. Effective digestion of fat is essential for overall health, because it allows for absorption of many essential nutrients, plays an integral role in cellular and structural function, and supplies energy to the body. When this is dysfunctional, disorders of malabsorption can occur. This article will give a brief overview of the physiologic process of fat digestion and absorption in healthy individuals as well as review important pathophysiology that can lead to fat malabsorption within the gastrointestinal tract and current diagnostic testing modalities.

show abstract

Section: Defects In Lipolysismentioning

confidence: 99%

Section: Clinical Diagnosis and Managementmentioning

confidence: 99%