What Are the Symptoms of Pancreatic Enzyme Deficiency?

What Is Pancreatic Enzyme Deficiency?

Pancreatic enzyme deficiency occurs when the pancreas does not produce enough digestive enzymes. Normally, the pancreas secretes enzymes such as lipase, amylase, and protease that break down proteins, fats, and carbohydrates in food. These enzymes facilitate the absorption of nutrients in the small intestine.

However, in some cases, the production of these enzymes either completely stops or is significantly reduced. This condition is called exocrine pancreatic insufficiency (EPI). Insufficient enzyme secretion leads to improper digestion of food and can cause serious nutritional deficiencies.

What Causes Pancreatic Enzyme Deficiency?

The most common causes of pancreatic enzyme deficiency include chronic pancreatitis, cystic fibrosis, and pancreatic cancer. Chronic pancreatitis results in long-term inflammation of the pancreas tissue, leading to loss of function. Cystic fibrosis is a genetic disorder that causes mucus buildup in the pancreatic ducts, preventing enzymes from reaching the intestines.

Surgical removal of part of the pancreas or autoimmune diseases that impair the pancreas's exocrine function can also cause enzyme deficiency. Less common causes include Shwachman-Diamond syndrome, celiac disease, and advanced type 1 diabetes.

What Are the Symptoms of Pancreatic Enzyme Deficiency?

Pancreatic enzyme deficiency usually presents with digestive symptoms. The most common symptom is fatty, foul-smelling stools (steatorrhea),caused by the inability to absorb fats properly, resulting in fat accumulation in the stool. Other frequent symptoms include weight loss, bloating, gas, abdominal pain, and diarrhea.

In the long term, the absorption of fat-soluble vitamins A, D, E, and K is impaired, leading to symptoms of vitamin deficiencies. For example, vitamin D deficiency affects bone health, while vitamin A deficiency can cause night blindness. In children, growth retardation can be an important sign.

Common Symptoms of Pancreatic Enzyme Deficiency

• Fatty, pale-colored, and foul-smelling stools (steatorrhea)
• Chronic diarrhea
• Abdominal bloating and discomfort
• Excessive gas and belching
• Weight loss (despite adequate nutrition)
• Loss of appetite
• Fatigue and weakness
• Symptoms related to fat-soluble vitamin deficiencies (e.g., night blindness, bone pain, dry skin)
• Abdominal pain (especially after meals)
• Muscle loss
• Growth and developmental delay (in children)
• Brittle nails, hair loss (due to malabsorption)
• Weakened immune system, frequent infections
• Burning sensation in the mouth, tongue sensitivity (especially with vitamin B12 and folate deficiency)

What Does Pancreatic Enzyme Deficiency Cause?

If left untreated, pancreatic enzyme deficiency leads to severe nutritional deficiencies. Since fats, proteins, and carbohydrates cannot be properly digested, the body cannot obtain enough of these essential nutrients. This results in an energy deficit and muscle wasting. At the same time, the immune system weakens, increasing susceptibility to infections.

Vitamin deficiencies can cause a wide range of health problems, from neurological issues to anemia. Long-term deficiency can negatively affect both physical and mental development in children. Untreated pancreatic enzyme deficiency significantly reduces quality of life.

What Should Be Done in Pancreatic Enzyme Deficiency?

Once diagnosed, the primary goal of treatment is to replace the missing pancreatic enzymes. For this purpose, patients are given pancreatic enzyme replacement therapy (PERT). This treatment involves taking capsules containing lipase, amylase, and protease with meals. The externally supplied enzymes help digest food properly. Additionally, replacement of any identified vitamin and mineral deficiencies is important.

Dietary support and avoiding high-fat foods can also help control symptoms. Treatment of underlying chronic causes (for example, alcohol restriction in chronic pancreatitis) should definitely be considered. Treatment is usually long-term and requires adaptation to the patient’s lifestyle.