MALDIGESTION ASSOCIATED WITH EXOCRINE PANCREATIC INSUFFICIENCY - IMPLICATIONS OF GASTROINTESTINAL PHYSIOLOGY AND PROPERTIES OF ENZYME PREPARATIONS FOR A CAUSE-RELATED AND PATIENT TAILORED TREATMENT

Clinical conditions in which secondary maldigestion associated with ex ocrine pancreatic insufficiency occur include chronic pancreatitis, cy stic fibrosis, pancreatic cancer, partial or total gastrectomy, and pa ncreatic resection, Maldigestion can cause serious weight loss, nutrit ional deficiencies, and subjective complaints associated with steatorr hea, The various causes of exocrine pancreatic insufficiency may be as sociated with cause-related changes in gastrointestinal physiology, su ch as changes in gastrointestinal intraluminal pH, bile acid metabolis m, gastric emptying, and intestinal motility. Therefore, to optimize t he efficacy of treatment, the management of exocrine pancreatic insuff iciency must be individually tailored to account for both the underlyi ng cause and any associated disturbance in gastrointestinal physiology , In addition, the properties of the pancreatic enzyme preparations an d adjuvant drugs need to be taken into consideration, This paper revie ws the pathophysiological mechanisms of maldigestion in exocrine pancr eatic insufficiency, discusses the efficacy of different therapy regim ens, and gives guidelines for a cause-related and patient-tailored tre atment with respect to both drug therapy and dietary counselling.