3.3　Clinical Symptoms of Pancreatic Exocrine Insuf...

3.3　Clinical Symptoms of Pancreatic Exocrine Insufficiency

Typical symptoms of pancreatic exocrine insufficiency are steatorrhoea，abdominal discomfort，malnutrition，weight loss and symptoms of vitamin deficiency（Andersen 2007）.Patients with steatorrhea typically report an increase in daily bowel movements，with fatty（“shiny”），bulky stools that are difficult to flush away（“sticky”）（HaPanEU 2016）.However，while it is important to evaluate the stool characteristics，they are neither sensitive nor specific for detection of steatorrhoea（Lankisch et al.1996；Dumasy et al.2004）.Verification of steatorrhoea conventionally requires measurement of stool fat excretion exceeding 7 g fat per day during ingestion of a standard diet（DiMagno et al.1973）.Often steatorrhoea is accompanied by diarrhoea.This is partly caused by accelerated gastric emptying and intestinal transit in patients with exocrineinsufficiency that can be reversed by enzyme supplementation（Layer et al.1997；Keller and Layer 2015）.It is self-evident that diagnosis of steatorrhea is not necessarily equivalent with diagnosis of chronic pancreatitis but may be due to a variety of other diseases including celiac disease and Crohn's disease.

Table 7.2　Clinical symptoms and signs of impaired absorption of lipid soluble vitamins in pancreatic exocrine insufficiency

Potential clinical symptoms and signs of micronutrient deficiencies due to impaired absorption of lipid soluble vitamins are detailed in Table 7.2.(https://www.daowen.com)

Further clinical consequences of pancreatic exocrine insufficiency can include hyperoxaluria，urinary oxalate stones，renal insufficiency，impairment of cognitive functioning and，thus，working ability（with resulting financial strain）and reduced overall quality of life（HaPanEU 2016）.

Absorption of fat-soluble vitamins can be impaired even in patients with mild to moderate exocrine insufficiency（Haaber et al.2000；Kalvaria et al.1986；Mann et al.2003a，b；Teichmann et al.2007）.Even after selective exclusion of patients with steatorrhea，exocrine insufficiency correlated with relelevant clinical consequences，i.e.osteoporotic fractures（Mann et al.2008）.Accordingly，not only severe pancreatic exocrine insufficiency but also mild to moderate forms appear to be of clinical relevance.