Secondary exocrine pancreatic insufficiency. Features of the choice of the enzyme

Exocrine pancreatic insufficiency is quite common in clinical practice of doctors of many specialties. Decrease in intraduodenal lipase levels below 5–10% of normal leads to pancreatic steatorrhea, weight loss and a potential decrease in quality of life. These clinical manifestations are more often presented in patients with a primary genesis of exocrine pancreatic insufficiency, while secondary exocrine insufficiency is more often subclinical, which predetermines its early diagnosis. However, many methods for diagnosing exocrine pancreatic insufficiency, which have been developed and used in clinical practice in recent years, have low sensitivity or specificity, or are time-consuming and poorly tolerated by patients. The method for determining the level of coprological elastase is not always reliable, especially in patients with chronic diarrhea, which predetermines its implementation in formalized stool, for example, during therapy. It is important to take into account the fact that with moderate exocrine pancreatic insufficiency, the sensitivity and specificity of assessing the level of fecal elastase can weaken by 30%. However, regardless of the receipt of diagnostic data and the cause of the development of exocrine pancreatic insufficiency, the goal of therapy is to eliminate the processes of maldigestion and malabsorption, reduce the severity of symptoms of indigestion and prevent their negative consequences. At the same time, it is necessary to include an enzyme preparation in the complex therapy, the choice of which, its dosage and duration of therapy are determined taking into account the individual characteristics of the patient and the severity of exocrine pancreatic insufficiency. In addition, in patients with suspected exocrine pancreatic insufficiency due to clinical manifestations, it is possible to use empirical enzyme replacement therapy. An example of such an approach for patients with secondary exocrine insufficiency is the appointment of the enzyme preparation containing pancreatin.