Exocrine pancreatic insufficiency (EPI) exists when pancreatic enzyme activity within the lumen of the small intestine is less than needed for normal digestion of nutrients. Although pancreatic enzymes are involved in protein, carbohydrate, and lipid digestion, enzyme insufficiency primarily affects lipid digestion. Steatorrhea, defined as excess fat in the stool, develops from an inability to absorb fat adequately, with resulting weight loss or failure to thrive, often accompanied by fat-soluble vitamin deficiencies.

The pancreas is formed from the fusion of dorsal and ventral foregut outgrowths. The main pancreatic duct empties, along with the common bile duct, into the duodenum at the ampulla of Vater. Secretion of the pancreatic digestive enzymes is stimulated in response to luminal nutrients by the small intestinal peptide hormones cholecystokinin (CCK), produced from I-cells, and secretin, produced from S-cells. CCK stimulates the release of the pancreatic enzymes in inactive form from the pancreatic acinar cells into...

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