Exocrine pancreatic insufficiency (EPI), an important cause of maldigestion and malnutrition, results from primary pancreatic disease or is secondary to impaired exocrine pancreatic function. Although chronic pancreatitis is the most common cause of EPI, several additional causes exist. These include pancreatic tumors, pancreatic resection procedures, and cystic fibrosis. Other diseases and conditions, such as diabetes mellitus, celiac disease, inflammatory bowel disease, and advanced patient age, have also been shown to be associated with EPI, but the exact etiology of EPI has not been clearly elucidated in these cases. The causes of EPI can be divided into loss of pancreatic parenchyma, inhibition or inactivation of pancreatic secretion, and postcibal pancreatic asynchrony. Pancreatic enzyme replacement therapy (PERT) is indicated for the conditions described above presenting with clinically clear steatorrhea, weight loss, or symptoms related to maldigestion and malabsorption. This review summarizes the current literature concerning those etiologies of EPI less common than chronic pancreatitis, the pathophysiology of the mechanisms of EPI associated with each diagnosis, and treatment recommendations.

Central European Institute of Technology Masaryk University 62500 Brno Czech Republic

Department of Gastroenterology and Digestive Endoscopy Masaryk Memorial Cancer Institute Brno 60200 Brno Czech Republic

Department of Gastroenterology and Internal Medicine University Hospital Brno Faculty of Medicine Masaryk University 62500 Brno Czech Republic

Department of Gastroenterology and Internal Medicine University Hospital Ostrava Faculty of Medicine University of Ostrava 70852 Ostrava Czech Republic

Department of Hematology Oncology and Internal Medicine University Hospital Brno Faculty of Medicine Masaryk University 62500 Brno Czech Republic

Department of Internal Medicine Hospital Boskovice 68001 Boskovice Czech Republic

Department of Pediatrics University Hospital Brno Faculty of Medicine Masaryk University 61300 Brno Czech Republic

Department of Surgery University Hospital Brno Faculty of Medicine Masaryk University 62500 Brno Czech Republic

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