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Initiating Pancreatic Enzyme Replacement Therapy (PERT) — Acquired Pancreatic Insufficiency (API) — Clinical Pathway: All Settings

Clinical Pathway for Pancreatic Enzyme Replacement Therapy (PERT) in Children with or at Risk for Exocrine Pancreatic Insufficiency (EPI)

Acquired Pancreatic Insufficiency (API)

Patients with previously normal exocrine function may lose function secondary to another process. Some of these are detailed in the table below.

Common Secondary Causes of API Clinical Presentation/Disease Process
Pancreatectomy
  • Trauma
  • Hyperinsulinism
  • Malignancy
  • Luminal resection (esophagectomy, gastrectomy, enterectomy)
Inflammatory Destruction of Pancreatic Acini
  • Chronic pancreatitis
  • Acquired idiopathic pancreatitis (AIP)
Inactivation/Loss of Digestive Enzymes
  • Zollinger-Ellison syndrome
  • Inflammatory bowel disease (IBD)
  • Celiac disease
Malignancy
  • Malignancies in the pancreatic parenchyma
    • (primary pancreatic cancers, metastases, lymphomas)
  • Chemotherapy
  • Bone marrow transplant
Atrophy
  • Diabetes mellitus (Types 1, 2, and 3c)

 

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