Pancreatic insufficiency

Last Review Date: March 6, 2017

What is it?

Pancreatic insufficiency is the inability of the pancreas to produce and/or transport enough digestive enzymes to break down food in the intestine and allow its absorption. It typically occurs as a result of chronic pancreatic damage - damage that may be caused by a variety of conditions. It is most frequently associated with cystic fibrosis in children and with chronic pancreatitis in adults; it is less frequently but sometimes associated with pancreatic cancer.

Pancreatic insufficiency usually presents with symptoms of malabsorption, malnutrition, vitamin deficiencies, and weight loss (or inability to gain weight in children) and is often associated with steatorrhoea (loose, fatty, foul-smelling stools). Diabetes also may be present in adults with pancreatic insufficiency.


  • Faecal pancreatic elastase - this is a protein-cleaving enzyme produced and secreted by the pancreas. It is resistant to degradation by other enzymes and so is excreted and can be measured in the stool. The amount of this enzyme is reduced in pancreatic insufficiency. 
  • Immunoreactive trypsin (IRT) - a serum test that detects obstruction of trypsinogen secretion into the intestine.This is the initial test used as part of a neonatal screen for detecting cystic fibrosis.
  • Faecal fat - the excretion of fat in the stools is increased in pancreatic insufficiency, but faecal fat is now rarely measured due to practical difficulties 
  • Faecal chymotrypsin - (an enzyme that digests protein): stool chymotrypsin is a screening test to determine whether sufficient amounts of this pancreatic enzyme are reaching the intestine. Not a common test.
In clinical practice, the diagnosis of pancreatic insufficiency is usually based on an assessment of the patient’s clinical state, self-report of bowel movements and weight loss in adults, or not gaining weight at the normal rate in children.

Non-laboratory tests

  • ERCP (endoscopic retrograde cholangiopancreatography): a flexible scope sometimes used to see and document damage to the pancreas
  • Secretin test (not widely available): a tube is positioned in the duodenum to collect pancreatic secretions stimulated by intravenous (IV) secretin
  • MRI/Ultrasound/CT scanning of the pancreas


Treatment involves dealing with the underlying condition, preventing further pancreatic damage, and managing the symptoms. Patients may be given oral pancreatic enzymes to aid digestion and vitamin supplements (especially fat-soluble vitamins A, D, E, and K).

Related pages

On this site
Tests: Trypsin, immunoreactive trypsin (IRT)
Conditions: Pancreatic diseases, pancreatic cancer, cystic fibrosis, diabetes

Elsewhere on the web
Merck Manuals Online Medical Library: Malabsorption Syndromes
Medscape Reference – Pancreatic Insufficiency