I confess I do not know much about pancreatic insufficiency or to give it its full title exocrine pancreatic insufficiency (EPI). However, according to this article I, like other oesophagectomy patients, could already have an element of this as soon as 3 months after surgery or could be at risk in the future. It is not confined to oesophagectomy patients, anyone who undergoes any surgery or disruption to the GI tract is potentially at risk.
The reason it occurs is because the lovely balance of the GI tract, as described at the beginning of the previous post on nutrition, is mightily disrupted by surgery. It causes a reduction in the levels of enzymes produced by the pancreas. This results in food not being broken down properly and the full dose of nutrients does not get absorbed by the small intestine. In particular the absorption of fat and fat soluable vitamins suffer and results in a charming thing called steatorrhea – fatty stools.
It does not take a genius to work out that if you do not absorb fat you will lose weight and loss of vitamins like A, D, E and K is not an insignificant knock to an already compromised physiology.
Testing for EPI from what I gather is in the form of stool and blood samples.
If your levels are found wanting, you can be offered pancreatic enzyme replacement therapy (PERT). Sounds amazing but it is simply taking additional enzymes with meals to support your pancreatic function. CREON seems to be the drug of choice in the UK and this is only available on prescription. The Creon website describes in delightful detail the other symptoms of EPI so enjoy.
Over the counter digestive enzymes
What I do not know is whether over the counter digestive enzymes do the same thing as Creon. They will almost certainly need to be enteric coated. I will do some digging online.