The problem of the exocrine pancreatic insufficiency in patients having a pancreatic resection Exocrine pancreatic insufficiency caused by pancreatic resection results from various factors which regulate digestion and absorption of nutrients. However, many aspects of secretion and gastrointestinal adaptation after pancreatic resection are not completely understood. In this paper we will review the current knowledge on these pancreatic pathophysiology aspects and we will also revise the current

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... odalities of treatment regarding pancreatic exocrine insufficiency following pancreatic resection. Physiology of the exocrine pancreatic secretion The pancreatic gland normally secretes more than 2 liters of juice per day which is constituted of water, bicarbonates and enzymes [1]; protein secretion per gram of pancreatic tissue is more elevated than that of any other organ [2] and more than 85% of the protein content is constituted of enzymes which are able to digest fats, proteins and glucides [3] . The pancreas normally produces more enzymes than are necessary for food digestion [1] and normal digestion is guaranteed up to a loss of 95% of pancreatic secretive capacity [4] . It has been also demonstrated that gastric lipase can compensate pancreatic lipase even if it is not capable of complete lipolytic activity [5] . Enzyme degradation in the intestinal lumen is the main factor for controlling nutrient absorption. The activity of pancreatic enzymes progressively decreases during their progression in the intestinal lumen: sixty percent of active trypsin and chymotrypsin are present in the jejunum whereas only 20 % are present in the ileum; amylases and lipases are more stable during their passage in the intestinal tract [6-8.].