Case report of exocrine pancreatic insufficiency in two palliative care patients

Background: This case report describes two patients with advanced disease who were found to have exocrine pancreatic insufficiency. There have been no prior case reports of exocrine pancreatic insufficiency in patients with advanced malignant disease in the palliative care setting. The instigation of diagnostic tests for exocrine pancreatic insufficiency might be delayed or omitted in light of the plausible explanations for symptoms of gastrointestinal disturbance in patients with progressive life-limiting illness, making clinical vigilance about this condition important, since the identification and treatment of exocrine pancreatic insufficiency could improve quality of life.

Case presentation: Both patients were admitted to the hospice with symptoms of gastrointestinal upset and weight loss. Once medications and dietary manipulation had failed to improve symptoms significantly, more detailed investigations resulted in diagnoses of exocrine pancreatic insufficiency.

Case management: Pancreatic enzyme replacement therapy was commenced.

Case outcome: Improvement in symptoms for both patients facilitated nursing care in the final stages of life.

Conclusions: Identification of exocrine pancreatic insufficiency and the instigation of pancreatic enzyme replacement therapy can, even in the late stages of illness, contribute significantly to symptom control of gastrointestinal disturbance and may allow patients to be cared for in their preferred environment.