When a patient receives surgery and treatment to remove oesophageal or gastric cancer, you would, in most cases, expect that they are on the road to recovery, ready to move on with their life.
However, at least 50% of these patients will go on to suffer from pancreatic exocrine insufficiency (PEI). With PEI, the pancreas cannot make enough enzymes for digestion, or the enzymes do not mix with food. As a result, the body is unable to break down food and absorb essential nutrients which can lead to malnutrition, micronutrient deficiencies, weight loss, fatigue and malabsorption, severely impacting a person’s quality of life post-operation.
Unfortunately, PEI is underdiagnosed and poorly treated. Yet, thanks to the generous donors of the PA Research Foundation, Dietitian Kelli Edmiston and her team of surgeons, gastroenterologists, oncologists and endocrinologists are working to improve the diagnosis and treatment of this overlooked condition.
“Our goal is to work out the most efficient way to identify and treat patients earlier so as to improve their nutrition and overall quality of life,” Kelli said.
After coming across previous research gathered in a 2024 systematic review suggesting that rates of PEI varied from 30% to 65%, Kelli began to identify a significant gap between evidence and practice.
“When I started asking patients more direct questions in my clinical work, I noticed that many patients showed symptoms of PEI. However, we were then left with the question of how to correctly diagnose the condition, as current methods are either inaccurate after this type of surgery, or too invasive for routine clinical use. Additionally, there are no agreed guidelines for the testing or treatment of PEI for patients that have had oesophageal or gastric cancer,” Kelli said.
“It is a difficult condition to diagnose because the symptoms are non-specific: abdominal pain, discomfort, frequent loose bowel movements, micronutrient deficiencies, fatigue and weight loss, and often overlap with or co-exist with other conditions such as dumping syndrome, reactive hyperglycaemia, and small intestinal bacterial overgrowth, making it difficult to identify what’s causing the problem.”
Kelli and her team, driven by the idea that there ‘must be a better way’ have been developing this project to understand how best to diagnose and treat PEI.
“Our research will have oesophageal, or gastric cancer patients undergo a full nutrition assessment and several different diagnostic tests, at a number of timepoints from cancer diagnosis to try to identify the presence of PEI,” Kelli said.
“We will then repeat those tests once they have had their preoperative treatment (Chemotherapy or Radiotherapy) and then again at six months post-operation to compare the rates over time and see whether preoperative treatments or the operation have the greatest impact on PEI.”
However, there is hope for those patients who are diagnosed with PEI as the treatment is simple.
“The treatment for PEI involves pancreatic enzyme replacement therapy (PERT). As a part of this therapy, the patient will take capsules that contain animal-based pancreatic enzymes. These enzymes work in a similar way to those that a healthy human pancreas would make,” Kelli said.
“The patient takes the medication each time they eat to replace their missing or inactive digestive enzymes, allowing the enzymes to mix with the food and facilitate nutrient absorption.” A solution that is straightforward and relatively easy to maintain.
By doing this, Kelli and her team are hoping to optimise patients nutritionally and improve the quality of life for all cancer survivors. Their work will no doubt bring relief to all patients struggling with this condition.
Kelli expressed her gratitude by saying, “If it weren’t for the donors, we wouldn’t be able to run this project that we believe will have a definite impact on cancer survivors. Thank you.”
