**7. Conclusion**

Pancreatic exocrine insufficiency is a condition commonly associated with diseases such as pancreatitis or cystic fibrosis. When pancreatic insufficiency is severe, impaired absorption of nutrients by the intestines may result, leading to deficiencies of essential nutrients and the occurrence of loose stools containing unabsorbed fat (steatorrhea). A shortage of the digestive enzymes necessary to break down food is the main cause of this dietary malabsorption. Unlike protein and starch digestion, lipid malabsorption is the overriding problem and the main cause of clinical symptoms and nutritional deficiencies. Until recently, approaches used to address problem of fat malabsorption due to pancreatic insufficiency have been focusing primarily on oral administration of exogenous pancreatic enzymes extracted from porcine source. Standard clinical practices dictate administration of lipase 25,000-75,000 units/meal by using pH-sensitive pancrelipase microspheres, along with dosage increases, compliance checks, and differential diagnosis in cases of treatment failure. Various pancreatin preparations are available, however, differences in galenic properties and release kinetics and other factors such as early acid inactivation, under dosage and patient incompliance may decrease clinical efficacy of the treatment. The FDA decreed that all manufacturers of pancreatic enzyme supplements must file new drug applications (NDA) to ensure consistent efficacy, safety, and quality of these agents. Accordingly, improved approaches to treat efficiently problem of fat malabsorption secondary to pancreatic insufficiency are investigated. New alternatives of enzyme substitution therapy are being developed. Emerging therapeutic landscape includes use of porcine free - lipase preparations. Enzyme supplements either from human, mammalian, microbial or plant origins are wisely suggested. Interestingly, newest approaches state the design of acid -stable variants of human pancreatic lipase as well as creation of functional dietary food with specific more digestible/absorbable lipid sources. However, how these pipeline therapies may help meet the ongoing challenges in treating lipid malabsorption in patients with pancreatic insufficiency and improve the long-term outcomes of these patients remains yet to be assessed.
