Diagnosis and Management of Exocrine Pancreatic Insufficiency (EPI)
Consensus Guidance of a Canadian Expert Panel
Exocrine pancreatic insufficiency (EPI) is a condition that occurs due to a reduction in pancreatic enzyme production, delivery, and/or activity to a level below the threshold required to maintain normal digestion. EPI results in impaired digestion and decreased absorption of nutrients.1,2
Investigate EPI if suggestive signs and symptoms develop in a patient with a known pancreatic disease or in patients with a predisposing condition.
The following signs and symptoms should be considered suggestive of EPI:
- Large-volume malodorous stools
- Unexplained weight loss
- Unexplained deficits in fat-soluble vitamins
- Clinical sequelae of certain micronutrient deficiencies
- Diabetes mellitus secondary to chronic pancreatitis
For patients with a condition predisposing to EPI, regular screening should include:
- Weight and body mass index
- Fat-soluble vitamins and other nutritional markers
- Bone mineral density scan
- Fecal tests such as FE-1
For patients with signs or symptoms suggestive of EPI, thorough investigation should include the following considerations:
- Duration and nature of symptoms (eg, steatorrhea)
- Documented unexplained weight loss
- Other basic laboratory values (including complete blood counts with differential, comprehensive metabolic panel, international normalized ratio, serum albumin, and prealbumin levels)
- Patient’s clinical history (including prior chronic or recurrent acute pancreatitis, alcohol abuse, smoking, and GI surgery)
- Any family history of a pancreatic disease
*These are select recommendations from the consensus guidance. For a complete list of recommendations, please refer to Durie P, et al. Curr Med Res Opin. 2018;34(1):25-33.
- Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World J Gastroenterol. 2013;19(42):7258-7266.
- Pezzilli R, Andriulli A, Bassi C, et al. Exocrine pancreatic insufficiency in adults: a shared position statement of the Italian Association for the Study of the Pancreas. World J Gastroenterol. 2013;19(44):7930-7946.
- Durie P, Baillargeon JD, Bouchard S, Donnellan F, Zepeda-Gomez S, Teshima C. Diagnosis and management of pancreatic exocrine insufficiency (PEI) in primary care: consensus guidance of a Canadian expert panel. Curr Med Res Opin. 2018;34(1):25-33.