From the Guidelines
Exocrine Pancreatic Insufficiency (EPI) typically presents with symptoms such as steatorrhea, weight loss, bloating, excessive flatulence, and fat-soluble vitamin deficiencies, as a result of inadequate pancreatic enzyme production. These symptoms are primarily due to the malabsorption of fats, proteins, and carbohydrates, leading to nutritional deficiencies and weight loss despite normal or increased food intake 1. The most common symptoms of EPI include:
- Steatorrhea (fatty, oily, foul-smelling stools that may float or be difficult to flush)
- Weight loss despite normal or increased food intake
- Abdominal pain or discomfort
- Bloating
- Excessive gas
- Diarrhea or frequent bowel movements
- Malnutrition despite eating well
- Deficiencies in fat-soluble vitamins (A, D, E, and K)
According to the most recent guidelines, EPI should be suspected in patients with high-risk clinical conditions, such as chronic pancreatitis, relapsing acute pancreatitis, pancreatic ductal adenocarcinoma, cystic fibrosis, and previous pancreatic surgery 1. The diagnosis of EPI can be challenging, but the fecal elastase test is the most appropriate initial test, and a level <100 mg/g of stool provides good evidence of EPI 1.
The symptoms of EPI can significantly impact a patient's quality of life, leading to malnutrition, weight loss, and fatigue. Effective management of EPI with pancreatic enzyme replacement therapy can alleviate these symptoms and improve nutritional status 1. It is essential to monitor patients with EPI regularly, including measurements of nutritional status, fat-soluble vitamin levels, and quality of life, to ensure optimal management and improve outcomes 1.
From the Research
Symptoms of Exocrine Pancreatic Insufficiency (EPI)
- Abdominal pain is one of the most prominent symptoms of EPI, as reported in the study 2.
- Malabsorption and malnutrition are common consequences of EPI, resulting from inadequate pancreatic enzyme delivery to the small intestine 3.
- Clinical manifestations of EPI can be nonspecific, leading to delayed recognition and diagnosis 3.
- EPI can cause reduced quality of life and life-threatening complications if left untreated or undertreated 4.
Associated Conditions and Comorbidities
- EPI is commonly associated with pancreatic disorders, such as chronic pancreatitis, pancreatic malignancy, and cystic fibrosis 3, 5.
- Other conditions, including diabetes, gastrointestinal disorders, sarcopenia, osteopenia, and cardiovascular disorders, can also be comorbid with EPI 2.
- Nutritional deficiencies, including fat-soluble vitamin deficiencies, can occur in patients with EPI due to malabsorption 3, 6.
Diagnosis and Treatment
- Diagnosis of EPI can be challenging due to the lack of specific testing and the nonspecific nature of its symptoms 3, 5.
- Pancreatic enzyme replacement therapy (PERT) is the mainstay of EPI treatment, aiming to replenish exocrine enzyme deficiency and improve nutrient absorption 3, 4, 5.
- PERT has been shown to improve symptoms, quality of life, and survival outcomes in patients with EPI, but optimal dosing and administration remain unclear 3, 2, 5.