GI Conditions
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      Exocrine Pancreatic Insufficiency

      Condition: Exocrine Pancreatic Insufficiency

      Brief Overview: Exocrine Pancreatic Insufficiency results when either the pancreas is functioning improperly, or the pancreatic enzymes are functioning improperly. EPI is a complication of pancreatic disease. Symptom presentation can be asymptomatic to mild, but those with advanced EPI generally have more noticeable symptoms.

      Prevalence: The exact prevalence of EPI is unknown.

      Etiology: According to UpToDate, causes of EPI include: chronic pancreatitis, pancreatic duct obstruction, Cystic Fibrosis, Shwachmann-Diamond syndrome, pancreatic resection, gastric resection, short bowel syndrome, severe undernutrition, hereditary hemochromatosis, and Alpha 1 antitrypsin deficiency.

      Risk Factors:

      • History of pancreatic or GI surgeries, including, but not limited to: Roux-en-Y gastric bypass, pancreaticduodenectomy, duodenal switch
      • Chronic pancreatitis
      • Cystic Fibrosis
      • Celiac Disease
      • Crohn’s
      • Hereditary hemochromatosis

      Commonly Associated Conditions:

      • Chronic pancreatitis
      • Cystic Fibrosis (CF)
      • Pancreatic resection
      • Pancreatic duct obstruction
      • Shwachmann-Diamond Syndrome
      • Gastrinoma
      • Celiac disease
      • Liver disease

      Common Medications:

      • Pancreatic enzymes
      • Vitamin/nutrient supplementation as needed

      Common Labs, Imaging, and Tests:

      • Stool test
      • Direct pancreatic function test
      • Abdominal Imaging – CT, ultrasound
      • Blood tests to check for/monitor any vitamin or nutrient deficiencies

      Common Symptoms:

      • Mild abdominal discomfort
      • Bloating, gas
      • Loose, greasy, foul-smelling stool
      • Weight loss
      • Cramping

      Common Treatments:

      • Pancreatic enzyme replacement therapy
      • Vitamin/nutrient supplementation as needed
      • Dietary modifications
      • Treatment of any underlying conditions

      Physical Findings:

      • Abdominal tenderness, distention
      • Weight loss

      Potential Complications and Contraindications:

      • Bone disease – osteopenia and osteoporosis
      • Vitamin/nutrient deficiencies
      • Malnutrition
      • Fatigue
      • Decreased immune function

      General Health and Lifestyle Guidance:

      • Avoid alcohol
      • Tobacco cessation
      • Work with your healthcare provider and dietician to make any recommended dietary modifications
      • Take all treatment as prescribed

      Suggested Questions to Ask Patients:

      • Have you experienced greasy or floating stools?
      • Are you losing weight unintentionally?
      • Do you take your medications/PERT consistently?
      • Do you notice changes in symptoms when you skip PERT doses?
      • Have you been tested for vitamin or mineral deficiencies?

      Suggested Talking Points:

      • Taking PERT as directed is important
      • Track your stools and any other symptoms to report to your healthcare provider
      • Make sure to report any new or worsening symptoms to your healthcare provider

      Sources: