Overview
Exocrine pancreatic insufficiency (EPI) is a condition in which the pancreas fails to produce or deliver sufficient digestive enzymes to the small intestine, impairing the body’s ability to properly digest and absorb nutrients from food. This leads to malnutrition, weight loss, gastrointestinal symptoms (such as bloating and diarrhea) and deficiencies in fat-soluble vitamins.1,2 EPI can result from a range of underlying conditions, including chronic pancreatitis, cystic fibrosis, pancreatic cancer or surgical resection of the pancreas.1,2,3,4
EPI is not a contagious or transmissible condition. It is typically the result of progressive damage to the pancreatic tissue or obstruction of pancreatic enzyme flow.2,4 Risk factors include genetic disorders, autoimmune diseases, chronic alcohol use and gastrointestinal surgery.2,3
Because EPI is most often secondary to another disease, prevention efforts focus on managing or mitigating the underlying causes, including:1,2
- Early intervention and management of chronic pancreatitis and cystic fibrosis2,5
- Avoidance of excessive alcohol consumption2,4
- Monitoring and follow-up for patients undergoing pancreatic surgery or those at risk of pancreatic tumors3
Routine health evaluations and appropriate imaging or laboratory tests can help identify pancreatic dysfunction before severe symptoms develop.1,3
Diagnosis: Diagnosing EPI often involves a combination of clinical history, symptom review and laboratory testing.1,3
Key diagnostic methods include:
- Fecal pancreatic elastase testing: A non-invasive stool test that measures pancreatic enzyme output3
- 72-hour fecal fat test: Evaluates fat malabsorption, though less commonly used due to patient burden1
- Direct pancreatic function tests: Rare in routine settings due to invasiveness and complexity2,4
Imaging (e.g., CT, MRI or endoscopic ultrasound) may also be used to assess pancreatic structure and aid diagnosis.1
Treatment: The cornerstone of EPI treatment and management is pancreatic enzyme replacement therapy (PERT), which helps restore digestive function.1,2 Treatment also includes:
- Nutritional support and vitamin supplementation1,4
- Monitoring for and addressing deficiencies1,5
- Managing underlying conditions (e.g., treating pancreatitis or optimizing cystic fibrosis care)2,4
Timely and accurate diagnosis through validated in vitro diagnostic methods is essential for effective management and improving patient quality of life.1,3
- American Gastroenterological Association. (2023). AGA clinical practice update on the diagnosis and management of exocrine pancreatic insufficiency: Expert review. Gastroenterology, 165(4), 765–774. https://doi.org/10.1053/j.gastro.2023.07.009
- Das, A., & Rathi, S. (2023). Pancreatic insufficiency. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555926/
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2023). Diagnosis of exocrine pancreatic insufficiency. https://www.niddk.nih.gov/health-information/digestive-diseases/exocrine-pancreatic-insufficiency/diagnosis
- Othman, M. O., Harb, D., & Barkin, J. A. (2018). Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician. International Journal of Clinical Practice. https://doi.org/10.1111/ijcp.13210
- North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). https://naspghan.org
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