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EPI Education

Take a deep dive into EPI and learn from experts in the field.

About EPI: EPI pathogenesis, symptoms, and diagnosis

Etiologies of EPI: Recognize EPI and the barriers to diagnosis

Management of EPI: Key information for managing EPI

Case Studies: Experts present case-based narratives on EPI

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Hello, I’m Dr. Kofi Clarke – I’m a board-certified gastroenterologist specializing in inflammatory bowel diseases and celiac disease. I will be discussing the etiology and pathophysiology of exocrine pancreatic insufficiency in certain patients with celiac disease. Exocrine pancreatic insufficiency (or EPI) may result from many underlying conditions including, but not limited to, chronic or acute pancreatitis, pancreatic surgery, or celiac disease. Causes of persistent gastrointestinal symptoms in patients with celiac disease include suboptimal compliance with a gluten free diet, microscopic colitis, bacterial overgrowth syndrome, IBS, brush border enzyme deficiency, refractory celiac disease and EPI which is often overlooked. Studies utilizing fecal elastase testing show EPI may be a common comorbidity of patients with celiac disease. EPI, is caused by inadequate production, delivery, or activity of pancreatic digestive enzymes leading to insufficient digestion of food, and therefore, malnourishment. During functional digestion, nutrients entering the duodenum trigger the release of hormones such as cholecystokinin, or CCK, which are required for the stimulation of digestive enzymes from the acinar cells in the pancreas. These enzymes are required for the breakdown of food and absorption of nutrients. In celiac disease, endocrine cells in the duodenal mucosa can be damaged by the body’s auto immune response, resulting in decreased levels of CCK. This reduced stimulation of vital digestive enzyme from the pancreas causes EPI, and results in symptoms of maldigestion and malabsorption of nutrients. Symptoms of celiac disease and EPI can be very similar, such as changes in the stool, and weight loss. According to the American College of Gastroenterology Clinical Guidelines on the diagnosis and management of celiac disease, patients with persistent gastrointestinal symptoms, signs, or laboratory abnormalities should be investigated for other causes, including EPI.

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Headshot of Kofi Clarke, MD, FACP, FRCP, AGAF.

Kofi Clarke, MD, FACP, FRCP, AGAF

Many Faces of EPI—Celiac

Learn about what can cause EPI in patients with celiac disease.

Headshot of Kofi Clarke, MD, FACP, FRCP, AGAF.

Kofi Clarke, MD, FACP, FRCP, AGAF


Take an immersive journey into the physiology of the exocrine pancreas and the pathophysiology of EPI.

Review the pathogenesis and clinical consequences of EPI.

Recognize EPI after pancreatic surgery and the challenges in postoperative diagnosis.

Learn about gastrointestinal complications that can occur in post-pancreatic surgery patients.

Practical approaches for the Healthcare Professional.

Recognize how to diagnose and treat EPI in chronic pancreatitis patients.

Learn how malabsorption due to EPI can cause problems in chronic pancreatitis patients.

Learn about gastrointestinal complications that can occur in post-pancreatic surgery patients.

Recognize the onset of other conditions and deficiencies in pancreatic cancer patients with EPI.

Review the etiology and risk factors of EPI in patients with chronic pancreatitis.

Review a patient case study and the risk factors of EPI in patients with acute pancreatitis.

Learn about what can cause EPI in patients with celiac disease.

Learn how these 3 considerations may be helpful in determining an EPI diagnosis.

Learn how to differentiate between EPI and IBS-D with these 8 questions.

Learn more about EPI symptoms, nutritional deficiencies, consequences, and PERT.

See how Dr. Domínguez-Muñoz evaluated a patient's symptoms and history to determine a diagnosis.