EPI in Primary Care

Practical Diagnosis and Management of EPI

Introduction

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

EPI should always be considered in individuals with a newly diagnosed pancreatic disease predisposing to EPI, including chronic pancreatitis, cystic fibrosis, pancreatic cancer, pancreatectomy, and gastrointestinal surgeries.^3*

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
Steatorrhea
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:

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.

References:

1.Lindkvist B. World J Gastroenterol. 2013;19(42):7258-7266. 2. Pezzilli R, Andriulli A, Bassi C, et al. World J Gastroenterol. 2013;19(44):7930-7946. 3. Durie P, Baillargeon JD, Bouchard S, Donnellan F, Zepeda-Gomez S, Teshima C. Curr Med Res Opin. 2018;34(1):25-33.

EPI in Primary Care

Expert opinion on practical diagnosis and management of EPI.