About EPI in Patients Without CF

Diagnosing EPI
can be challenging1

EPI is associated with a number of conditions

EPI often goes misdiagnosed because the GI symptoms overlap with those of other conditions, including2-4:

  • Irritable bowel syndrome
  • Celiac disease
  • Crohn’s disease
  • Ulcerative colitis

The broad array of symptoms and a lack of patient awareness contribute to underdiagnosis2,5

In a survey of 1,001 adult patients with chronic GI issues and 500 clinicians5:

1 in 4

patients with EPI were originally diagnosed with another GI condition

≈7 in 10

patients never heard of EPI

≈8 in 10

patients weren’t aware that their GI symptoms could be EPI related

It takes ≈4 years on average until a patient seeks
medical help for GI symptoms.5

Unmanaged symptoms of EPI can make mealtime a struggle6:

EPI may cause the following symptoms4,7,8:

  • Abdominal pain
  • Bloating
  • Excessive flatulence
  • Frequent stools
  • Nausea
  • Malaise
  • Diarrhea
  • Steatorrhea

The symptoms of EPI develop when ≈90% of exocrine function is lost1

Patients with EPI are also managing underlying disorders3,9:


Percentage Underlying Conditions Percentage Underlying Conditions

Effective management of EPI depends on 1,2,7:

Pill icon

Pancreatic enzyme replacement therapy

Bottle and weight icon

Lifestyle and dietary modifications

Vitamins and bottle icon

Maintaining adequate nutritional status with vitamin/nutrient supplements

In patients with EPI due to chronic pancreatitis

The American College of Gastroenterology (ACG) suggests PERT to improve the complications of malnutrition.10

CF=cystic fibrosis; EPI=exocrine pancreatic insufficiency; GI=gastrointestinal; PERT=pancreatic enzyme replacement therapy.

References: 1. Perbtani Y, Forsmark CE. Update on the diagnosis and management of exocrine pancreatic insufficiency. F1000Res. 2019;8:F1000 Faculty Rev-1991. doi:10.12688/f1000research.20779.1 2. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017;23(suppl 12):S203-S209. 3. Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019;12:129-139. doi:10.2147/CEG.S168266 4. Othman MO, Harb D, Barkin JA. Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician. Int J Clin Pract. 2018;72(2):e13066. doi:10.1111/ijcp.13066 5. Kirsch B. Widespread lack of awareness of pancreatic insufficiency. MDedge News. Published December 16, 2016. Accessed November 6, 2022. www.mdedge.com/gihepnews/article/120327/ibd-intestinal-disorders/widespread-lack-awareness-pancreatic-insufficiency 6. Johnson CD, Williamson N, Janssen-van Solingen G, et al. Psychometric evaluation of a patient-reported outcome measure in pancreatic exocrine insufficiency (PEI). Pancreatology. 2019;19(1):182-190. doi:10.1016/j.pan.2018.11.013 7. Ockenga J. Importance of nutritional management in diseases with exocrine pancreatic insufficiency. HPB (Oxford). 2009;11(suppl 3):11-15. doi:10.1111/j.1477-2574.2009.00134.x 8. Johnson CD, Arbuckle R, Bonner N, et al. Qualitative assessment of the symptoms and impact of pancreatic exocrine insufficiency (PEI) to inform the development of a patient-reported outcome (PRO) instrument. Patient. 2017;10(5):615-628. doi:10.1007/s40271-017-0233-0 9. Brennan GT, Saif MW. Pancreatic enzyme replacement therapy: a concise review. JOP. 2019;20(5):121-125. 10. Gardner TB, Adler DG, Forsmark CE, Sauer BG, Taylor JR, Whitcomb DC. ACG Clinical Guideline: chronic pancreatitis. Am J Gastroenterol. 2020;115(3):322-339. doi:10.14309/ajg.0000000000000535