About EPI in Patients Without CF
EPI is associated with a
number of conditions
EPI is characterized by deficiencies in the amount or
activity of exocrine pancreatic enzymes. This can result
in the inability to digest food properly, or maldigestion.1-3
EPI is commonly found in the following conditions3:
of patients with chronic pancreatitis have EPI
of patients with type 1 diabetes have EPI
of patients with type 2 diabetes have EPI
of patients with pancreatic cancer have EPI
EPI is often misdiagnosed because symptoms overlap with irritable bowel syndrome, celiac disease,
Crohn’s disease, and ulcerative colitis.4
On average, it takes 3.7 years until a patient seeks medical
help for GI symptoms5
Symptoms of EPI include4,6-8:
- Abdominal pain
- Bloating
- Flatulence
- Frequent stools
- Nausea
- Malaise
- Diarrhea
- Steatorrhea
(foul-smelling, bulky, oily stools)
Because the signs and symptoms of EPI are similar to those of other GI diseases, EPI may go undetected.9 A survey of 1,001 adult patients with chronic GI issues and 500 clinicians revealed5:
≈25%
of patients with EPI were originally diagnosed with another GI condition
66%
of patients never heard of EPI
78%
of patients weren’t aware that their GI symptoms could be EPI related
The food-driven GI symptoms of EPI can cause patients to avoid certain foods at mealtime4
Managing EPI includes1,7,9:
Pancreatic enzyme replacement therapy
Maintaining adequate nutritional status with vitamin/nutrient supplements
Lifestyle and dietary modifications
CF=cystic fibrosis; EPI=exocrine pancreatic insufficiency; GI=gastrointestinal.
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. Brennan GT, Saif MW. Pancreatic enzyme replacement therapy: a concise review. JOP. 2019;20(5):121-125. 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, 2020. www.mdedge.com/gihepnews/article/120327/ibd-intestinal-disorders/widespread-lack-awareness-pancreatic-insufficiency 6. Wooldridge JL, Heubi JE, Amaro-Galvez R, et al. EUR-1008 pancreatic enzyme replacement is safe and effective in patients with cystic fibrosis and pancreatic insufficiency. J Cyst Fibros. 2009;8(6):405-417. doi:10.1016/j.jcf.2009.07.006 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. Domínguez-Muñoz JE. Chronic pancreatitis and persistent steatorrhea: what is the correct dose of enzymes? Clin Gastroenterol Hepatol. 2011;9(7):541-546. doi:10.1016/j.cgh.2011.02.027 9. 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.