Exocrine Pancreatic Insufficiency

Author: Samer Al-Kaade, MD; Chief Editor: George T Griffing, MD

Background

Exocrine pancreatic insufficiency (EPI) is a condition characterized by deficiency of the exocrine pancreatic enzymes, resulting in the inability to digest food properly, or maldigestion. The etiology of this deficiency includes both pancreatic and nonpancreatic causes.

Presentation

The major symptoms of exocrine pancreatic insufficiency (EPI) include steatorrhea and weight loss. The most common symptomatic complaint is diarrhea, which is frequently watery, reflecting the osmotic load received by the intestine.

Workup

Laboratory Studies

A complete laboratory evaluation is required not only to diagnose exocrine pancreatic insufficiency (EPI) but also to determine the extent of the malabsorption and assess manifestations of the underlying disease, if present.

Treatment

Approach Considerations

Management approaches to exocrine pancreatic insufficiency (EPI) include the following:

  • Lifestyle modifications (eg, avoidance of fatty foods, limitation of alcohol intake, cessation of smoking, and consumption of a well-balanced diet)
  • Vitamin supplementation (primarily the fat-soluble vitamins A, D, E, and K)
  • Pancreatic enzyme replacement therapy (PERT), which is the therapeutic mainstay

Long-term monitoring of patients with EPI should focus on the following 2 issues:

  • Correction of nutritional deficiencies
  • Treatment of causative diseases (when possible); such treatment will vary according to the specific disease present