Exocrine Pancreatic Insufficiency
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.
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.
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.
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