Fast Five Quiz: Exocrine Pancreatic Insufficiency Signs and Symptoms

Romesh Khardori, MD, PhD


March 08, 2021

As maldigestion prevents absorption of vitamin D, patients with EPI are at high risk of developing osteopenia, osteomalacia or osteoporosis due to decreased bone mineral density. With severe disease, bone pain and pathologic fractures occur with low calcium levels leading to secondary hyperparathyroidism. It is important for all patients with EPI to undergo bone mineral density testing.

Some other conditions also commonly occur with EPI. Anemia resulting from malabsorption can be either microcytic (related to iron deficiency) or macrocytic (related to vitamin B12 deficiency). When presenting with EPI, anemia may arise from causative diseases, for example, iron deficiency anemia is often a manifestation of celiac disease, vitamin B12 deficiency may be caused by ileal involvement in Crohn's disease, ileal resection can also cause megaloblastic anemia.

Bleeding disorders can also occur due to vitamin K malabsorption and subsequent hypoprothrombinemia. The presenting symptom is usually ecchymosis; melena and hematuria may also occur.

Learn more about presentation of EPI.

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