Exocrine Pancreatic Insufficiency: An Overview

Abstract

Exocrine Pancreatic Insufficiency (EPI) is identified by the insufficiency of exocrine pancreatic enzymes resulting in malabsorption. Patients with mild EPI maybe asymptomatic or have mild abdominal discomfort and bloating while advanced EPI results in steatorrhea and weight loss. The causes can be divided into pancreatic and extra-pancreatic origin. Pancreatic causes include chronic pancreatitis, cystic fibrosis, pancreatic tumors, and pancreatic resection. Extra-pancreatic causes include diabetes, IBD, celiac disease, etc.There are various direct and indirect tests available to diagnose EPI, with indirect ones such as the concentration of fecal elastase beingmost commonly used. However, the gold standard test for diagnosis is a72-hour fecal fat test.Treatment for pancreatic exocrine insufficiency includes lifestyle modifications, dietary consultation, and a structured assessment of nutritional status. The mainstay remains pancreatic enzyme replacement therapy, which is administered in the form of enteric-coated minimicrospheres during meals.