Exocrine pancreatic insufficiency (EPI) is an underrecognized yet clinically significant condition that can profoundly affect digestive health and nutritional status. Characterized by inadequate pancreatic enzyme activity, EPI often presents with nonspecific gastrointestinal symptoms that overlap with more common disorders, making it easy to miss in routine practice.
Key Points
- EPI is increasingly recognized, but remains frequently underdiagnosed in clinical practice.
- Symptoms are often nonspecific, including chronic diarrhea, bloating, and abdominal discomfort.
- High-risk patients include those with chronic pancreatitis, pancreatic cancer, IPMNs, or prior pancreatic surgery.
- Diagnosis is challenging due to limitations of current tests, including fecal fat collection and fecal elastase.
- Pancreatic enzyme replacement therapy (PERT) is the cornerstone of treatment, but delays in diagnosis and limited therapeutic options remain key unmet needs.
In a recent discussion, Sarah Enslin, PA-C, and Jennifer Geremia, PA-C, highlighted the evolving understanding of EPI, emphasizing the growing awareness of the condition, the challenges that continue to delay diagnosis, and the critical need for more effective testing and treatment strategies to improve patient outcomes.
Both experts pointed to the need for greater clinical awareness and improved diagnostic strategies for EPI, a condition they say is often overlooked despite its significant impact on patients.
Reflecting on trends in clinical practice, Enslin noted that EPI is not a new diagnosis, but rather one that clinicians are recognizing more frequently as awareness improves. In her view, the condition has likely been underdiagnosed for years, only now gaining broader attention as providers become more attuned to its presentation and associated risk factors.
Geremia echoed this sentiment, stressing that EPI should remain firmly in the differential diagnosis for patients with compatible symptoms and comorbidities. Both underscored that missing the diagnosis can have meaningful consequences, including poor quality of life and nutritional deficiencies.
The speakers highlighted the nonspecific nature of EPI symptoms as one of the greatest barriers to diagnosis. As Enslin explained, patients commonly present with vague complaints such as chronic diarrhea, bloating, and abdominal discomfort, all of which are symptoms that can easily be attributed to more common gastrointestinal disorders. While clinicians often associate EPI with chronic pancreatitis or cystic fibrosis, both experts emphasized the importance of broadening that perspective, pointing to additional at-risk populations, including patients with pancreatic cancer, intraductal papillary mucinous neoplasms, or a history of pancreatic surgery.
