Encourage patients who may be experiencing GI symptoms to be open and discuss all of their symptoms with you. Some patients may feel embarrassed or uncomfortable talking about GI symptoms, but you can help make it easier by letting them know that you're comfortable listening to them. Make sure to discuss the following with your patients:
It is key to take a history in your patients suspected of having EPI since not all patients will present with typical signs and symptoms of EPI as some patients will limit fat intake because of symptoms.
EPI should be suspected in patients who present with symptoms including frequent diarrhea, unexplained weight loss, fatty stools, flatulence, bloating, or abdominal pain, especially if they have also have been diagnosed with a condition that has been associated with EPI.
There are a number of direct and indirect tests that can be performed to confirm a diagnosis of EPI. Once a diagnosis of EPI has been confirmed, you can help patients manage the symptoms and ensure a normal nutritional status.
Quantitative fecal fat
The 72-hour fecal fat collection is the standard for indirect testing, expressed as the coefficient of fat absorption (CFA). This test is the current standard for measuring fat absorption in clinical trials with EPI patients. By measuring the stool fat and knowing the fat content of the diet, researchers can determine the CFA – the percentage of fat in the diet that is absorbed. Normal CFA is approximately 93%. Steatorrhea is classically defined as at least 7 g of fecal fat over 24 hours, in the context of a 72-hour stool test while on 100 g of fat daily. Quantification of fecal fat can be inconvenient and difficult for both patients and laboratory personnel.
Qualitative fecal fat
Qualitative fecal fat analysis by microscopic examination of random stool samples can be used as a screening test.
The fecal elastase concentration, or FEC, measures the concentration of pancreatic enzyme elastase. Its sensitivity is limited to moderate or severe disease (lower sensitivity with milder steatorrhea), and it can give false positive results when diluted by watery stools. It is, however, done on a single stool sample, and it is used in clinical practice.