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EPI is largely a clinical diagnosis1-4*

Patients with EPI may present with signs and symptoms similar to other GI disorders. A careful workup is necessary when suspecting EPI and should include patient history, symptom assessment, and asking about underlying conditions. It's also important to get specific details about GI issues, including symptom onset, frequency, and severity, and patient diet.

*Tests can help confirm a diagnosis.

Evaluate patients for signs and symptoms of EPI

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. Some patients may limit fat intake to minimize symptoms.3,4

Patients with EPI may present with one or more of the following signs and symptoms4-6:

  • Diarrhea
  • Flatulence
  • Bloating
  • Abdominal pain
  • Unexplained weight loss
  • Steatorrhea

Consider EPI in patients with underlying conditions

Know the underlying conditions and surgical procedures that can lead to EPI.

EPI may be present in patients with the following underlying conditions or procedures7-10:

  • Cystic fibrosis (CF)
  • Chronic pancreatitis (CP)
  • Pancreatectomy (PY)
  • Pancreatic cancer

Other underlying conditions and procedures in which EPI has been reported include11-15:

  • Acute pancreatitis (AP)
  • Crohn’s disease
  • Celiac disease
  • Type 1 diabetes
  • Gastric resection/bypass

Ask your patients specific questions to help them open up about their symptoms

Patients may find it difficult to discuss GI issues with their doctor and may be embarrassed to disclose their symptoms. Because EPI is largely a clinical diagnosis, asking specific questions may help you reach a diagnosis sooner.1,16*

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Urgency/Frequency

  • How urgently do you need to have bowel movements? How frequently?
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Stool Details

  • How would you describe your stool? Is it loose? Does it float? Is it greasy? Is the color pale?
  • Does it smell very foul? Is it difficult to flush?
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Other Considerations

  • Have you had any unexplained weight loss?
  • Do you feel like you are managing your symptoms by limiting what you eat?

Code directly for EPI using
ICD-10 code K86.8117

Image of EPI Conversation Guide

An open conversation can reveal the facts

Use the EPI Conversation Guide to help you reach a diagnosis sooner.*

*Tests can help confirm a diagnosis.

Tests that can help confirm a diagnosis of EPI

Non-invasive measures:

  • Fecal elastase concentration (FE-1)2
  • Qualitative fecal fat18
  • Quantitative fecal fat18

Invasive measures:

  • Secretin-pancreozymin stimulation (performed at specialized centers)1
Learn about EPI management

References: 1. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73. 2. Leeds JS, Oppong K, Sanders DS. The role of fecal elastase-1 in detecting exocrine pancreatic disease. Nat Rev Gastroenterol Hepatol. 2011;8(7):405-415. 3. Durie P, Baillargeon JD, Bouchard S, Donnellan F, Zepeda-Gomez S, Teshima C. Diagnosis and management of pancreatic exocrine insufficiency (PEI) in primary care: consensus guidance of a Canadian expert panel. Curr Med Res Opin. 2018;34(1):25-33. 4. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122. 5. Ferrone M, Raimondo M, Scolapio JS. Pancreatic enzyme pharmacotherapy. Pharmacotherapy. 2007;27(6):910-920. 6. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017;23(suppl 12):203S-209S. 7. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl 6):1-28.
8. Kempeneers MA, Ali UA, Issa Y, et al. Natural course and treatment of pancreatic exocrine insufficiency in nationwide cohort on chronic pancreatitis. Pancreas. 2020;49:242-248. 9. Matsumoto J, Traverso LW. Exocrine function following the Whipple operation as assessed by stool elastase. J Gastrointestinal Surg. 2006;10(9):1225-1229. 10. Yuasa Y, Murakami Y, Nakamura H, et al. Histological loss of pancreatic exocrine cells correlates with pancreatic exocrine function after pancreatic surgery. Pancreas. 2012;41(6):928-933. 11. Hollemans RA, Hallensleben NDL, Mager DL, et al. Pancreatic exocrine insufficiency following acute pancreatitis: systematic review and study level meta-analysis. Pancreatology. 2018;1-10. 12. Huang W, de la Iglesia-Garcia D, I Baston-Rey, et al. Exocrine pancreatic insufficiency following acute pancreatitis: systematic review and meta-analysis. Dig Dis Sci. 2019;64(7):1985-2005. 13. Singh VK, Haupt ME, Geller DE, Hall JA, Quintana Diez PM. Less common etiologies of exocrine pancreatic insufficiency. World J Gastroenterol. 2017;23(39):7059-7076. 14. Chaudhary A, Dominguez-Munoz JE, Payer P, Lerch MM. Pancreatic exocrine insufficiency as a complication of gastrointestinal surgery and the impact of pancreatic enzyme replacement therapy. Dig Dis. 2020;38(1):53-68. 15. Pezzilli R, Andriulli A, Bassi C, et al. Exocrine Pancreatic Insufficiency Collaborative Group. Exocrine pancreatic insufficiency in adults: a shared position statement of the Italian Association for the Study of the Pancreas. World J Gastroenterol. 2013;19(44):7930-7944. 16. EPI Uncovered. American Gastroenterological Association website. https://www.gastro.org/press-release/largest-analysis-examining-barriers-to-epi-diagnosis-finds-patients-with-digestive-health-issues-overlook-their-symptoms. Published October 24, 2016. Accessed December 4, 2018. 17. Centers for Disease Control and Prevention. ICD-10 Coordination and Maintenance Committee Meeting, March 18-19, 2015. 18. Hammer HF. Pancreatic exocrine insufficiency: diagnostic evaluation and replacement therapy with pancreatic enzymes. Dig Dis. 2010;28(2):339-343. 19. Data on file. AbbVie Inc. Source: SHS data (2015-2017), 2017. 20. Data on file. Ruder Finn GI Symptoms Study (by Harris Interactive); 2013. 21. Data on file. AbbVie Inc. Source: SHS data (2018-2020), 2020.