Clinical Diagnosis
of EPI

EPI is largely a clinical diagnosis1*

A careful workup is necessary when suspecting Exocrine Pancreatic Insufficiency (EPI) and should include patient history, symptom assessment, and asking about underlying conditions and procedures. It's also important to get specific details about GI issues (including symptom onset, frequency, and severity) and patient diet.

Evaluate patients for signs and symptoms of EPI

Patients with EPI may present with signs and symptoms similar to other GI disorders. It’s key to take a history in your patients suspected of having EPI since not all patients will present with the classic clinical signs. Additionally, some patients may limit fat intake which can minimize symptoms.2-4

Patients with EPI may present with one or more of the following signs and symptoms2:

  • Diarrhea
  • Flatulence
  • Abdominal pain
  • Unexplained weight loss
  • Bloating
  • Steatorrhea (foul-smelling, greasy, oily stools)

Look for underlying conditions and procedures to help uncover EPI

EPI may be present in patients with the following underlying conditions or procedures5-8:

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

Other underlying conditions and procedures in which EPI has been reported include9-13:

  • Acute pancreatitis
  • Crohn’s disease
  • Celiac disease
  • Type I diabetes
  • Gastric resection/bypass

Watch a short video featuring physicians who offer insights into diagnosing EPI via telemedicine.

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 can help you reach a diagnosis sooner.1,14*†

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  • 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?
ICD-10 icon

Code directly for EPI using ICD-10 code K86.8115

Tests that can help confirm a diagnosis of EPI

  • FE-1: A single stool sample collection; a fecal elastase-1 value <200 µg/g of stool is considered abnormal16
  • Quantitative fecal fat: An entire stool collection over a 72-hour period in which patients must follow a specific diet (100 g of fat daily for 5 consecutive days); >7 g of fecal fat/24-hour period is considered abnormal17

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. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017;23(12)(suppl):S203-S209. 3. Durie P, Baillargeon J-D, 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. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl 6):vi1-vi28. 6. Kempeneers MA, Ali UA, Issa Y, et al; for Dutch Pancreatitis Study Group. Natural course and treatment of pancreatic exocrine insufficiency in nationwide cohort on chronic pancreatitis. Pancreas. 2020;49(2):242-248. 7. Matsumoto J, Traverso LW. Exocrine function following the Whipple operation as assessed by stool elastase. J Gastrointest Surg. 2006;10(9):1225-1229. 8. 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. 9. Hollemans RA, Hallensleben NDL, Mager DJ, et al; for Dutch Pancreatitis Study Group. Pancreatic exocrine insufficiency following acute pancreatitis: systematic review and study level meta-analysis. Pancreatology. 2018;18(3):253-262. doi:10.1016/j.pan.2018.02.009 10. Huang W, de la Iglesia-Garcia D, Baston-Rey I, et al. Exocrine pancreatic insufficiency following acute pancreatitis: systematic review and meta-analysis. Dig Dis Sci. 2019;64(7):1985-2005. doi:10.1007/s10620-019-05568-9 11. 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. 12. Chaudhary A, Domínguez-Muñoz JE, Layer 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. doi:10.1159/000501675 13. 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):7930-7946. 14. EPI Uncovered. American Gastroenterological Association website. Published October 24, 2016. Accessed November 13, 2020. 15. Centers for Disease Control and Prevention. ICD-10 coordination and maintenance committee meeting. March 18-19, 2015. 16. 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. 17. Hart PA, Conwell DL. Diagnosis of exocrine pancreatic insufficiency. Curr Treat Options Gastroenterol. 2015;13(3):347-353.