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:
- Abdominal pain
- Unexplained weight loss
Consider EPI in patients with associated conditions
Think about EPI in patients who have one of the conditions known to be associated with EPI.
Conditions and surgical procedures associated with EPI7-15:
- Chronic pancreatitis (CP)
- Cystic fibrosis (CF)
- Pancreatic cancer
- Gastric surgery
- Diabetes (type I and IIIC)
- Obstruction of the biliary or pancreatic duct
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.2*
- How urgently do you need to have bowel movements? How frequently?
- Do you wake in the middle of the night to have a bowel movement? How frequently?
- 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?
- 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 K86.8116
An open conversation can reveal the facts
Use the EPI discussion guide to help you reach a diagnosis sooner.*
*Tests can confirm a diagnosis.
Tests that can help confirm a diagnosis of EPI
- Fecal elastase concentration (FE-1)2
- Qualitative fecal fat17
- Quantitative fecal fat: Standard for fat maldigestion (patient must follow a diet of 100g of fat/day)17,18
- Secretin-pancreozymin stimulation (performed at specialized centers)1
Clinically Diagnosing EPI
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. 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. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(suppl 1):5S-20S. 10. Hardt PD, Hauenschild A, Jaeger C, Teichmann J, Bretzel RG, Kloer HU; for the S2453112/S2453113 Study Group. High prevalence of steatorrhea in 101 diabetic patients likely to suffer from exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations: a prospective multicenter study. Dig Dis Sci. 2003;48(9):1688-1692. 11. Cavalot F, Bonomo K, Fiora E, et al. Does pancreatic elastase-1 in stools predict steatorrhea in type 1 diabetes? Diabetes Care. 2006;29(3):719-721. 12. Hahn JU, Kerner W, Maisonneuve P, Lowenfels AB, Lankisch PG. Low fecal elastase 1 levels do not indicate exocrine pancreatic insufficiency in type-1 diabetes mellitus. Pancreas. 2008;36(3):274-278. 13. Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978-2990. 14. Czakó L, Hegyi P, Rakonczay Z, Wittmann T, Otsuki M. Interactions between the endocrine and exocrine pancreas and their clinical relevance. Pancreatology. 2009;9(4):351-359. 15. Hackert T, Schütte K, Malfertheiner P. The pancreas: causes for malabsorption. Viszeralmedizin. 2014;30(3):190-197. 16. Centers for Disease Control and Prevention. ICD-10 Coordination and Maintenance Committee Meeting, March 18-19, 2015. 17. Hammer HF. Pancreatic exocrine insufficiency: diagnostic evaluation and replacement therapy with pancreatic enzymes. Dig Dis. 2010;28(2):339-343. 18. Mayo Foundation for Medical Education and Research. Test ID: FATF - Specimen: Fat, Feces. Mayo Clinic website. http://www.mayomedicallaboratories.com/test-catalog/Specimen/8310. Accessed October 2, 2018. 19. 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. 20. Data on file. AbbVie Inc. Source: SHS data (2015-2017), 2017. 21. Data on file. Ruder Finn GI Symptoms Study (by Harris Interactive); 2013.