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Making the diagnosis of EPI, particularly at the beginning of the condition, at the beginning of the disease, can be very challenging. Particularly in the early stages because it can mimic other GI conditions. Not only that, frequently the patients do not completely open up, and they don’t tell you all the symptoms that they’re having.
And, actually, frequently what I see is that we, as physicians, are not asking the right questions, so we are not making the right diagnosis early on.
When we can sense that the patient is a little bit apprehensive, that the patient doesn’t like to talk about stool. So we tell them, listen, we are in the gastroenterology world. We do colonoscopies, we deal with stool every day. We talk about stool and GI symptoms every day. So, we need to know all of the information so we can put all of the pieces of the puzzle together and try to come out with a diagnosis as soon as possible to prevent problems associated with malabsorption of food. Frequently during the first visit, you get a good history and then during the second or subsequent visits, you start to hear more and more information about their symptoms that actually are going to help you make the diagnosis.
It’s very, very helpful to tell the patients, listen, write down what you ate and what happened after you ate.
If you have a big dinner, you know, what happens after? Do you ever wake up in the middle of the night to have a bowel movement? Because frequently they don’t make the connection or they forgot.
When the patients call us even before we see them in the office, if they say that the stool is looking funny and they don’t know how to describe it and so, nowadays everybody has a camera in their phones.
Believe it or not, we tell our patients to take a picture and send it or bring it, because that’s going to be extremely helpful.
Another way that I approach the patients when we’re dealing particularly about the bowel movements, how they look, and if they’re oily or not I show them pictures that we have actually of what steatorrhea is, or how a pale bowel movement or a floating bowel movement looks. And these are very helpful tools to have with you to help the patient open up.
Share these videos with your patients who
may want to learn more about living with EPI.