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Diagnosing EPI Using Telemedicine

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DESI: Hello, I’m Desi Williams, your moderator for today’s discussion. And today, we’re going to be speaking with a panel of physicians who are experts in the clinical diagnosis and treatment of Exocrine Pancreatic Insufficiency, or EPI, as it’s commonly known. Our focus today is diagnosis of EPI through telemedicine.

DESI: Joining me today are Dr. Adler, Dr. Briggs, and Dr. Suarez. Welcome doctors.

ALL DOCTORS: Thank you.

DESI: Today’s current technologies and circumstances have significantly increased the number of patient interactions that occur through telemedicine. Dr. Adler, are there different questions you ask when you begin to suspect EPI?

DR. ADLER: You know, when we talk to patients about EPI, I mean, we try to be straightforward and direct with them. Uh, so that they know exactly what it is we’re trying to know. And we do ask them pretty detailed questions about their bowel habits.

DR. ADLER: So paradoxically, we’re probably taking better histories now, uh, because we have so much more time to talk because we’re not doing an in-person physical exam.

DESI: So for you, Dr. Suarez, do you have any specific patient examples of how telemedicine may have benefited your patients?

DR. SUAREZ: You know, when we talk about diet, I've had a great example whereby they've been in their home and they're in their kitchen and they’ll, I’ll be like, okay, let’s look at your fridge.

DR. SUAREZ: Let’s see what you got in there. And so, they would open it up. And voila! There's a lot of things in there that may be causing a lot or contributing to their symptoms.

DR. ADLER: I’ve had people that I’ve been seeing for possible EPI evaluations who are literally smoking during the virtual visit and obviously that’s, if they do have EPI that’s a huge thing they want to stop.

DESI: How do you encourage patients to get specific and really open up about what's really going on with them?

DR. BRIGGS: Well, the first thing I do is I try to open up with them, that there’s a vast array of syndromes that can cause many of the same symptomatology that they may be experiencing and right away I feel like they feel like they’ve got an advocate that’s on their team.

DR. SUAREZ: You just need to be up front with them and just tell them that I’m here for you. I know that you’ve been going through this for many years and like Dr. Briggs has said, be an advocate for them, just be, just showing empathy from the get-go.

DESI: Uncovering symptoms is critical in arriving at a clinical diagnosis of EPI. Dr. Suarez, what are symptoms that you look for that might point to a suspected potential EPI diagnosis?

DR. SUAREZ: Yeah, the primary symptom and signs would include, uh, abdominal pain, excessive flatulence, abdominal bloating, and then things, such as, unexplained weight loss and an oily, greasy, foul-smelling stool.

DESI: As EPI can be confused with other GI conditions, it is important to ensure you are receiving a complete medical history from the patient to identify EPI risk factors or underlying conditions. Dr Adler, what are some underlying conditions that you look for when suspecting a potential, uh, EPI diagnosis?

DR. ADLER: Sure, when people have EPI, we start thinking about underlying causes and there’s a, there’s a small handful of diseases that we see very frequently, typically chronic pancreatitis, acute pancreatitis of varying severity, uh, people with gastric resections or pancreatic tumors, pancreatic cancers.

DR. ADLER: Up to and including those who have had pancreatic resections for any reason, either benign or malignant disease. And then to a lesser extent, sometimes we see it in the context of celiac disease or even diabetes Type I.

DESI: And, Dr. Briggs, with you working in more of a primary care setting, what are you seeing as some of the underlying conditions that might lead to a suspected EPI diagnosis?

DR. BRIGGS: So as a primary care physician, obviously I'm having to take care of patients with a vast array of medical conditions. Like Crohn’s disease seems to be connected, um, celiac disease seems to be connected, anybody with gastric surgery and then again, like a gastric sleeve or a gastric bypass.

DR. BRIGGS: All of these are complaints that I always have to consider EPI as a component.

DESI: While many things have changed in this diagnostic process, due to telemedicine, testing has largely remained unchanged. Dr. Adler, where are you sending your patients for testing?

DR. ADLER: We’ll typically send patients we’re seeing via telehealth to an outside lab that can either come to one of our laboratories or if they live far away, they can go to a nearby laboratory. But sometimes you can make a presumptive diagnosis of EPI based on, for example, history that you take over telehealth and review of prior labs and imaging. So that’s very, very convenient in the telehealth era.

DESI: So, now that you and your patients have become accustomed to telemedicine, do you anticipate that your practice will continue to fine tune your telemedicine approach? Or do you anticipate that your practice will start to slip back into the old normal?

DR. SUAREZ: Yeah, I think absolutely telemedicine is here and it’s going to thrive and it’s definitely in the future.

DR. BRIGGS: I’m really excited where this new era of medicine is taking us.

DESI: There you have it, three different physicians with three different approaches in their practice who all seem to agree on one thing, and that's the fact that telemedicine will continue to play a role in EPI diagnosis moving forward. So, Doctors Adler, Briggs, and Suarez, thank you so much for your time and your insights today.

DR. ADLER: Yeah, thanks for letting us be a part of this really important conversation.

DESI: For telemedicine tools that can help explain EPI, its causes and treatment, visit today.

Improving patient dialogue with Andres Gelrud, MD

Connecting the Dots: EPI Diagnosis with Rogelio Silva, MD

Diagnosing EPI Using Telemedicine

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