Consider EPI in your differential diagnosis1

Patients with EPI may present with signs and symptoms similar to other GI conditions or diseases.

Signs and symptoms of EPI may include2-5:

Running person icon

Diarrhea

(frequent, soft bowel
movements)

Hands clutching a stomach

Abdominal pain

Balloon icon

Bloating

A gas cloud

Flatulence

Weight scale icon

Unexplained
weight loss

Toilet icon

Steatorrhea*

*Steatorrhea: >7 g of fecal fat per day while consuming 100 g of dietary fat per day.5

Select a condition below to view the shared symptoms with EPI2-10:

Female EPI patient
EPI
Symptoms
Diarrhea
Abdominal pain
Bloating
Flatulence
Unexplained
weight loss

Steatorrhea*
Image of two identical female patients, side by side
EPI
Symptoms
Diarrhea
Abdominal pain
Bloating
Flatulence
Unexplained
weight loss
Steatorrhea*
IBS-D
Symptoms
Diarrhea
Abdominal pain
Bloating
Flatulence
Mucus in stool
Image of two identical female patients, side by side
EPI
Symptoms
Diarrhea
Abdominal pain
Bloating
Unexplained
weight loss

Steatorrhea*
Flatulence
CELIAC
Symptoms
Diarrhea
Abdominal pain
Bloating
Unexplained
weight loss

Steatorrhea*
Anemia Constipation
Image of two identical male patients, side by side
EPI
Symptoms
Diarrhea
Abdominal pain
Bloating
Flatulence
Unexplained
weight loss

Steatorrhea*
SIBO
Symptoms
Diarrhea
Abdominal pain
Bloating
Flatulence
Unexplained
weight loss

Steatorrhea*
Anemia
Image of two identical male patients, side by side
EPI
Symptoms
Diarrhea
Abdominal pain
Unexplained
weight loss

Steatorrhea*
Bloating Flatulence
CROHN'S
Symptoms
Diarrhea
Abdominal pain
Unexplained
weight loss

Steatorrhea*
Anemia Fever
Hematochezia
Anorexia
Image of two identical female patients, side by side
EPI
Symptoms
Diarrhea
Abdominal pain
Unexplained
weight loss

Bloating Flatulence
Steatorrhea*
UC
Symptoms
Diarrhea
Abdominal pain
Unexplained
weight loss

Anemia Fever
Hematochezia
Mucus in stool
Anorexia

*Steatorrhea: >7 g of fecal fat per day while consuming 100 g of dietary fat per day.5

†Anemia has been reported in patients with EPI.4

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Clinically relevant maldigestion may occur earlier than overt symptoms of EPI3,11-13

Steatorrhea, the classic clinical sign of EPI, may not appear until the disease is advanced and may be absent when patients limit fat intake to avoid symptoms.

There may be significant maldigestion and malabsorption in patients without the classic clinical sign of steatorrhea.

References: 1. 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. 2. Ferrone M, Raimondo M, Scolapio JS. Pancreatic enzyme pharmacotherapy. Pharmacotherapy. 2007;27(6):910-920. 3. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122. 4. 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. 5. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73. 6. Longo DL, Fauci AS, Kasper DL, et al, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012. 7. Celiac disease symptoms. Celiac Disease Foundation website. https://celiac.org/celiac-disease/understanding-celiac-disease-2/celiacdiseasesymptoms. Accessed August 16, 2018. 8. Ruiz AR Jr. Bacterial overgrowth syndrome. Merck Manual Professional Version website. https://www.merckmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/bacterial-overgrowth-syndrome. Updated February 2018. Accessed August 16, 2018. 9. Lichtenstein G. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2012:913-921. 10. Sands BE, Siegel CA. Crohn’s disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Vol 2. 9th ed. Philadelphia, PA: Saunders Elsevier; 2010:1941-1973. 11. Dumasy V, Delhaye M, Cotton F, Deviere J. Fat malabsorption screening in chronic pancreatitis. Am J Gastroenterol. 2004;99(7):1350-1354. 12. Hart PA, Conwell DL. Diagnosis of exocrine pancreatic insufficiency. Curr Treat Options Gastroenterol. 2015;13(3):347-353. 13. Smith RC, Smith SF, Wilson J, et al; Working Party of the Australasian Pancreatic Club. Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency. Pancreatology. 2016;16(2):164-180.