Consider EPI in your differential diagnosis of GI symptoms

Patients with EPI may present with signs and symptoms similar to other GI conditions or diseases. If your patient presents with one or more symptoms, consider EPI in your differential diagnosis.1

Symptoms of EPI may include2,3:

  • FREQUENT DIARRHEA
    (usually characterized by frequent, soft bowel movements)
  • UNEXPLAINED WEIGHT LOSS
  • STEATORRHEA*
  • FLATULENCE
  • BLOATING
  • ABDOMINAL PAIN

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

Select a condition to see how symptoms overlap with EPI2-8

EXOCRINE
PANCREATIC
INSUFFICIENCY
(EPI)

EPI

SYMPTOMS

  • Diarrhea
  • Abdominal pain
  • Bloating
  • Flatulence
  • Steatorrhea*
  • Weight loss
IRRITABLE
BOWEL
SYNDROME - DIARRHEA

EPI

SYMPTOMS

SHARED SYMPTOMS

IRRITABLE BOWEL SYNDROME
- DIARRHEA SYMPTOMS

  • Steatorrhea*
  • Weight loss
  • Diarrhea
  • Abdominal pain
  • Bloating
  • Flatulence
  • Mucus in stool
CELIAC
DISEASE

EPI

SYMPTOMS

SHARED SYMPTOMS

CELIAC DISEASE SYMPTOMS

  • Flatulence
  • Diarrhea
  • Abdominal pain
  • Bloating
  • Steatorrhea*
  • Weight loss
  • Anemia
  • Constipation

SMALL INTESTINAL
BACTERIAL
OVERGROWTH

EPI

SYMPTOMS

SHARED SYMPTOMS

SMALL INTESTINAL BACTERIAL OVERGROWTH SYMPTOMS

  • Diarrhea
  • Abdominal pain
  • Bloating
  • Flatulence
  • Steatorrhea*
  • Weight loss
  • Anemia
CROHN'S
DISEASE

EPI

SYMPTOMS

SHARED SYMPTOMS

CROHN’S DISEASE SYMPTOMS

  • Bloating
  • Flatulence
  • Diarrhea
  • Abdominal pain
  • Steatorrhea*
  • Weight loss
  • Anemia
  • Fever
  • Hematochezia
  • Anorexia
ULCERATIVE
COLITIS

EPI

SYMPTOMS

SHARED SYMPTOMS

ULCERATIVE COLITIS SYMPTOMS

  • Bloating
  • Flatulence
  • Steatorrhea*
  • Diarrhea
  • Abdominal pain
  • 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.



Steatorrhea, the
classic clinical sign
of EPI, may not
appear until disease
is advanced2,3,9

There may be significant maldigestion and malabsorption in patients without the classic clinical sign of steatorrhea. Clinically relevant maldigestion may occur earlier than the appearance of overt symptoms of EPI. Symptoms may not present until pancreatic damage is advanced.

Steatorrhea occurs when pancreatic function is ≤10% of normal output. Due to excess fat content in the stool, patients with steatorrhea will report bowel movements that are loose, floating, oily, and hard to flush.

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. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2) :116-122. 3. Ferrone M, Raimondo M, Scolapio JS. Pancreatic enzyme pharmacotherapy. Pharmacotherapy. 2007;27(6):910-920. 4. Longo DL, Fauci AS, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012. 5. Signs & symptoms of celiac disease. Celiac Support Association website. http://csaceliacs.org/symptoms_of_celiac_disease.jsp. Accessed August 11, 2016. 6. Bacterial overgrowth syndrome. The Merck Manual website. http://www.merckmanuals.com/professional/gastrointestinal_disorders/malabsorption_syndromes/bacterial_overgrowth_syndrome. Accessed August 11, 2016. 7. 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. 8. Lichtenstein G. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2012:913-921. 9. DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973;288(16):813-815.