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:

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(frequent, soft bowel

Hands clutching a stomach

Abdominal pain

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A gas cloud


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weight loss

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

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. Accessed August 16, 2018. 8. Ruiz AR Jr. Bacterial overgrowth syndrome. Merck Manual Professional Version website. 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.