An EPI patient wearing a flannel shirt

Several underlying medical conditions and surgical procedures affect the pancreas and may cause Exocrine Pancreatic Insufficiency (EPI). That’s why it’s important to be open with your doctor about your complete medical history. What may feel like “stomach issues” may be EPI if you have or have had one or more of the following: 

Underlying conditions or procedures which cause EPI

Other underlying conditions or procedures which may cause EPI


An EPI patient speaks

Where do you find support?

A doctor speaks

How is EPI diagnosed?

A green and orange pill capsule icon

How is EPI treated?

Reference sources:

1. Durie P, Baillargeon J-D, Bouchard S, Donnellan F, Zepeda-Gomez S, Teshima C. Diagnosis and management of pancreatic exocrine insufficiency (PEI) in primary care: consensus guidance of a Canadian expert panel. Curr Med Res Opin. 2018;34(1):25-33. 2. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl 6):vi1-vi28. 3. Kempeneers MA, Ali UA, Issa Y, et al; for Dutch Pancreatitis Study Group. Natural course and treatment of pancreatic exocrine insufficiency in a nationwide cohort of chronic pancreatitis. Pancreas. 2020;49(2):242-248. 4. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017;23(12)(suppl):S203-S209. 5. Matsumoto J, Traverso LW. Exocrine function following the Whipple operation as assessed by stool elastase. J Gastrointest Surg. 2006;10(9):1225-1229. 6. Yuasa Y, Murakami Y, Nakamura H, et al. Histological loss of pancreatic exocrine cells correlates with pancreatic exocrine function after pancreatic surgery. Pancreas. 2012;41(6):928-933. 7. Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World J Gastroenterol. 2013;19(42):7258-7266. 8. Hollemans RA, Hallensleben NDL, Mager DJ, et al; for Dutch Pancreatitis Study Group. Pancreatic exocrine insufficiency following acute pancreatitis: systematic review and study level meta-analysis. Pancreatology. 2018;18(3):253-262. doi:10.1016/j.pan.2018.02.009 9. Huang W, de la Iglesia-García D, Baston-Rey I, et al. Exocrine pancreatic insufficiency following acute pancreatitis: systematic review and meta-analysis. Dig Dis Sci. 2019;64(7):1985-2005. doi:10.1007/s10620-019-05568-9 10. Singh VK, Haupt ME, Geller DE, Hall JA, Quintana Diez PM. Less common etiologies of exocrine pancreatic insufficiency. World J Gastroenterol. 2017;23(39):7059-7076. 11. Pezzilli R, Andriulli A, Bassi C, et al; Exocrine Pancreatic Insufficiency collaborative Group. Exocrine pancreatic insufficiency in adults: a shared position statement of the Italian Association for the Study of the Pancreas. World J Gastroenterol. 2013;19(44):7930-7946. 12. Chaudhary A, Domínguez-Muñoz JE, Layer P, Lerch MM. Pancreatic exocrine insufficiency as a complication of gastrointestinal surgery and the impact of pancreatic enzyme replacement therapy. Dig Dis. 2020;38(1):53-68. doi:10.1159/000501675 13. EPI Uncovered. American Gastrointestinal Association website. https://s3.amazonaws.com/agaemailassets/images/EPI_Uncovered_AGA_Survey_Infographic.pdf. Published October 24, 2016. Accessed November 13, 2020. 14. Zhang J, Hou J, Liu D, et al. The prevalence and characteristics of exocrine pancreatic insufficiency in patients with type 2 diabetes: a systematic review and meta-analysis. Int J Endocrinol. 2022;2022:7764963. doi:10.1155/2022/7764963  15. Radlinger B, Ramoser G, Kaser S. Exocrine pancreatic insufficiency in type 1 and type 2 diabetes. Curr Diab Rep. 2020;20(6):18. doi:10.1007/s11892-020-01304-0