Symptoms of EPI
One or more of these symptoms, in addition to various clinical features, could mean EPI2
Abdominal pain
Bloating
Flatulence
Unexplained
weight loss
Steatorrhea*
Clinical features associated with malabsorption and malnutrition may occur earlier than overt symptoms, such as steatorrhea.3,4
- According to a survey conducted by the American Gastroenterological Association (AGA), the top 3 symptoms EPI patients present with are frequent gas and/or bloating, unexplained abdominal pain, and frequent diarrhea5†
- Steatorrhea does not occur until at least 90% of pancreatic output has been compromised, and it may be subclinical when patients limit fat intake to avoid symptoms6
- Take a careful history of patients suspected to have EPI since not all patients will present with the same combination, frequency, and/or severity of symptoms4,5
Symptoms of EPI can overlap with those of other GI conditions
Symptoms such as diarrhea, abdominal pain, bloating, and flatulence are common across a wide range of various GI conditions, which is why it's important to keep EPI in your differential diagnosis.2
| EPI2 | IBS-D7,8 | SIBO9 | IBD10-13 | Celiac disease14 | |
| Diarrhea | applicable | applicable | applicable | applicable | applicable |
|---|---|---|---|---|---|
| Abdominal pain | applicable | applicable | applicable | applicable | applicable |
| Bloating | applicable | applicable | applicable | applicable | applicable |
| Flatulence | applicable | applicable | applicable | applicable | applicable |
This chart is intended for informational purposes only. This is not a complete list of signs and symptoms and is not intended to be used to diagnose, treat, or care for any particular patient.
With EPI, the inability to properly digest fats may cause stools to appear greasy or smell foul due to too much fat in stools. This is known as steatorrhea, a symptom that may not appear until 90% of exocrine pancreatic function is compromised. As a result of inadequate enzyme output or activity, EPI leads to maldigestion and malabsorption, which leads to malnutrition and malnutrition-related complications.2,15-17*
Assessing clinical features can help you distinguish between EPI and other GI conditions
Overlapping symptoms of other GI conditions can make it difficult to get to an EPI diagnosis. Therefore, it's important to assess clinical features, such as symptom onset and stool quality, in addition to symptom presentation.2,12,18,19
| EPI2,12,18,20 | IBS-D7,12,21 | SIBO9,12 | IBD10-12 | Celiac disease12,14 | |
| Symptom onset related to food intake | Worsens with fatty meal | Worsened by foods high in sugar and fiber |
applicable‡ | Triggered by gluten | |
|---|---|---|---|---|---|
| Nocturnal symptoms | Improve when sleeping | applicable§ | |||
| Stool quality | Fatty; may not be very loose | Watery | Fatty | Bloody/purulent | Watery/fatty |
| Fecal Urgency | applicable | applicable | applicable‖ | ||
| Fecal incontinence | applicable | applicable | |||
| Unexplained weight loss | applicable | In extreme cases | applicable | applicable |
This chart is intended for informational purposes only. This is not a complete list of clinical features and is not intended to be used to diagnose, treat, or care for any particular patient.
With EPI postprandial onset of symptoms is due to inadequate production, delivery, or activity of digestive enzymes.2,16,22
Take a closer look at the underlying conditions and surgical procedures that can cause EPI.
*Steatorrhea: ≥7 g of fecal fat per day while consuming 100 g of dietary fat per day in the context of a 72-hour stool test.6
†EPI Uncovered is based on an online survey conducted by Harris Poll from May 17 through June 20, 2016. It included 1,001 US adults aged 18 and older who experienced at least 2 gastrointestinal issues 3 or more times in the past 3 months ("patients"), as well as 250 primary care physicians (PCPs) and 250 gastroenterologists in the United States who are 18 years or older and licensed. Figures for patients were weighted where necessary based on age, education, gender, race/ethnicity, region, income, size of household, marital status, and likelihood to be online to bring them into line with their actual proportions in the population. Figures for PCPs and gastroenterologists were weighted on years in practice, gender, and region, where necessary, to bring them into line with their actual proportions in the population.
‡May occur despite fasting (ileitis).
§May occur in Crohn's disease ileitis.
‖May occur in ulcerative colitis.
EPI = exocrine pancreatic insufficiency; GI = gastrointestinal; IBD = inflammatory bowel disease; IBS-D = irritable bowel syndrome with diarrhea; SIBO = small intestinal bacterial overgrowth.