Current Treatment Options in Gastroenterology

, Volume 13, Issue 3, pp 347–353 | Cite as

Diagnosis of Exocrine Pancreatic Insufficiency

  • Phil A. Hart
  • Darwin L. Conwell
Pancreas (T Stevens, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pancreas

Opinion statement

The accurate diagnosis of exocrine pancreatic insufficiency (EPI) helps identify those in need of pancreatic enzyme replacement therapy. Conversely, ruling out EPI identifies those in which additional evaluation should be pursued to explain their symptoms. There are many available tests that can be used to diagnose EPI; however, the tests must be tailored to each clinical scenario. Tests that are convenient but less accurate (e.g., fecal elastase-1, qualitative fecal fat determination) are best suited for patients with a high pretest probability of EPI. In contrast, tests that are highly accurate but more cumbersome (e.g., endoscopic pancreatic function testing, 72-h fecal fat collection) are favored in patients suspected to have mild EPI or an early stage of chronic pancreatitis. Additional research is needed to identify a more convenient means of accurately diagnosing at all stages of EPI.


Exocrine insufficiency Steatorrhea Chronic pancreatitis Pancreatic enzymes Lipase 



Coefficient of fat absorption


Exocrine pancreatic insufficiency


Fecal elastase-1


13C-mixed triglyceride breath test


Pancreatic enzyme replacement therapy


Proton pump inhibitor


Compliance with Ethics Guidelines

Conflict of Interest

Phil A. Hart declares that he has no conflict of interest.

Darwin L. Conwell declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC 2015

Authors and Affiliations

  1. 1.Section of Pancreatic Disorders, Division of Gastroenterology, Hepatology, & NutritionThe Ohio State University Wexner Medical CenterColumbusUSA

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