Diagnosis of Exocrine Pancreatic Insufficiency
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.
KeywordsExocrine insufficiency Steatorrhea Chronic pancreatitis Pancreatic enzymes Lipase
Coefficient of fat absorption
Exocrine pancreatic insufficiency
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
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