Current Treatment Options in Gastroenterology

, Volume 16, Issue 3, pp 306–315 | Cite as

Diagnosis and Management of Exocrine Pancreatic Insufficiency

  • Chris E. ForsmarkEmail author
Pancreas (V Chandrasekhara, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pancreas


Purpose of review

Recent studies have documented that many patients with pancreatic exocrine insufficiency (EPI) are not identified and are not treated with appropriate dosages of pancreatic enzyme replacement therapy. This review will summarize the approach to diagnosis, treatment, and monitoring for treatment effect and complications in patients with exocrine insufficiency.

Recent findings

While chronic pancreatitis is the most commonly identified cause of EPI, pancreatic cancer and pancreatic surgery are increasingly important. The diagnosis of EPI remains challenging, but fecal elastase is the most clinically useful test. Treatment requires an understanding of the appropriate dosage and timing of enzyme replacement, but recent studies show that clinicians often do not have this understanding. Monitoring and prevention of complications of EPI is increasingly important, particularly osteopenia and osteoporosis. In those that fail to respond, coexistent small intestinal bacterial overgrowth should be considered.


Many clinicians do not consider EPI in the differential diagnosis, and patients with EPI are routinely undertreated in the USA. Appropriate identification of those at risk and use of appropriate enzyme therapy, along with monitoring for metabolic complications of EPI, are essential to provide effective care for these patients.


Chronic pancreatitis Pancreatic cancer Exocrine pancreatic insufficiency 


Compliance with ethical standards

Conflict of interest

Chris E Forsmark 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 •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Gastroenterology, Hepatology, and NutritionUniversity of FloridaGainesvilleUSA

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