A patient with exocrine pancreatic insufficiency (EPI) may present with a range of clinical findings.
EPI should be suspected in a patient with chronic diarrhea, a history of pancreatic disease, or exposure to a risk factor (alcohol abuse, certain drugs).
Clinical signs and symptoms may include:
(1) bloating or abdominal discomfort
(2) borborygmi
(3) flatulence
(4) chronic diarrhea
(5) steatorrhea
(6) unintended weight loss
(7) weakness with sarcopenia
(8) complications of deficiency in fat vitamins (A, D, E, K, B12), including skin rash, neurologic symptoms, osteopenia, and visual complaints)
(9) protein malnutrition
The most performed screening test is fecal elastase-I (FE-I). In EPI the fecal levels of pancreatic elastase-I are reduced.
Other tests may include:
(1) coefficient of fat absorption (requiring a 72-hours fecal fat collection while on a high fat diet)
(2) breath tests following a test meal
(3) imaging studies of the pancreas
(4) endoscopic collection of pancreatic fluid after stimulation