How Is Exocrine Pancreatic Insufficiency Diagnosed?

For a reliable diagnosis of this uncommon but dangerous intestinal illness, many blood tests and a physical examination are typically necessary.

With exocrine pancreatic insufficiency (EPI), an uncommon illness, your small intestine struggles to break down food because of issues with specific enzymes. To diagnose it, a physical examination, a discussion of your symptoms, and laboratory tests are typically required.

EPI resembles other digestive illnesses, making diagnosis difficult. However, as EPI can cause starvation and other potentially fatal consequences, receiving a proper diagnosis and treating it are essential.

What is pancreatic insufficiency?

During the digestive process, your pancreas secretes digestive juices that contain enzymes to aid in the breakdown of food and facilitate the easy absorption of its nutrients as it passes through your small intestine.

The majority of EPI patients either have insufficient pancreatic production of digestive enzymes or insufficient enzyme delivery to the small intestine for complete digestion. EPI can also result from other disorders involving digestive enzymes.

Even though it's not very common in the general population, people with cystic fibrosis and chronic pancreatitis often get an EPI diagnosis.

How is it diagnosed?

Examining your medical history is typically the first step in the diagnosis of EPI. EPI can result from diseases including pancreatitis and surgeries related to the upper gastrointestinal tract or pancreas.

A 2022 study indicates that physical characteristics following pancreatic surgery, such as a diameter of more than 3 millimetres in the primary pancreatic duct, may be risk factors for end-stage pancreatitis (EPI).

A personal history of excessive alcohol consumption, smoking, or both may further increase your risk of developing EPI and other pancreatic function issues. In a similar vein, a family history of pancreatitis or other pancreatic disorders may also increase your chance of developing endometriosis (EPI).

In addition, a medical practitioner or other qualified specialist will assess your symptoms and do a physical examination. A physician will be searching for indications of malnourishment and unexplained weight loss.

A physician may also feel for signs of soreness or pain in your belly, listen for sounds coming from your abdomen with a stethoscope, and examine for abdominal swelling.

Blood tests, stool testing, and pancreatic function tests are among the lab tests that are performed to diagnose EPI.

The faecal elastase-1 (FE-1) test is one of the most widely used and beneficial stool tests for exocrine pancreatic function, according to a 2019 publication. One type of digestive enzyme is FE-1, and insufficient amounts of this enzyme in your stool may be a sign of endometriosis (EPI).

During a pancreatic function test, an intravenous (IV) line is used to provide secretin, a hormone that causes your pancreas to produce more enzymes, and a tube passes through your nose and into your small intestine. Via the tube, a fluid sample is obtained for laboratory analysis.

The purpose of EPI blood tests is to measure certain vitamin and mineral levels that may be indicative of malnutrition.

Symptoms

Typical EPI symptoms include the following:

• excess gas
• bloating
• weight loss
• abdominal cramps and pain
• diarrhea or loose, foul-smelling stool

What can mimic exocrine pancreatic insufficiency?

Doctors frequently wait to test for EPI since the symptoms of the condition are similar to those of many other digestive illnesses. Even those who have established risk factors for EPI can attest to this.

Less than 7% of patients with pancreatic cancer or chronic pancreatitis, according to a 2020 study, may undergo an EPI test.

The following are some of the more prevalent illnesses that can resemble pancreatic insufficiency symptoms:

• celiac disease
• Crohn’s disease
• irritable bowel syndrome
• ulcerative colitis
• illnesses like SIBO (small intestine bacterial overgrowth)

What is the marker for pancreatic insufficiency?

A few other markers can also be useful in the diagnosis of pancreatic insufficiency, in addition to the results of the FE-1 test.

Serum trypsinogen, a substance produced by the pancreas that circulates in your bloodstream, is one of the most helpful markers for assessing exocrine pancreatic function.

Pancreatic insufficiency is indicated by a serum (blood) trypsinogen level of less than 20 nanograms per millilitre. This may help to corroborate other symptoms and laboratory results that point to EPI.

Is pancreatic insufficiency fatal?

The condition known as pancreatic insufficiency is curable.

However, if left untreated, it might result in serious side effects, such as early death from starvation or cardiovascular disease. Moreover, it may result in osteoporosis and a lower standard of living.

Takeaway

EPI typically follows pancreatitis, an inflammatory illness involving the pancreas. However, anyone can develop it. Seek medical attention if you have unexplained weight loss, notice painful or difficult digestion or both.

The sooner you begin pancreatic enzyme replacement therapy (PERT) and implement dietary and other lifestyle modifications if you are diagnosed with end-stage pancreatitis (EPI), the sooner you will start to feel better and be healthier.