Exocrine Pancreatic Insufficiency (EPI) is a disorder marked by deficient production or secretion of pancreatic enzymes, causing maldigestion and malabsorption. It commonly arises from chronic pancreatitis, cystic fibrosis, pancreatic cancer, and post-pancreatic surgery but may also occur in diabetes, celiac disease, and aging. Despite its substantial impact on nutrition and quality of life, EPI is frequently underdiagnosed and undertreated.
The condition arises from loss of functional pancreatic tissue or enzyme flow obstruction, leading to impaired breakdown of fats, proteins, and carbohydrates.
Clinical manifestations include steatorrhea, weight loss, bloating, and deficiencies in fat-soluble vitamins (A, D, E, K). Symptoms often develop insidiously and can be nonspecific, delaying diagnosis.
Diagnosis relies on clinical suspicion, nutritional evaluation, and laboratory tests. Faecal elastase-1 is a preferred non-invasive screening tool, though its sensitivity declines in mild EPI. Direct pancreatic function tests are more accurate but invasive and rarely used in routine practice.
Pancreatic Enzyme Replacement Therapy (PERT) is the mainstay of treatment, tailored to meal fat content. Acid-suppressing agents and dietary modifications may enhance enzyme efficacy and correct micronutrient deficiencies. Without treatment, EPI can lead to severe malnutrition, osteoporosis, and immune dysfunction. Early intervention with PERT significantly improves outcomes, necessitating long-term monitoring of nutritional status and bone health.
EPI remains an underrecognized yet clinically significant condition with diverse causes and serious consequences. Improved awareness, prompt diagnosis, and personalized management—particularly with PERT—are critical for optimizing patient well-being and preventing complications