Exocrine pancreatic insufficiency: prevalence, diagnosis, and management

Figures & data

Table 1 Prevalence of EPI in different clinical conditions

EPI caused by pancreatic disorders
Disease	EPI prevalence	Factors associated with EPI occurrence
Chronic pancreatitis	30%–90%	• Long disease duration • Alcoholic etiology • Extensive calcifications • Ductal obstruction
Acute pancreatitis	Mild pancreatitis: 15%–20% Severe pancreatitis: 30%–40%	• Necrosis extent (>30%) • Alcoholic etiology
Autoimmune pancreatitis	30%–60%	Extensive mass/calcification
Unresectable pancreatic cancer	20%–60%	• Head localization • Large size • Ductal obstruction • Coexistent chronic pancreatitis
Pancreatic neoplasms after surgery	Pancreaticoduodenectomy: 80%–90% Distal pancreatectomy: 20%–50%	• Whipple intervention* • Gastropancreatic anastomosis*
Benign pancreatic tumor (before surgery)	30%–60%	• Head localization • Large size • Ductal obstruction • Coexistent chronic pancreatitis
Cystic fibrosis	80%–90%	Classes I, II, III, VI CFTR mutations
Shwachman–Diamond syndrome	80%–90%	-
EPI caused by extrapancreatic disorders
Type I diabetes	30%–50%	• High insulin requirement • Poor glycemic control • Early diabetes onset
Type II diabetes	20%–30%	• Insulin requirement • Poor glycemic control • Long diabetes duration
Inflammatory bowel disease	Ulcerative colitis: 10% Crohn’s disease: 4%	• Disease reactivation (only for temporary EPI) • Long disease duration • Surgical patients
Celiac disease	5%–80%	Untreated disease (no gluten-free diet)
Pediatric intestinal transplantation	10%
HIV syndrome	10%–50%	Retroviral therapy
Gastrointestinal surgery	Total/subtotal gastrectomy: 40%–80% Esophagectomy: 16%	• Extensive intestinal resection • Vagal denervation
Sjogren’s syndrome	10%–30%
Aging	15%–30%	Age >80 years
Tobacco usage	10%–20%	Alcohol usage
Somatostatin analogs therapy	20%

Note:

* Only for head tumor.

Abbreviation: EPI, exocrine pancreatic insufficiency; CFTR, cystic fibrosis transmembrane conductance regulator; AP, acute pancreatitis; AIP, autoimmune pancreatitis; CT, computed tomography; USP, United States Pharmacopeia; EUS, endoscopic ultrasonography.