Exocrine pancreatic insufficiency (EPI)
Definition:
Exocrine pancreatic insufficiency (EPI) refers to reducing
pancreatic enzyme activity (mainly pancreatic lipase) in the
intestinal lumen below the threshold required for digestive
functions. Leading to significant fat, carbohydrate, and protein
maldigestion and malabsorption
Causes:
- Cystic fibrosis in children (Chronic
pancreatitis in adults)
- Other causes include
- Acute pancreatitis
- Pancreatic tumors
- Diabetes mellitus
- Celiac disease
- Inflammatory bowel disease
- Bariatric surgery
- HIV/AIDS
- Genetic and congenital causes
Diagnosis
2 methods: Fecal elastase or Quantitative Fecal fat measurement
Fecal Elastase
<200 mcg/g indicates pancreatic insufficiency (watery stools may
give falsely low result)
Children with CF should be tested annually (or more frequently if
poor growth or abnormal stooling)
Pancreatic function test
Pancreatic function tests can also be used if diagnosis is in
question. These tests involve the collection of duodenal aspirates
before and after stimulation of the pancreas with a secretagogue,
such as secretin. The basis for this test is that secretin causes
the secretion of bicarbonate- and enzyme-rich fluid from the
pancreas. A peak bicarbonate concentration of less than 80 mEq/L is
consistent with pancreatic exocrine insufficiency.
References:
https://www.ncbi.nlm.nih.gov/books/NBK555926/