Have you considered pancreatic enzyme insufficiency in patients with predisposing conditions?

The prevalence of EPI (Exocrine Pancreatic Insufficiency) in the general population is unknown. However, the prevalence of EPI can be fairly high among certain subgroups of individuals. The importance of a past medical, surgical, family and social history is important to explain the symptoms and guide investigations of potential EPI causes and a confirmed diagnosis.5

The estimated prevalence of EPI can vary by condition or surgical procedure 5,10,16,17

In addition to high prevalence in patients with with Chronic Pancreatitis (CP), Cystic Fibrosis (CF) and pancreatic cancer, EPI may also coexist with gastrointestinal conditions.

According to the AGA’s 2023 Clinical Practice Update Expert Review and Best Practice Advice, EPI should be considered in patients with moderate-risk clinical conditions, such as duodenal diseases, including celiac and Crohn's disease; previous intestinal surgery; longstanding diabetes mellitus; and hypersecretory states.4

Review the estimated prevalence of EPI by condition and surgical procedure:

Common Predisposing Conditions
Chronic Pancreatitis (Mild - severe disease)
30-85%
Cystic Fibrosis (Approximate EPI prevalence in newborns)
85%
Inoperable Pancreatic Cancer
50-100%
Gastrointestinal Conditions
Celiac Disease
12-30%
Crohn’s Disease
14%
Inflammatory Bowel Disease
19-30%
Ulcerative Colitis
22%
Metabolic and Immunodeficiency Conditions
Diabetes Type 1
26-44%
Diabetes Type 2
12-20%
HIV/AIDS
26-45%
Bariatric and Pancreatic Surgeries
BPD/DS*
75%
Distal Pancreatectomy
19-80%
Roux-en-Y Gastric Bypass†
9-31%
Sleeve Gastrectomy
4%
Whipple
56-98%

*Biliopancreatic diversion with duodenal switch

†In one study, EPI was diagnosed in 9.1% of patients one year after Roux-en-Y, mini-omega or loop gastric bypass. In another study, 31% of patients were diagnosed with EPI 52 months after distal and proximal Roux-en-Y gastric bypass. The prevalence of EPI after bariatric surgery can vary based on the type and extent of the surgery. The likelihood of EPI after gastric banding is low, however after a sleeve gastrectomy, the neuronal network is impaired, and small percentage of patients with EPI can be expected (4.3%).16,17

Real patient perspectives — the path to EPI diagnosis‡

 

In an online survey, patients reported that before being diagnosed with EPI, their most troublesome symptoms were: diarrhea, stomach pain, oily stools and gas. Prior to their EPI diagnosis:

38%

Worried about interruptions from urgent, unpredictable symptoms

39%

Reported being upset not knowing what was causing their symptoms

‡PANCREAZE Patient Survey: Online survey conducted in January 2023. Responses from 133 EPI patients and caregivers of patients with EPI. Respondents were not remunerated for their participation in the survey.