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

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:

Celiac Disease

12-30%

Inflammatory Bowel Disease

19-30%

Chronic Pancreatitis (Mild - severe disease)

30-85%

Inoperable Pancreatic Cancer

50-100%

Crohn’s Disease

14%

Irritable Bowel Syndrome

4-6%

Ulcerative Colitis

22%

Surgery: Distal Pancreatectomy

19-80%

Cystic Fibrosis (Approximate EPI prevalence in newborns)

85%

Sleeve Gastrectomy

5%

Diabetes Type 1

26-44%

Surgery: Roux-en-Y Gastric Bypass*

9-31%

Diabetes Type 2

12-20%

Biliopancreatic diversion with duodenal switch

75%

HIV/AIDS

26-45%

Surgery: Whipple

56-98%

Celiac Disease

12-30%

Chronic Pancreatitis (Mild - severe disease)

30-85%

Crohn’s Disease

14%

Ulcerative Colitis

22%

Cystic Fibrosis (Approximate EPI prevalence in newborns)

85%

Diabetes Type 1

26-44%

Diabetes Type 2

12-20%

HIV/AIDS

26-45%

Inflammatory Bowel Disease

19-30%

Inoperable Pancreatic Cancer

50-100%

Irritable Bowel Syndrome

4-6%

Surgery: Distal Pancreatectomy

19-80%

Sleeve Gastrectomy

5%

Surgery: Roux-en-Y Gastric Bypass†

9-31%

Biliopancreatic diversion with duodenal switch

75%

Surgery: Whipple

56-98%

Consider EPI in patients with the above conditions.

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.5

*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†

 

Timely and accurate diagnosis of EPI is important, as delays in treatment prolong maldigestion and malabsorption, with potentially serious consequences for malnutrition, overall health and quality of life.7 In a recent online survey of EPI patients:

57%

Of patients reported that 2 or more physicians were required for a confirmed diagnosis of EPI.

25%

Of patients reported waiting more than a year to seek help for 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.