Exocrine pancreatic insufficiency: prevalence, diagnosis, and management

Gabriele Capurso,1 Mariaemilia Traini,1 Matteo Piciucchi,2 Marianna Signoretti,2 Paolo Giorgio Arcidiacono1 1Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy; 2Digestive and Liver Disease Unit, Sant’Andrea Hospital, Sapienza University, Rome, Italy Abstract: Exocrine pancreatic insufficiency (EPI) is a condition caused by reduced or inappropriate secretion or activity of pancreatic juice and its digestive enzymes, pancreatic lipase in particular. EPI can result in clinical manifestation and biochemical alterations causing reduced quality of life and life-threating complications. EPI is common in pancreatic disorders, where it should be suspected and actively investigated, and in many extrapancreatic conditions. There are various tests available to diagnose EPI, with indirect, noninvasive ones, such as concentration of fecal elastase being more commonly employed. Administration of pancreatic enzymes replacement therapy remains the mainstay of EPI treatment. The present review article will discuss current evidence regarding the prevalence of EPI, the available tests to diagnose it and its treatment. Keywords: exocrine pancreatic insufficiency, chronic pancreatitis, pancreatic cancer, elastase, malnutrition, diagnosis, therap