This rare, but serious, digestive disorder usually requires several lab tests and a physical examination to be diagnosed accurately.

Exocrine pancreatic insufficiency (EPI) is a rare disorder where problems with certain enzymes make it difficult for your small intestine to digest food. A combination of a physical exam, review of your symptoms, and lab work is usually necessary to diagnose it.

EPI can be a challenge to diagnose because it mimics other digestive disorders. But getting an accurate diagnosis and treating EPI is critical, as it can lead to malnutrition and other potentially life threatening complications.

As food enters your small intestine during digestion, your pancreas excretes digestive juices containing enzymes that help break food down so its nutrients can be readily absorbed.

For most people with EPI, their pancreas doesn’t produce enough enzymes for proper digestion or not enough enzymes reach their small intestine for full digestion. EPI may also develop from other conditions related to digestive enzymes.

Though it’s relatively uncommon in the general public, a diagnosis of EPI is frequently received by individuals with chronic pancreatitis and those with cystic fibrosis.

Diagnosing EPI usually starts with a review of your medical history. Conditions such as pancreatitis and surgery involving your pancreas or upper gastrointestinal tract can lead to EPI.

A 2022 study suggests that certain physical features after pancreatic surgery, such as a main pancreatic duct diameter of more than 3 millimeters, are risk factors for EPI.

A personal history of smoking, drinking too much alcohol, or both may also raise your risk of EPI and other difficulties with pancreatic function. Similarly, having a family history of pancreatitis or other pancreas conditions may also raise your risk of having EPI.

A doctor or healthcare professional will also perform a physical examination and review your symptoms. A doctor will be looking for signs of unexplained weight loss and malnutrition.

A doctor may also check for abdominal swelling, listen with a stethoscope for sounds from your abdomen, and tap or gently press on your abdomen for signs of tenderness or pain.

Several types of lab tests are also used to diagnose EPI, including blood tests, stool tests, and tests of pancreatic function.

A 2019 report suggests that one of the most commonly performed and helpful stool tests for exocrine pancreatic function is called the fecal elastase-1 (FE-1) test. FE-1 is one type of digestive enzyme, and low levels of it in your stool can indicate that you have EPI.

A pancreatic function test is performed using an intravenous (IV) line to deliver secretin, a hormone that stimulates enzyme production in your pancreas, and a tube that runs through your nose down to your small intestine. A sample of fluid is retrieved through the tube to be analyzed in a lab.

Blood tests for EPI look for levels of certain vitamins and minerals that might indicate that you have malnutrition.

Typical symptoms of EPI can include:

  • abdominal cramps and pain
  • bloating
  • diarrhea or loose, foul-smelling stool
  • excess gas
  • weight loss

Because symptoms of EPI are shared by many other digestive disorders, doctors often don’t test for EPI right away. This is true even for people with established risk factors for EPI.

A 2020 study suggests that fewer than 7% of people with pancreatic cancer or chronic pancreatitis are tested for EPI.

Among the more common conditions that can mimic symptoms of pancreatic insufficiency are:

While results of the FE-1 test are widely used to help diagnose pancreatic insufficiency, there are a few other markers that are also helpful.

One of the most useful markers is serum trypsinogen, which can be used to determine your exocrine pancreatic function by testing the chemical made by your pancreas that circulates in your bloodstream.

A serum (blood) trypsinogen level of fewer than 20 nanograms per milliliter suggests you have pancreatic insufficiency. This can be useful in supporting other symptoms and lab tests that indicate EPI.

Pancreatic insufficiency is a treatable disorder.

But if it’s not managed properly, it can lead to severe complications, including early mortality due to cardiovascular conditions or malnutrition. It can also lead to osteoporosis and a reduced quality of life.

EPI tends to follow difficulties with your pancreas, such as the inflammatory condition pancreatitis. But it can develop in anyone. If you notice concerning pain or difficulties with your digestion or you experience unexplained weight loss, consult a doctor.

If you receive a diagnosis of EPI, the earlier you start on pancreatic enzyme replacement therapy (PERT) and begin to make dietary and other lifestyle changes, the sooner you’ll start to feel better and healthier.