What Is EPI?

Like other rare conditions, exocrine pancreatic insufficiency (EPI) is often difficult to diagnosis, especially if you’re only experiencing mild to moderate symptoms.

Keep reading to learn more about the diagnosis process and what tests you can expect.

How Is EPI Diagnosed?

Diagnosing EPI will likely begin with your doctor performing a physical examination and asking about your medical history. Your medical history will provide important clues for diagnosing EPI. For example, EPI is more common in those who’ve had digestive tract surgery or have a history of pancreatic disease. Your doctor will also ask questions about your family’s medical history.

Your doctor will also try to rule out other conditions that can cause similar symptoms such as:

If you have symptoms of severe EPI, such as fatty, oily stools, unexplained diarrhea and weight loss, some doctors may diagnose you based on your physical exam and medical history alone. More likely, you’ll also undergo specific diagnostic tests to help your doctor identify any underlying condition that’s causing your EPI, such as pancreatitis or pancreatic cancer.

Imaging Tests

CT Scans

CT scans are a special type of X-ray used to examine soft tissue for damage or abnormalities, such as masses and tumors.

Endoscopic Ultrasound

In this test a probe is inserted into your mouth, down your esophagus, and into your stomach, until the probe reaches the first part of your small intestine. It provides a detailed image of the pancreas and lets your doctor look for pancreatitis, pancreatic tumors, and cysts.


If more information is needed about the appearance of your pancreas, your doctor may use an MRI instead of a CT scan to look for pancreatic cancer.

Abdominal X-ray

An X-ray may be used to look for damage in the pancreas.

Pancreatic Function Tests

In addition to imaging tests, you can also expect to undergo laboratory tests that measure the functionality of your pancreas.

Stool Tests

Fat in the stool is one of the first signs of EPI. This can be measured or looked for under a microscope.

The Van de Kamer test measures the amount of fat in the stool and is considered one of the most sensitive ways to diagnose EPI. However, the test is difficult to complete because it requires collecting stool samples for three days and keeping strict measurements of your fat intake. The test is challenging to do and the large volume of stool samples makes it unpleasant for the patient and laboratory staff. Because of this, doctors rarely use it.

A test called fecal elastaseis widely used for EPI. It measures levels of the enzyme elastase in a person’s stool, which people with EPI have in smaller amounts. While it’s easy to use, it’s only reliable for detecting moderate to severe EPI.

Breath Test

A breath test is the most reliable and practical way to diagnose moderate EPI. This test involves eating a meal with a special chemical signature in it. After you digest the meal and breathe out an air sample, the chemicals in the air are measured to see how much of the signature remains. The amount of the signature that you exhale is related to how well your pancreas is working.

The breath test is also the only test that can measure the success of therapy to replace your pancreatic enzymes. However, this test is not yet widely available due to its expense.

Secretin Test

While the secretin test is a direct measurement of how well your pancreas is working, it requires inserting a tube into the small intestine. Since it’s so invasive, it’s rarely used compared to other tests.

Blood Tests

Your doctor can order a blood test to determine nutrient shortages or signs of malnutrition caused by EPI.

The Takeaway

If you have symptoms of EPI it’s important that you talk with your doctor. Diagnosing EPI and any underlying conditions as early as possible will help improve your quality of life and prevent further complications.