If your doctor thinks you may have exocrine pancreatic insufficiency (EPI), they’ll order a combination of stool, blood, imaging, and pancreatic function tests.

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Digestive diseases affect 40 million people in the United States. One of these conditions is exocrine pancreatic insufficiency (EPI), which means the pancreas doesn’t produce or doesn’t make enough digestive enzymes.

Because no single test can confirm EPI, diagnosis usually involves a variety of tests. Your doctor may request stool, blood, and pancreatic function testing to confirm your diagnosis.

Learn more about how EPI is diagnosed.

A stool elastase test, also known as a fecal elastase-1 or FE-1 test, can identify low FE-1 levels in the stool. This can be a sign of EPI.

To perform this test, your doctor will give you a container to collect your stool. It’ll then be sent to a laboratory for testing.

A pancreatic function test examines how the pancreas responds to secretin, a hormone made by the small intestine that triggers the release of digestive enzymes.

To perform a pancreatic function test, your doctor will give you secretin through an IV. They’ll then insert a tube into your nose to your small intestine to collect fluids.

An upper gastrointestinal (GI) endoscopy may also be used to complete this test. This means they’ll pass a small, flexible tube called an endoscope through your mouth and into your esophagus.

Your doctor may recommend blood tests to determine if you have low levels of fat-soluble vitamins and minerals. They can also look for other signs of malnutrition that may indicate EPI.

After a technician draws your blood, it’ll be sent to a lab for testing. Your doctor will call you later to discuss the results.

If you have painful abdominal symptoms, your doctor may suggest imaging tests like:

These can give a more detailed picture of your pancreas and surrounding organs.

Doctors often request MRCPs because they can identify subtle duct changes, which they can use to determine pancreas function. Imaging, like a CT scan, may also be used to determine underlying causes of EPI.

In addition to laboratory tests and diagnostic imaging, your doctor will usually ask about your family and medical history. This can be useful to learn more about your symptoms and determine if you have risk factors for EPI.

Your doctor may ask about your family history of conditions like pancreatitis as well as whether you smoke or drink.

They might also perform a physical exam looking for signs of malnutrition and abdominal swelling or pain. This can include taking your weight, touching your abdomen, and listening to your abdomen with a stethoscope.

To diagnose EPI, doctors may look for evidence of nutrient malabsorption and measure the amount of exocrine pancreatic secretion. Diagnosis of EPI often involves direct and indirect testing.

While direct testing tries to evaluate pancreas secretive production, indirect testing looks for side effects of insufficient production.

If your doctor thinks that you have EPI, they may also request additional testing to determine what underlying causes are involved. This can also rule out other conditions that cause similar symptoms.

You should let your doctor know if you’re showing signs of EPI. These can include:

  • weight loss
  • diarrhea
  • smelly, greasy stools
  • abdominal pain
  • bloating
  • excess gas
  • low bone mass
  • trouble with night vision

Learn more about the signs and symptoms of EPI.

Treatment for EPI involves pancreatic enzyme replacement therapy (PERT) and lifestyle changes. If you have other conditions related to your EPI, these may require additional treatments, too.

Learn more about the treatment for EPI.

EPI may be caused by an inherited condition like cystic fibrosis that can’t be prevented. However, lifestyle changes may help reduce your risk of developing EPI from pancreatitis in some cases.

Avoiding smoking and alcohol, eating a balanced diet, finding healthy ways to manage stress, and getting regular exercise are some examples of lifestyle choices that can support pancreatic health.

To test for EPI, your doctor will usually look for signs of malnutrition and measure pancreatic secretions. They may recommend blood, stool, and pancreatic functioning tests.

They can also use medical imaging to check the health of your pancreas and look for other related health conditions.

If testing indicates that your pancreas isn’t producing enough enzymes, lifestyle changes and PERT can help you manage your symptoms.