Symptoms and Associated Conditions of Exocrine Pancreatic Insufficiency (EPI)

The symptoms of EPI may be overlooked because they are similar to those of other GI conditions2-9

Symptoms EPI IBS-D Celiac disease Small intestinal bacterial overgrowth
Abdominal pain
Weight loss

This chart is for informational purposes only. This list is not a complete list of symptoms and it is not intended to be used to diagnose, treat, or care for any particular patient.

*Steatorrhea: >7 g of fecal fat per day while consuming 100 g of dietary fat per day.

Steatorrhea, which is characterized by foul-smelling, greasy stools, is the most common clinical manifestation of EPI and may not appear until the disease is advanced.3

EPI is associated with certain conditions that affect
the pancreas3,10

Look for symptoms of EPI in patients
with these associated conditions3,10-17:

How EPI Is Diagnosed
Understand the impact that EPI can have

Understand the impact that EPI can have

Learn More
EPI is largely a clinical diagnosis

EPI is largely a clinical diagnosis*

*Tests can help confirm a diagnosis of EPI.

Get the Details
Use the CREON® (pancrelipase) Treatment Tracker to help educate patients about their therapy

What should a treatment plan for EPI include?

Learn More

Indications and Important
Safety Information


CREON® (pancrelipase) Delayed-Release Capsules is a pancrelipase which is a combination of porcine-derived lipases, proteases, and amylases indicated for the treatment of exocrine pancreatic insufficiency due to cystic fibrosis, chronic pancreatitis, pancreatectomy, or other conditions.

Important Safety Information

  • Fibrosing colonopathy is associated with high-dose use of pancreatic enzyme replacement in the treatment
    of cystic fibrosis patients. Exercise caution when doses of CREON exceed 2,500 lipase units/kg of body weight
    per meal (or greater than 10,000 lipase units/kg of body weight per day).
  • To avoid irritation of oral mucosa, care should be taken to ensure that CREON is not crushed, chewed, or retained in the mouth. CREON should always be taken with food.
  • Porcine-derived pancreatic enzyme products contain purines. Caution should be exercised when prescribing CREON to patients with gout, renal impairment, or hyperuricemia.
  • There is theoretical risk of viral transmission with all pancreatic enzyme products including CREON.
  • Exercise caution when administering pancrelipase to a patient with a known allergy to proteins of porcine origin.
  • Adverse reactions that occurred in at least 2 cystic fibrosis patients (greater than or equal to 4%) receiving CREON were vomiting, dizziness, and cough.
  • Adverse reactions that occurred in at least 1 chronic pancreatitis or pancreatectomy patient (greater than or equal to 4%) receiving CREON were hyperglycemia, hypoglycemia, abdominal pain, abnormal feces, flatulence, frequent bowel movements, and nasopharyngitis.
  • CREON is not interchangeable with any other pancrelipase product.

Reference: 1. CREON [package insert]. North Chicago, IL: AbbVie Inc.

  1. References:
  2. CREON [package insert]. North Chicago, IL: AbbVie Inc.
  3. Leeds JS, Oppong K, Sanders DS. The role of fecal elastase-1 in detecting exocrine pancreatic disease. Nat Rev Gastroenterol Hepatol. 2011;8(7):405-415.
  4. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122.
  5. Ferrone M, Raimondo M, Scolapio JS. Pancreatic enzyme pharmacotherapy. Pharmacotherapy. 2007;27(6):910-920.
  6. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017;23(suppl 12):S203-S209.
  7. Celiac disease symptoms. Celiac Disease Foundation website.​/understanding-celiac-disease-2​/celiacdiseasesymptoms/. Accessed October 20, 2017.
  8. Longo DL, Fauci AS, Kasper DL, et al, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012.
  9. Bacterial overgrowth syndrome. The Merck Manual website.​/professional​/gastrointestinal-disorders​/malabsorption-syndromes​/bacterial-overgrowth-syndrome. Accessed October 20, 2017.
  10. DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973;288(16):813-815.
  11. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(suppl 1):S5-S20.
  12. Hardt PD, Hauenschild A, Jaeger C, Teichmann J, Bretzel RG, Kloer HU. High prevalence of steatorrhea in 101 diabetic patients likely to suffer from exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations: a prospective multicenter study. Dig Dis Sci. 2003;48(9):1688-1692.
  13. Cavalot F, Bonomo K, Fiora E, et al. Does pancreatic elastase-1 in stools predict steatorrhea in type 1 diabetes? Diabetes Care. 2006;29(3):719-721.
  14. Hahn JU, Kerner W, Maisonneuve P, Lowenfels AB, Lankisch PG. Low fecal elastase 1 levels do not indicate exocrine pancreatic insufficiency in type-1 diabetes mellitus. Pancreas. 2008;36(3):274-278.
  15. Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978-2990.
  16. Czakó L, Hegyi P, Rakonczay Z, Wittmann T, Otsuki M. Interactions between the endocrine and exocrine pancreas and their clinical relevance. Pancreatology. 2009;9(4):351-359.
  17. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl 6):vi1-vi28.
  18. Yuasa Y, Murakami Y, Nakamura H, et al. Histological loss of pancreatic exocrine cells correlates with pancreatic exocrine function after pancreatic surgery. Pancreas. 2012;41(6):928-933.

back to top #tbd