Underlying Conditions and Procedures
That Can Cause EPI

Exocrine Pancreatic Insufficiency (EPI) may be present in patients with the following underlying conditions and procedures

  • Highly concentrated and viscous pancreatic juice blocks the pancreatic ducts leading to acinar atrophy, pancreatic fibrosis, and EPI2
  • Approximately 90% of patients with CF have EPI3
  • Destruction of functioning pancreatic parenchyma and obstruction of the pancreatic duct results in insufficient amounts of enzymes being secreted into the duodenum, and EPI2,4
  • 6%-22% of patients with CP have EPI at the time of CP diagnosis5,6
  • The probability of developing EPI increases over time to4-6:
    • 28% at 5 years after onset of CP
    • 50% at 12 years after onset of CP
    • 70% at 20 years after onset of CP
  • Prevalence may vary based on etiology, severity, and duration of CP4-6
  • EPI is a common complication of partial or complete removal of the pancreas, such as pancreatoduodenectomy (Whipple procedure)7,8
  • Frequency and severity of EPI may vary due to underlying condition, type and extent of surgery, and timing of EPI assessment9,10
  • Obstruction of the pancreatic duct by tumors, destruction of the pancreas by tumor growth, and loss of pancreatic tissue from surgery often lead to EPI2,11
  • Unresectable pancreatic cancer: 50%-92% of patients with unresectable pancreatic cancer have EPI12-14
  • Resectable pancreatic cancer (pre-surgery): 42%-68% of patients with resectable pancreatic cancer have EPI7,15,16
  • Resectable pancreatic cancer (post-surgery): 55%-89% of patients with resectable pancreatic cancer have EPI15-19

Other underlying conditions and procedures in which EPI has been reported include:

  • EPI can be a potential complication of AP and may develop early in the recovery phase or later20,21
  • EPI due to AP may be transient or permanent22
  • Alcoholic etiology, severity of AP, extent of necrosis, and previous episodes of AP may increase risk in developing EPI23
  • Crohn's disease could lead to EPI via a variety of mechanisms, including24:
    • Production of pancreatic autoantibodies
    • Damage to the pancreatic duct due to duodenal reflux
    • Scarring or inflammation leading to reduced secretory hormone secretion
  • Drugs used for the treatment of Crohn's disease have also been found to cause acute pancreatitis25
  • Celiac disease may lead to altered synthesis, storage, and/or secretion of secretin and cholecystokinin (CCK) due to defective postprandial response to intraluminal contents by an atrophic upper intestinal mucosa24
  • Pancreatic dysfunction is generally transient in patients with celiac disease and may improve with a gluten-free diet in some patients24
  • Pancreatic exocrine and endocrine tissue are closely linked both anatomically and physiologically. Conditions that affect one tissue type can cause an impairment in the other24,26,27
  • Potential causes of EPI in patients with type I diabetes include24:
    • Impaired acinar-islet interaction
    • Diminished trophic effects of insulin
    • Autonomic diabetic neuropathy
    • Diabetic microangiopathy
    • Autoantibodies against exocrine tissue
  • Gastric surgical procedures can result in physiological changes that disrupt neural or hormonal stimulation of pancreatic enzyme secretion or anatomical changes that cause asynchrony between gastric emptying and discharge of bile and pancreatic enzymes, resulting in EPI28,29
  • The prevalence of EPI after gastric surgery may vary widely based on the type and extent of surgery29
How EPI Is Diagnosed
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Understand the impact that EPI can have

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Symptoms of EPI are not always evident

Recognize the Signs
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What should a treatment plan for EPI include?

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