Understanding Exocrine
Pancreatic Insufficiency (EPI)

Normal pancreatic exocrine function

The secretion of pancreatic enzymes is an integral component of the digestion and absorption of nutrients. When nutrients arrive in the proximal small bowel, pancreatic enzymes begin to break them down.2,3

The “normal” amount of pancreatic enzyme secretion varies with content and volume of the meal ingested3

Meal-associated lipase averages 720,000 units per meal, ranging from 480,000 to 960,000 units per meal.3

EPI is a condition that affects the pancreas

EPI is a condition that occurs when the pancreas does not provide sufficient amounts of the three primary pancreatic digestive enzymes, which include lipase, amylase, and protease.4

Steatorrhea is observed when pancreatic enzyme output drops below 10% of normal5

There may be significant maldigestion and malabsorption without the classic clinical sign of steatorrhea, which may not occur until disease is advanced6,7

Fat maldigestion is the most profound digestive dysfunction in EPI4

  • Malabsorption of fat-soluble vitamins A, D, E, and K may accompany EPI4
  • Maldigestion and poor absorption of nutrients can lead to malnutrition6,8-10
Learn more about
EPI symptoms
Symptoms of EPI are not always evident. Learn to recognize the signs

Symptoms of EPI are not always evident

Recognize the Signs
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. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73.
  4. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl 6):vi1-vi28.
  5. Ferrone M, Raimondo M, Scolapio JS. Pancreatic enzyme pharmacotherapy. Pharmacotherapy. 2007;27(6):910-920.
  6. 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.
  7. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122.
  8. Dumasy V, Delhaye M, Cotton F, Deviere J. Fat malabsorption screening in chronic pancreatitis. Am J Gastroenterol. 2004;99(7):1350-1354.
  9. Graff GR, Maguiness K, McNamara J, et al. Efficacy and tolerability of a new formulation of pancrelipase delayed-release capsules in children aged 7 to 11 years with exocrine pancreatic insufficiency and cystic fibrosis: a multicenter, randomized, double-blind, placebo-controlled, two-period crossover, superiority study. Clin Ther. 2010;32(1):89-103.
  10. Whitcomb DC, Lehman GA, Vasileva G, et al. Pancrelipase delayed-release capsules (CREON) for exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery: a double-blind randomized trial. Am J Gastroenterol. 2010;105(10):2‌276-‌2286.
  11. Lindkvist B, Phillips ME, Domínguez-Muñoz JE. Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: Prevalence and diagnostic use [published online July 17 2015]. Pancreatology. 2015. doi: 10.1016/j.pan.2015.07.001.

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