How Is EPI Diagnosed? Understanding Tests for Exocrine Pancreatic Insufficiency
Key Takeaways
- EPI diagnosis involves more than symptoms alone.
- A fecal elastase-1 test is commonly used when evaluating for EPI.
- Blood tests may help identify nutritional deficiencies or other effects of malabsorption.
- Specialized pancreatic function testing may be used in certain situations.
- Digestive symptoms can have many causes, so testing should be interpreted by a healthcare professional.
- Nutrition support can be an important part of living with EPI.
- Eligible patients may be able to receive complimentary registered dietitian counseling through My EPI Plan.
Exocrine pancreatic insufficiency (EPI) occurs when the pancreas does not provide enough digestive enzymes for the body to properly break down food. This can contribute to digestive symptoms and problems absorbing nutrients.
But how is EPI diagnosed?
There isn’t one symptom that automatically means someone has EPI. Doctors generally consider a person’s symptoms, medical history, risk factors, physical examination, and test results when evaluating for the condition.
Testing may include a fecal elastase test, blood tests, and, in some situations, pancreatic function testing.
Understanding what these tests involve can make it easier to have an informed conversation with your healthcare provider.
When Might a Doctor Consider Testing for EPI?
EPI can cause symptoms such as bloating, abdominal discomfort, diarrhea, excess gas, loose or greasy stools, and unexplained weight loss. However, these symptoms can also occur with many other digestive conditions.
EPI may be more likely when digestive symptoms occur alongside conditions that can affect pancreatic function, including chronic pancreatitis, cystic fibrosis, pancreatic cancer, or certain types of pancreatic or upper gastrointestinal surgery.
That is why your doctor may look at the bigger picture rather than relying on symptoms alone.
If you are experiencing persistent digestive changes, keeping track of your symptoms, eating patterns, weight changes, and any known medical conditions can be helpful when preparing for an appointment.
What Tests Are Used to Diagnose EPI?
1. Fecal Elastase Test
The fecal elastase-1 (FE-1) test is the most commonly used stool test for evaluating EPI.
Elastase is an enzyme produced by the pancreas. The test measures the amount of pancreatic elastase present in a stool sample.
Your healthcare provider will give you instructions for collecting a sample, which is then sent to a laboratory for analysis.
A low fecal elastase result may be a sign of EPI, but test results need to be interpreted in the context of the individual’s symptoms and other clinical information.
It’s also important to follow the collection instructions provided by your healthcare team because the type and quality of the stool sample can affect testing.
2. Blood Tests
Blood tests do not typically diagnose EPI by themselves. However, they may help your healthcare provider look for nutritional consequences that can occur when digestion and nutrient absorption are impaired.
Depending on your situation, your doctor may evaluate certain vitamins, minerals, or other indicators of nutritional status.
Fat-soluble vitamins including vitamins A, D, E, and K can be of particular interest because EPI-related malabsorption may contribute to lower levels of these nutrients.
Blood testing can therefore provide additional information about how digestive problems may be affecting your nutritional health.
3. Pancreatic Function Testing
In some cases, a doctor may recommend a more specialized pancreatic function test.
One type of testing evaluates how the pancreas responds to secretin, a hormone involved in stimulating pancreatic secretions. The test can involve collecting pancreatic fluid for analysis.
These tests are more specialized and are not routinely performed everywhere. Your healthcare provider will determine whether additional pancreatic testing is appropriate based on your individual circumstances.
Is There a Single Test That Confirms EPI?
Not necessarily.
Although fecal elastase is commonly used when evaluating for EPI, diagnosis involves more than simply looking at one number.
Your healthcare provider may consider:
- Your digestive symptoms
- Your medical and family history
- Conditions that may increase your risk of EPI
- Physical examination findings
- Fecal elastase results
- Blood test results
- Signs of malnutrition or nutrient deficiencies
- Other testing when appropriate
This broader evaluation is important because symptoms associated with EPI can overlap with other digestive conditions.
What Happens After an EPI Diagnosis?
If testing and your overall clinical picture support an EPI diagnosis, your healthcare provider can discuss treatment and nutrition strategies.
One of the primary treatments for EPI is pancreatic enzyme replacement therapy (PERT). PERT provides digestive enzymes to help the body break down food and absorb nutrients.
Your doctor may also monitor nutritional status and recommend dietary adjustments or supplements when appropriate.
Nutrition can be an important part of managing EPI. Rather than assuming that certain foods need to be eliminated, working with a healthcare professional can help you develop an approach that supports adequate nutrition while taking your digestive symptoms into account.
How Nutrition Counseling Can Help With EPI
Receiving an EPI diagnosis can raise a lot of practical questions:
- What should I eat?
- How can I maintain adequate nutrition?
- Should I change how often I eat?
- What nutrients should I be monitoring?
- How do digestive enzymes fit into meals?
- How can I manage digestive symptoms while still enjoying a balanced diet?
A registered dietitian can provide individualized nutrition education based on your health needs, eating habits, and treatment plan.
My EPI Plan is designed to help eligible patients access nutrition support. Eligible patients may qualify for up to 3 hours of complimentary counseling with a registered dietitian to help them understand and incorporate positive nutritional decisions into their daily routine.
Nutrition counseling can be especially valuable when you’re trying to understand how an EPI diagnosis affects your everyday relationship with food.
Visit the My EPI Plan program page to learn more about the program, available resources, and eligibility requirements.
