This prospective study followed patients for 3 and 12 months after an episode of acute pancreatitis (AP) to look for signs suggestive of exocrine pancreatic dysfunction (EPD). Researchers used clinically significant weight loss and GI symptoms as practical markers. Among 186 patients who completed the 12-month follow-up, 23.7% lost at least 10% of their baseline body weight. Weight-loss patterns varied: some patients lost weight early and later regained it, while others did not meet the threshold at 3 months but developed substantial weight loss by 12 months. Formal diagnoses of exocrine pancreatic insufficiency (EPI), new diabetes, and pancreatic enzyme replacement therapy (PERT) use were relatively uncommon. These results suggest that pancreatic dysfunction after AP may be underrecognized in routine care.

The strongest long-term predictor of meaningful weight loss was AP severity. In multivariable analysis, severe AP was independently associated with a much higher likelihood of losing at least 10% of body weight at 12 months. Generalized estimating equation modeling showed that patients with severe AP lost the most weight over time. Men also lost more weight than women at 12 months. The authors conclude that a meaningful subset of patients experience ongoing nutritional consequences after AP and that EPD is a likely contributor, even when formal EPI diagnosis is not made. Overall, the study highlights the need for closer long-term follow-up after AP, especially in patients with more severe disease, and for larger prospective studies to better define when nutritional support or PERT may be beneficial.

Reference: Phillips AE, Ooka K, Pothoulakis I, et al. Assessment of Weight Loss and Gastrointestinal Symptoms Suggestive of Exocrine Pancreatic Dysfunction After Acute Pancreatitis. Clin Transl Gastroenterol. 2020 Dec 15;11(12):e00283. doi: 10.14309/ctg.0000000000000283. PMID: 33464001; PMCID: PMC7743841.

This systematic review and meta-analysis examined the prevalence, risk factors, diagnosis, and treatment response of small intestinal bacterial overgrowth (SIBO) in patients with chronic pancreatitis (CP). Across 13 studies, including 518 patients with CP, the pooled prevalence of SIBO was 38.6%, compared with 9.9% in controls, and patients with CP had markedly higher odds of testing positive for SIBO than controls. Prevalence estimates varied widely across studies, in part because of differences in diagnostic methods. Studies using lactulose hydrogen breath testing reported substantially higher SIBO prevalence than those using glucose hydrogen breath testing (GHBT), highlighting an important diagnostic inconsistency. The analysis also found that pancreatic exocrine insufficiency (PEI) and diabetes mellitus were each associated with significantly higher odds of SIBO in CP.

The review suggests that SIBO may be an important and underrecognized contributor to persistent GI symptoms and malnutrition in patients with CP, especially in those who remain symptomatic despite pancreatic enzyme replacement therapy (PERT). Five studies assessed antibiotic treatment. Pooled data suggested that rifaximin was associated with better symptomatic improvement than doxycycline plus metronidazole, raising the possibility of an alternative strategy for patients with CP who do not respond adequately to PERT alone. Overall, the authors conclude that SIBO is common in CP, that GHBT remains the preferred practical diagnostic test despite limitations, and that pancreatic dysfunction itself may play a role in SIBO development. They also emphasize that better diagnostic tools and higher-quality prospective studies are still needed to clarify the condition’s true burden and best treatment approach.

Reference: El Kurdi B, Babar S, El Iskandarani M, et al. Factors That Affect Prevalence of Small Intestinal Bacterial Overgrowth in Chronic Pancreatitis: A Systematic Review, Meta-Analysis, and Meta-Regression. Clin Transl Gastroenterol. 2019 Sep;10(9):e00072. doi: 10.14309/ctg.0000000000000072. PMID: 31517648; PMCID: PMC6775338.

This review explains that exocrine pancreatic insufficiency (EPI) can result from a wide range of pancreatic and non-pancreatic disorders, and that it is often underrecognized despite its impact on nutrition and quality of life. Among pancreatic causes, the review highlights acute and chronic pancreatitis, pancreatic tumors, cystic fibrosis, and pancreatic surgery as major contributors. Acute pancreatitis can lead to EPI even after mild disease. Chronic pancreatitis remains one of the most common and clinically significant causes because ongoing inflammation and fibrosis progressively reduce enzyme secretion. Pancreatic cancer and pancreatic resections also can cause EPI through duct obstruction, tissue loss, and disrupted digestive coordination. Cystic fibrosis causes pancreatic damage through CFTR-related duct obstruction and progressive destruction of exocrine tissue.

The review also emphasizes that EPI can develop in non-pancreatic conditions such as diabetes, celiac disease, inflammatory bowel disease, gastrointestinal surgery, advanced age, and even certain medications. In these settings, EPI may arise through impaired hormonal signaling, autoimmune mechanisms, neuropathy, altered anatomy, or reduced stimulation of pancreatic secretion. Because symptoms such as diarrhea, steatorrhea, bloating, and weight loss overlap with many other gastrointestinal disorders, diagnosis can be missed unless clinicians actively consider it. Fecal elastase-1 is noted as the most commonly used test. Overall, the article argues that broader awareness of EPI risk factors and earlier diagnosis are essential so patients can receive appropriate treatment, nutritional support, and pancreatic enzyme replacement when needed.

Reference: Tang C, Zhou J, Song Y, Liu S. Etiologies of exocrine pancreatic insufficiency. Gastroenterol Rep (Oxf). 2025 Mar 10;13:goaf019. doi: 10.1093/gastro/goaf019. PMID: 40066317; PMCID: PMC11893156.

Exocrine pancreatic insufficiency (EPI) is a condition in which pancreatic enzyme activity falls below the level needed for normal digestion, leading to malabsorption, steatorrhea, bloating, abdominal discomfort, weight loss, and nutritional deficiencies. The most common causes are chronic pancreatitis in adults and cystic fibrosis in children. EPI also can occur with pancreatic cancer, diabetes, celiac disease, inflammatory bowel disease, HIV, bariatric surgery, and other conditions. Because symptoms are often nonspecific and overlap with other gastrointestinal disorders, diagnosis requires careful clinical evaluation along with testing. Fecal elastase-1 is the most commonly used noninvasive screening test. Other options include direct pancreatic function tests, 72-hour fecal fat testing, breath testing, and assessment of vitamin and micronutrient deficiencies.

Management focuses on correcting malabsorption, preventing complications, and improving quality of life. Pancreatic enzyme replacement therapy is the mainstay of treatment. It typically starts with weight-based lipase dosing taken with meals and snacks and then titrated to symptom control and stool normalization. Some patients also may need acid suppression to improve enzyme effectiveness. Ongoing care includes monitoring weight, body mass index, bone density, and fat-soluble vitamins, along with counseling on small frequent meals, alcohol abstinence, smoking cessation, and appropriate dietary adjustments. Because untreated EPI can lead to malnutrition, osteoporosis, cardiovascular complications, and reduced quality of life, early recognition and consistent management are important. The article emphasizes coordinated care across gastroenterology, primary care, pharmacy, dietetics, endocrinology, and other specialties to support diagnosis, adherence, and long-term management.

Reference: Tian C, Ghodeif AO, Arshad S, Gillespie E. Exocrine Pancreatic Insufficiency. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated September 14, 2025.

This review focuses on causes of exocrine pancreatic insufficiency (EPI) beyond chronic pancreatitis. The authors emphasize that EPI can arise not only from clear pancreatic disorders such as pancreatic cancer, pancreatic resection, pancreatic duct obstruction, and cystic fibrosis, but also from conditions with less well-defined mechanisms, including diabetes, celiac disease, inflammatory bowel disease, certain gastrointestinal surgeries, Zollinger–Ellison syndrome, nonalcoholic fatty pancreas disease, aging, and microbiome-related changes. Across these conditions, EPI generally develops through one or more of three pathways: loss of pancreatic tissue, impaired enzyme secretion or activation, or poor coordination between food delivery and pancreatic enzyme release. The review highlights that EPI is often underrecognized despite its links to steatorrhea, weight loss, malnutrition, vitamin deficiencies, reduced quality of life, and worse outcomes. This is particularly evident in pancreatic cancer and after pancreatic surgery.

The authors stress that treatment should focus on recognizing symptomatic maldigestion early and starting pancreatic enzyme replacement therapy (PERT) when patients have steatorrhea, weight loss, or other clear signs of malabsorption. They note that PERT is especially important in pancreatic cancer, after pancreatic resections, and in cystic fibrosis. It also may benefit selected patients with diabetes, celiac disease, or inflammatory bowel disease when EPI is confirmed or strongly suspected. Management should include nutrition support, vitamin monitoring, and, in some cases, acid suppression to improve enzyme effectiveness. Overall, the review argues that clinicians should think more broadly about who may have EPI, because prompt diagnosis and treatment may improve symptoms, nutritional status, quality of life, and in some settings even survival.

Reference: Kunovský L, Dítě P, Jabandžiev P, et al. Causes of Exocrine Pancreatic Insufficiency Other Than Chronic Pancreatitis. J Clin Med. 2021 Dec 10;10(24):5779. doi: 10.3390/jcm10245779. PMID: 34945075; PMCID: PMC8708123.

This review explains that exocrine pancreatic insufficiency (EPI) can arise from a broad range of pancreatic disorders and is often underrecognized despite its impact on nutrition and quality of life. Major pancreatic causes include acute and chronic pancreatitis, pancreatic tumors, cystic fibrosis, and pancreatic surgery. Acute pancreatitis can lead to EPI even after mild disease. Chronic pancreatitis is a particularly common cause because ongoing inflammation and fibrosis gradually reduce pancreatic enzyme secretion. Pancreatic cancer and postsurgical changes also can trigger EPI through duct obstruction, tissue loss, and disrupted digestion. Cystic fibrosis causes progressive pancreatic damage through CFTR-related duct dysfunction and blockage. The review also highlights rarer inherited causes, such as Shwachman–Diamond syndrome, Johanson–Blizzard syndrome, and Pearson syndrome.

The article emphasizes that EPI is not limited to primary pancreatic disease. Non-pancreatic conditions such as diabetes, celiac disease, inflammatory bowel disease, gastrointestinal surgery, advanced age, and some medications also may impair pancreatic exocrine function through hormonal, immune, vascular, neurologic, or anatomic mechanisms. Because symptoms such as diarrhea, steatorrhea, bloating, and weight loss overlap with many other gastrointestinal disorders, clinicians may miss the diagnosis unless they actively consider it. Fecal elastase-1 is described as the most commonly used test. Overall, the review argues that broader awareness of EPI risk factors and earlier diagnosis are essential so patients can receive timely treatment, nutritional support, and pancreatic enzyme replacement when appropriate.

Reference: Tang C, Zhou J, Song Y, Liu S. Etiologies of exocrine pancreatic insufficiency. Gastroenterol Rep (Oxf). 2025 Mar 10;13:goaf019. doi: 10.1093/gastro/goaf019. PMID: 40066317; PMCID: PMC11893156.

Exocrine pancreatic insufficiency (EPI) occurs when the pancreas does not make enough digestive enzymes, or when those enzymes do not work as they should, preventing the body from properly breaking down and absorbing nutrients from food. As a result, patients may experience symptoms such as gas, bloating, abdominal pain, diarrhea, greasy or foul-smelling stools, and unexplained weight loss. In more severe cases, poor absorption can lead to malnutrition and vitamin deficiencies. The condition is often associated with chronic pancreatitis, pancreatic cancer, cystic fibrosis, or surgery involving the pancreas, stomach, or intestines. To confirm a diagnosis, clinicians may use tests such as fecal elastase, fecal fat testing, or a secretin stimulation test to evaluate how well the pancreas is producing and releasing digestive enzymes.

Treatment focuses on restoring digestion, improving nutrient absorption, and reducing day-to-day symptoms. The main treatment is pancreatic enzyme replacement therapy, which is taken with every meal and snack to help the body digest food more effectively. Patients also are encouraged to work with their healthcare provider on dietary and lifestyle strategies, including eating a nutritious, well-balanced diet with fruits, vegetables, whole grains, and healthy proteins. The article notes that fat should not be avoided unnecessarily, since it plays an important role in absorbing essential vitamins. Eating smaller, more frequent meals also may help some patients manage symptoms more comfortably, and vitamin or mineral supplements may be recommended if deficiencies develop. Avoiding tobacco and alcohol also is encouraged. Ultimately, the goal of treatment is to control symptoms, prevent nutritional complications, and improve overall quality of life.

Reference: Exocrine Pancreatic Insufficiency. Clin Gastroenterol Hepatol. 2020 Jun;18(7):xv. doi: 10.1016/j.cgh.2020.03.011.