Fast Five Quiz: Exocrine Pancreatic Insufficiency Presentation and Diagnosis

B.S. Anand, MD


May 04, 2020

A full malabsorption workup comprising numerous tests is required to differentiate exocrine pancreatic insufficiency from other causes of malabsorption. This workup may include fat absorption tests, a D-xylose test, a carbohydrate absorption test, a bile salt absorption test, a three-stage Schilling test, and the carbon 14 D-xylose breath test.

Stool tests can be useful to determine the levels of fecal elastase and chymotrypsin (two proteases produced by the pancreas) to help distinguish between pancreatic and intestinal causes of malabsorption. However, in the absence of testing a formed stool, routinely checking for exocrine pancreatic insufficiency in patients with chronic diarrhea using fecal elastase levels is unreliable. In patients with mild exocrine pancreatic insufficiency, diagnostic testing using fecal elastase levels has a lower sensitivity and specificity, which may result in an underestimation of exocrine pancreatic insufficiency.

Pancreatic function can be measured indirectly. For example, qualitative fecal fat analysis via microscopic examination of random stool samples can be used as a screening test only, and the measurement of fecal elastase and fecal chymotrypsin levels may serve as an indirect indicator of pancreatic function. Typical findings in exocrine pancreatic insufficiency are increased fecal fat and decreased enzyme levels.

The most sensitive approach for assessing exocrine pancreatic function is direct pancreatic function testing using endoscopy or the Dreiling tube method after stimulation with secretin or cholecystokinin. This is normally performed at specialized centers.

Learn more about the workup of exocrine pancreatic insufficiency.

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