How Common Is EPI in Patients with Chronic Abdominal Pain, Diarrhea?

Overall, pancreatic exocrine insufficiency was identified in 10 patients (4.6%; 95% CI 2.2-8.3%) with five patients having severe pancreatic exocrine insufficiency (2.3%; 95% CI 0.8-5.3%).

A study published in the Journal of Gastroenterology and Hepatology aimed to determine the prevalence of pancreatic exocrine insufficiency (PEI) in patients with chronic unexplained abdominal pain, diarrhea, or diarrhea-predominant irritable bowel syndrome (IBS-D).

Findings from a previous study had shown that in patients with IBS-D, 6.1% had evidence of severe PEI. For this study, 218 patients (mean age 60 years) with unexplained abdominal pain and/or diarrhea for at least 3 months or IBS-D were included in the analysis; patients were asked to fill out questionnaires and to donate stool samples so that elastase concentration could be measured. Patients with fecal elastase of <100mcg/g stool were considered to have severe PEI while those with <200mcg/g stool represented mild to moderate PEI. 

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Overall, PEI was identified in 10 patients (4.6%; 95% CI 2.2–8.3%) with five patients having severe PEI (2.3%; 95% CI 0.8–5.3%); male sex and heavy alcohol use were significantly linked to abnormal pancreatic function. Based on results from endoscopic ultrasound or abdominal CT, the researchers found that two of the patients exhibited features of chronic pancreatitis.

“One in 50 patients with IBS-D or otherwise unexplained abdominal pain or diarrhea have an abnormal fecal elastase, but unexpected pancreatic insufficiency was detected in only a minority of these,” the authors concluded. “This study failed to confirm the high prevalence of PEI among patients with unexplained GI symptoms previously reported.”

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