Sarah Enslin, PA-C

EPI Across Disease States: Identifying High-Risk Patients

This episode focuses on the full spectrum of clinical conditions that warrant high suspicion for EPI. Jennifer Geremia leads with the primary pancreatic risk factors: chronic pancreatitis (with or without confirmatory imaging), recurrent acute pancreatitis regardless of etiology, prior pancreatic surgeries such as the Whipple procedure, cystic fibrosis, and pancreatic cancer. She notes that patients with these primary conditions are frequently under-screened and undertreated, even when the risk is well established.

The discussion expands to non-primary pancreatic conditions. The panelists highlight that celiac disease, type 2 diabetes, and Crohn's disease should also raise EPI suspicion—not because of direct pancreatic damage, but due to the shared mechanisms of malabsorption and maldigestion. Lifestyle factors such as smoking and heavy alcohol use are identified as important aggravators in the right clinical context.

A particularly valuable clinical insight emerges around severe acute pancreatitis and disconnected duct syndrome. Sarah Enslin notes that patients labeled simply as "acute" may actually have significant parenchymal loss and thus EPI—yet this is often missed because the framing remains acute rather than chronic. Dr. Kaul clarifies that typical mild acute pancreatitis does not routinely lead to EPI; it is the severe cases with significant parenchymal destruction that carry the highest risk.

The episode closes with a discussion of surgical and procedural risk factors: bariatric surgery (especially gastric bypass), small bowel resection for any cause (including IBD), and all foregut surgeries. The panel also spotlights pancreatic cancer patients—both surgical and non-surgical—as a special and complex high-risk population in whom EPI can be easily obscured by oncologic therapies and their side effects.

EPI Unmet Needs: Barriers to Diagnosis and Long-Term Consequences

," the panel explores the significant gaps in EPI diagnosis and the downstream consequences of untreated disease on patient quality of life and health.

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Panelists discuss the wide range of pancreatic and non-pancreatic conditions that increase suspicion for exocrine pancreatic insufficiency to improve identification of high-risk patients.

EPI Explained: Recognizing Symptoms and the Road to Diagnosis

Welcome back to another HCP Live Peer Exchange series. In this episode titled "

," moderator Dr. Vivek Kaul discusses exocrine pancreatic insufficiency with Jennifer Geremia, PA-C, and Sarah Enslin, PA-C.

The panel opens by introducing the scope of this peer exchange series, which is dedicated to closing gaps in exocrine pancreatic insufficiency (EPI) care across diagnosis, dosing, and care transitions. Dr. Kaul sets the stage by asking panelists about what symptomatology prompts them to think about EPI when reviewing their patient lists.

Jennifer Geremia highlights the postprandial nature of EPI symptoms as the key clinical indicator—patients often present with post-meal pain, bloating, flatus, and sometimes diarrhea. She emphasizes that steatorrhea, while textbook, is not always the presenting complaint. A critical insight is raised: many patients may not yet have an established primary pancreatic diagnosis when they first present, so clinicians must probe proactively—even in patients known to have had a pancreatic event—to catch EPI early.

Sarah Enslin reinforces that EPI presents broadly and atypically. Patients rarely arrive with the hallmark steatorrhea. Instead, vague chronic abdominal pain, chronic gas, and bloating are the more typical presentations, and EPI should remain high on the differential even in patients who appear to have a functional disorder. The moderator summarizes that symptoms exist on a spectrum, and the disease often challenges textbook frameworks.

A theme emerges: patients don't read a textbook, so clinicians must maintain a wide differential, take thorough histories, and remain vigilant to recognize EPI even when the presentation is incomplete or overlapping with other GI conditions.

," the panel examines the full range of conditions—from chronic pancreatitis to celiac disease, diabetes, and bariatric surgery—that put patients at elevated risk for EPI.

Panelists discuss recognizing the varied and often atypical symptoms of exocrine pancreatic insufficiency to improve early diagnosis and clinical awareness.

Sarah Enslin, PA-C

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