Vivek Kaul, MD 

Closing the Loop: Key Recommendations and Future Directions for EPI

In the final episode, each panelist synthesizes their top recommendations for advancing EPI care. Sarah Enslin leads with a call for better diagnostic tools—while fecal elastase is adequate, a significant proportion of patients will never submit a stool sample regardless of education or encouragement. Blood-based testing, if validated, would dramatically improve diagnostic access and patient compliance. Her second priority is simplifying treatment: non-porcine PERT alternatives are an urgent unmet need for patients with dietary restrictions, and reducing pill burden through new formulations would improve long-term adherence. Her third recommendation targets access—patient assistance programs exist and are valuable, but navigating them adds burden in already-stretched clinical environments.

Jennifer Geremia emphasizes clinician awareness as the foundational gap: EPI is not a new disease, but it remains chronically underdiagnosed—partly due to missed recognition across specialties, and partly due to comorbidities that obscure it. She advocates for leveraging patient organizations like the National Pancreas Foundation (NPF), which provides comprehensive, no-cost resources for patients including digital nutrition guides and peer support communities. She also spotlights the often-overlooked chronic pancreatitis population, noting that these patients face stigma, pain, and fragmented care—and benefit enormously from structured pain management and palliative care engagement.

Dr. Kaul underscores that access disparities—particularly in underserved communities and rural America—represent a major structural challenge. Drawing a parallel to advances in IBD advocacy through organizations like the CCFA, he calls for the same level of organized, patient-centered advocacy in EPI and benign pancreatic disease. He highlights education platforms, industry partnerships, and peer exchange programs as actionable levers for closing the awareness gap.

The episode closes with expressions of gratitude. Dr. Kaul thanks his panelists for a rich, clinically grounded exchange and acknowledges that the conversation reflects real-world challenges that they encounter every day in their practices.

Thank you for watching this HCP Live Peer Exchange series on exocrine pancreatic insufficiency. Please subscribe to our enewsletter for information on upcoming video series.

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In the final episode, each panelist synthesizes their top recommendations for advancing EPI care.

Evidence in Practice: What a New Prescribing Survey Reveals About EPI Care Gaps

This episode spotlights a recent publication by Ashkar and colleagues—co-authored by Jennifer Geremia—surveying prescribing practices for EPI across a broad cross-section of healthcare professionals. The study included providers from primary care, gastroenterology, pulmonology, and surgery, capturing both APP and physician perspectives.

Key findings revealed that insurance coverage and patient access to therapy were among the top three drivers of product selection—confirming what the panel has observed in clinical practice. Patient assistance programs and provider perceptions of patient-reported outcomes were also influential in prescribing decisions.

Notably, the survey showed meaningful variability in which patient populations providers screen for EPI. Approximately one-third of respondents identified alcohol use as a high-risk category to evaluate, which the panel found informative. Type 2 diabetes ranked higher than expected as a condition prompting EPI consideration, suggesting growing awareness—though still reactive rather than proactive—in that population.

Dr. Kaul reflects that the paper confirms the real-world diversity of approaches to EPI screening and prescribing, reinforcing that the gaps discussed throughout this series are not theoretical—they are documented and persistent. He encourages all viewers to read the paper as a benchmark of current practice. The survey validates the importance of education, standardization, and reducing barriers to access as the core priorities for improvement.

," the panel presents their top problem-solving recommendations for clinicians, drawing on everything covered in the series to outline a forward-looking roadmap for improving EPI care.

This episode spotlights a recent publication by Ashkar and colleagues—co-authored by Jennifer Geremia—surveying prescribing practices for EPI across a broad cross-section of healthcare professionals.

Bridging the Gaps: Care Transitions and Breakdowns in EPI

This episode addresses the practical failures in care coordination that allow EPI to fall through the cracks. Sarah Enslin immediately identifies three critical breakdown points: the initial diagnosis phase (delayed referral from primary care), post-hospitalization transitions (from inpatient to outpatient care following acute or necrotizing pancreatitis), and cancer care transitions (patients diagnosed endoscopically who then enter oncologic care and lose GI follow-up).

Post-surgical patients—those after Whipple procedures, necrosectomies, or other pancreatic or GI surgeries—are particularly at risk. Jennifer Geremia notes that surgeons and interventional endoscopists have transient touchpoints and may not provide long-term follow-up themselves. Making explicit GI follow-up recommendations—with specific names or community referral lists—at discharge is an actionable step. Empowering patients with awareness of their own need for follow-up also adds a layer of self-advocacy.

Dr. Kaul highlights the emergency department as a particularly challenging handoff environment. Chronic pancreatitis patients cycling through the ED—often labeled as drug seekers—represent a missed opportunity for meaningful intervention. Without structured discharge pathways, these patients leave without appropriate outpatient referral. Building structured ED protocols and after-visit summaries that facilitate GI referral is proposed as a quality improvement opportunity.

The panel closes on an optimistic note: larger practices and academic centers have the opportunity to develop dedicated pancreas specialty clinics—modeled on IBD and liver clinics—where intake processes are smoother, handoffs are more deliberate, and multidisciplinary coordination is embedded into clinic design. Leveraging EMR tools like structured handoff sheets and cross-system patient notes also enhances continuity within integrated health systems.

," the panel examines a recently published survey on PERT prescribing practices across healthcare professionals, offering a real-world view of how EPI is currently managed—and where gaps persist.

Clinicians reveal where pancreatic care falls apart—diagnosis delays, post-discharge gaps, lost oncology follow-up—and how to fix handoffs fast.

Team-Based EPI Care: Why Multidisciplinary Coordination Matters

This episode broadens the lens from individual clinical decisions to the systems and teams required to deliver high-quality EPI care. Dr. Kaul opens by acknowledging that providers do not work in silos—they operate within complex health systems, alongside multiple specialties, and across different care settings.

Sarah Enslin provides a compelling framework: at the most basic level, an EPI patient interacts with primary care, GI, and nutrition—already three providers. In chronic pancreatitis, over 80% of patients experience pain during their disease course, potentially adding pain specialists or palliative care. In pancreatic cancer, the team expands further to include surgical, medical, and radiation oncology. Managing EPI effectively requires all of these stakeholders to be aligned.

Jennifer Geremia highlights the PCP's role in health maintenance: bone density scans, annual fat-soluble vitamin checks, and other monitoring tasks are well within PCP scope and can be proactively embedded in notes and patient instructions to coordinate care efficiently. This minimizes redundant specialist visits while keeping patients appropriately monitored.

Dr. Kaul reflects on the unique reality of specialty clinic schedules—patients may only be seen every 3–6 months at a referral center, making the PCP's more frequent contact invaluable as a touchpoint for day-to-day management continuity. He also notes that combining multiple services results in patients being seen multiple times per year across their care team—especially important during the early stages of a new diagnosis when the path is still unclear and patients need more support.

," the panel examines where the care continuum most commonly breaks down for EPI patients and how to design better handoffs across care settings.

Why EPI outcomes improve when GI, primary care, nutrition and pain teams coordinate—streamlining labs, vitamins and follow-ups for patients.

Vivek Kaul, MD

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