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.

In the next episode, "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.