Closing the Gaps in Exocrine Pancreatic Insufficiency Care: Improving Diagnosis, Dosing, and Care Transitions - Episode 1
EPI Explained: Recognizing Symptoms and the Road to Diagnosis
Panelists discuss recognizing the varied and often atypical symptoms of exocrine pancreatic insufficiency to improve early diagnosis and clinical awareness.
Welcome back to another HCP Live Peer Exchange series. In this episode titled "EPI Explained: Recognizing Symptoms and the Road to Diagnosis," 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.
In the next episode, "EPI Across Disease States: Identifying High-Risk Patients," 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.
