Closing the Gaps in Exocrine Pancreatic Insufficiency Care: Improving Diagnosis, Dosing, and Care Transitions - Episode 7
Putting PROs to Work: The PEIQ and Symptom Scores in EPI Management
Clinicians weigh PEI questionnaires, symptom scores, and AGA updates to track exocrine pancreatic insufficiency and tailor patient-centered care.
This episode examines the role of structured patient-reported outcome (PRO) tools in EPI care, with a focus on the Pancreatic Exocrine Insufficiency Questionnaire (PEIQ) and a newer PEI Symptom Score published in 2025. Dr. Kaul introduces the discussion by acknowledging these tools' structured framework value for providers who want to systematize their approach or conduct quality improvement projects.
Jennifer Geremia shares that in her personal practice, she asks these questions conversationally rather than formally administering the questionnaire, as GI clinicians tend to intuitively cover the relevant domains. She views the PEIQ as most useful as a structured guide for less experienced providers or as a monitoring tool to track clinical improvement over time. Crucially, she highlights a key disconnect: there is no reliable correlation between fecal elastase levels and symptom severity—meaning test numbers alone do not tell the full clinical story.
Sarah Enslin agrees, adding that the challenge is balancing the dominant symptom burden with a composite score, noting these do not always align. The real power of PRO tools is in personalizing treatment: understanding which symptom dimensions most affect a specific patient allows the clinician to tailor management rather than defaulting to a generic approach.
Dr. Kaul expands on how academic centers can leverage these scoring tools for research—retrospective reviews, registry datasets, and QA projects can all benefit from systematically captured PRO data. He also champions the AGA's Clinical Practice Update (CPU) on EPI, describing it as a practical, accessible 'baby guideline' designed to fill the gap between full guideline publications. He co-authored this work with Dr. Dave Whitcomb and notes it emerged directly from community conversations about unmet needs in EPI care.
The PEIQ is described in detail: it covers 18 items including pain, bloating, bowel movement frequency, urgency and consistency, nausea, vomiting, eating behavior, loss of appetite, weight, and quality-of-life domains (daily activities, concentration, emotional well-being, social functioning, and sleep). Serial scoring helps track treatment progress more objectively than global impressions alone, and can prompt investigation when expected improvement is not materializing.
In the next episode, "Starting Treatment: Educating Patients and Initiating PERT for EPI," the panel shifts to the treatment phase—what to tell patients at diagnosis, how to begin PERT, and the role of lifestyle modification and multidisciplinary support services.
