Less common etiologies of exocrine pancreatic insufficiency

Table 4 Symptoms and tests used in the diagnosis of exocrine pancreatic insufficiency[2,16,23,24]

Clinical symptoms

Steatorrhea

Diarrhea

Flatulence

Weight loss

Laboratory findings

Fecal fat > 7 g/d on a 100-g fat/d diet

Inconvenient; special high-fat diet and prolonged collection of feces

Considered gold standard

An abnormal coefficient of fat absorption is not specific for EPI

Fecal elastase-1 level ≤ 200 μg/g stool; < 100 μg/g stool = severe EPI

Simple, convenient, and widely available

Measured on a random stool sample

Liquid stools may lead to falsely low results due to dilution

Less accurate in mild stages of disease

Positive qualitative fecal fat (Sudan III) staining

Special high-fat diet

Less accurate; semi-quantitative microscopic method

Insensitive for mild disease

Fecal chymotrypsin ≤ 6 U/g stool

Less sensitive than fecal elastase for mild EPI

Fluorescein dilaurate (pancreolauryl test)

Easy to perform

Not widely available

13C-mixed triglyceride breath test

Well established

Not widely available

Imaging/endoscopy

Pancreatic duct dilatation

Main pancreatic duct calculi

Endosonographic criteria of chronic pancreatitis

Secretin-enhanced diffusion-weighted magnetic resonance cholangiopancreatography imaging

New

Not widely available

EPI: Exocrine pancreatic insufficiency.