What are the key clinical features that suggest a diagnosis of exocrine pancreatic insufficiency in adults?

Key clinical features suggesting a diagnosis of exocrine pancreatic insufficiency (EPI) in adults include symptoms and signs related to malabsorption and pancreatic dysfunction. These features typically comprise steatorrhoea (fatty, pale, bulky, and foul-smelling stools), weight loss despite adequate food intake, abdominal bloating, and nutritional deficiencies such as fat-soluble vitamin (A, D, E, K) deficiencies. Chronic or recurrent upper abdominal pain may also be present, especially in the context of chronic pancreatitis, which is a common underlying cause of EPI. Additionally, adults with EPI may exhibit signs of malnutrition and poor nutritional status, including muscle wasting and osteoporosis due to malabsorption of calcium and vitamin D. A history of conditions known to impair pancreatic exocrine function, such as chronic pancreatitis (including alcohol-related), cystic fibrosis, pancreatic surgery, or pancreatic duct obstruction, further supports the diagnosis. Clinical suspicion should be heightened in patients with chronic abdominal pain and malabsorption symptoms, particularly when imaging or biochemical tests indicate pancreatic structural or functional abnormalities. Monitoring for type 3c diabetes is also relevant, as it often coexists with EPI in chronic pancreatic disease. These clinical features guide the need for further diagnostic testing and initiation of pancreatic enzyme replacement therapy to manage symptoms and prevent complications ¹ (Whitcomb et al., 2023).