BACKGROUND

Exocrine pancreatic insufficiency (EPI) is an underdiagnosed entity among patients with new-onset chronic diarrhea (CD). The aim of this study is to investigate the prevalence of EPI in patients with CD.

MATERIALS AND METHODS

Patients with new-onset CD (≥4 weeks) from 2018 to 2021 were enrolled in this single-center prospective study. If stool fecal elastase (FE) was <200 μg/g, patients were offered a confirmatory 72-hour fecal fat test.

RESULTS

FE testing was completed by 97 patients, of which 9 had low FE (9.3%). Average weight was significantly higher in patients with low FE (98.5 ± 29.3 kg vs 82.2 ± 22.2 kg; = 0.045). There was no significant difference in gender, age, race, presence of diabetes mellitus, and history of tobacco or alcohol use between the two groups. After controlling for other factors, patients with low FE had a statistically higher weight in comparison to those with normal FE. Nine patients in the entire cohort were started on pancreatic enzymes (three based on low FE and six empirically based on high pretest probability for EPI). Six of the nine patients had complete resolution of symptoms (including two of three patients with low FE).

CONCLUSION

Considering the 9.3% prevalence of EPI among patients with CD, we propose screening for EPI with stool FE as part of the initial workup for these patients. Clinicaltrial.gov number NCT03407534.