Exocrine Pancreatic Insufficiency

Undiagnosed EPI May Be Prevalent in Individuals With IBS-D

In patients with diarrhea-predominant irritable bowel syndrome (IBS-D), 6.1% of patients also had severe exocrine pancreatic insufficiency (EPI), according to a new study.

The researchers attempted to determine the prevalence of EPI in patients with IBS-D by using fecal elastase (Fel-1) stool testing. They also attempted to determine clinical characteristics that may lead to EPI in these patients.

The study enrolled 144 adult patients with IBS-D who came to tertiary hospital outpatient clinics. Their mean age was 60 years, and 78% were women. Study participants completed validated questionnaires and provided a stool sample, which was used to measure fecal elastase concentration. A Fel-1 concentration ranging from more than 100 μg/g to less than 200 μg/g was considered an indicator of EPI, and patients whose results fell into this range received endoscopic ultrasonography and laboratory testing for pancreatic pathology.

As a result, the researchers found EPI in 6.1% of patients. Moreover, during endoscopic ultrasonography, pancreatic steatosis was the chief discovery in these patients. Regarding predisposing clinical characteristics, dyspepsia was independently associated with EPI at an odds ratio of 34.7 (95% confidence interval, 4.95-366.4).

Treatment with pancreatic enzyme replacement therapy resulted in a statistically significant improvement in the number of bowel movements daily, Bristol stool scale score, and scores for distension, pain, and IBS severity in these patients.

“EPI is present in 5% of patients who fulfill Rome IV criteria for [IBS-D], and dyspepsia was [...] strongly associated with EPI,” the researchers concluded.

—Ellen Kurek


Olmos JI, Piskorz MM, Litwin N, et al. Exocrine pancreatic insufficiency is undiagnosed in some patients with diarrhea-predominant irritable bowel syndrome using the Rome IV Criteria. Dig Dis Sci. Published online June 15, 2022. doi:10.1007/s10620-022-07568-8