Novel Exocrine Pancreatic Insufficiency Symptom Score May Improve Screening For Pancreatic Exocrine Insufficiency

Background and Aims: Exocrine Pancreatic Insufficiency (EPI) often goes undiagnosed or misdiagnosed due to its nonspecific symptomatology. Traditionally, clinicians may focus primarily on symptoms like diarrhea and steatorrhea, potentially overlooking more prevalent symptoms. This study evaluates the Exocrine Pancreatic Insufficiency Symptom Score (EPI/PEI-SS), a novel patient-generated symptom score designed to capture a wider range of EPI-related symptoms and quantify symptoms based on frequency and severity, and aims to assess the efficacy of the EPI/PEI-SS in differentiating between individuals with and without EPI, including other gastrointestinal (GI) conditions.Methods: A total of 324 participants (155 with EPI and 169 without) completed the EPI/PEI-SS, an online survey evaluating frequency and severity across three symptom categories: abdominal, toilet-, and food-related. Statistical analyses were used to compare symptom sub- and total scores between groups and understand individual symptom contributions.Results: Individuals with EPI reported significantly higher EPI/PEI-SS scores (98.11, range 1-213) and sub-scores, indicating a greater symptom burden compared to those without EPI (38.86, range 0-163). This burden persists for people with EPI despite use of pancreatic enzyme replacement therapy (PERT, median 72,000 units of lipase). The tool effectively differentiated between EPI and non-EPI participants, including those with other GI conditions. Conclusion: The EPI/PEI-SS demonstrates promise in the ability to identify and distinguish symptoms of EPI compared to other GI conditions. Future research should replicate the study alongside fecal elastase testing to determine whether it can be used as an addition or alternative for EPI diagnosis, plus evaluate the EPI/PEI-SS for use for individual treatment monitoring with PERT.