Unique causes of exocrine pancreatic insufficiency: When to consider pancreatic enzyme supplementation: A narrative review

Exocrine pancreatic insufficiency (EPI) is a clinically significant disorder characterized by inadequate secretion or activity of pancreatic digestive enzymes, leading to maldigestion, malabsorption, and adverse nutritional and metabolic consequences. The causes of EPI can be divided into loss of pancreatic parenchyma, inhibition or inactivation of pancreatic secretion, and postcibal pancreatic asynchrony. Although most associated with intrinsic pancreatic diseases such as cystic fibrosis, chronic pancreatitis or pancreatic cancer, EPI is increasingly recognized in a range of other conditions including diabetes, inflammatory bowel disease, celiac disease, hypersecretory states, gastrointestinal surgeries, small intestinal bacterial overgrowth, drug side effects and aging. This narrative review summarizes the diagnosis and treatment of EPI along with a focused review of the pathophysiology, clinical consequences, diagnostic approaches, and treatment principles of EPI for a variety of conditions.