Diagnosis for Exocrine Pancreatic Insufficiency

How do doctors diagnose EPI?

To diagnose exocrine pancreatic insufficiency (EPI), your doctor will ask about your medical and family history, perform a physical exam, and order tests.

Medical and family history

To help diagnose EPI, your doctor will ask about your

Doctor talking with a patient.To help diagnose EPI, your doctor will ask about your symptoms and medical and family history.

Physical exam

During a physical exam, your doctor may

  • examine your body for signs of weight loss or malnutrition
  • check your abdomen for swelling
  • listen to sounds within your abdomen using a stethoscope
  • tap on your abdomen checking for tenderness or pain

What tests do doctors use to diagnose EPI?

Doctors most often order stool tests, blood tests, and sometimes pancreatic function tests to diagnose EPI. Doctors may order additional tests to check for diseases that can cause EPI, if the cause is unknown.

Stool tests

Stool elastase test, also called fecal elastase-1 or FE-1 test, is the most commonly used stool test. Low levels of FE-1 in the stool may be a sign of EPI. Your doctor will give you a container for catching and holding a stool sample. You should provide a solid or semisolid stool sample for this test. You will receive instructions on where to send or take the kit for testing.

Blood tests

A health care professional will take a blood sample from you and send the sample to a lab. Doctors may use blood tests to check for low levels of fat-soluble vitamins and minerals or other signs of malnutrition.

Pancreatic function test

Your doctor may order a pancreatic function test to measure how your pancreas responds to secretin, a hormone made by the small intestine. The test measures pancreatic fluid instead of pancreatic enzymes and may not accurately diagnose EPI. This test is done only at some centers in the United States.

During a pancreatic function test, health care professionals give you intravenous (IV) secretin and insert a tube through your nose and into your small intestine. Health care professionals will collect fluid samples with the tube and send the samples to a lab for analysis.

In some cases, doctors use upper gastrointestinal (GI) endoscopy to perform part or all of this test.

Last Reviewed January 2023
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.