Do You Have Exocrine Pancreatic Insufficiency or Something Else?
Updated on June 25, 2026
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People who have exocrine pancreatic insufficiency (EPI), a disease that interferes with the body’s ability to digest fat in food, typically experience a host of digestive symptoms, including stomach pain, gas, and bloating.
EPI is rare, and many of its symptoms overlap with those of other gastrointestinal (GI) conditions. This can make it difficult for doctors to diagnose people with EPI. However, without proper treatment, EPI can lead to vitamin deficiencies and, eventually, complications such as low bone mass and malnutrition. Here’s how EPI compares to other digestive issues and how it is diagnosed.
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Conditions That Cause EPI-Like Symptoms
EPI’s symptoms mirror those of many other digestive health problems.
Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is marked by abdominal pain, bloating, bouts of diarrhea or constipation, and flatulence. While fatty stools, or steatorrhea, are a telltale sign of EPI, people with IBS are less likely to see this. As with EPI, IBS symptoms tend to occur after eating, but IBS symptoms may also be triggered by stress, infection, certain foods, and other factors.
Crohn’s Disease
A type of inflammatory bowel disease (IBD), Crohn’s is marked by chronic inflammation of the GI tract, such as the end of the small intestine. As with EPI, people who have Crohn’s often experience abdominal pain, diarrhea, steatorrhea, and weight loss. But Crohn’s also typically causes bloody stools, fever, and anemia, a decrease in red blood cells that can cause fatigue.
Ulcerative Colitis
People with either EPI or ulcerative colitis can experience abdominal pain, diarrhea, and weight loss, but ulcerative colitis doesn’t typically cause bloating, flatulence, and steatorrhea. It can, however, trigger mucus in stools, like IBS. Ulcerative colitis is more similar to Crohn’s in that it’s an IBD, but with colitis, inflammation is located in the large intestine. The two conditions also share symptoms such as anemia, loss of appetite, and bloody stools, as well as some that affect the skin, eyes, and joints.
Celiac Disease
Celiac disease, an autoimmune disorder triggered by gluten, and EPI have many symptoms in common. Like people with EPI, those with celiac disease often experience bloating, diarrhea, and weight loss. People with celiac disease may also have anemia, and some will feel constipated. While you may primarily notice symptoms of EPI after eating foods that contain fat, people with celiac disease may experience symptoms when eating bread, pasta, cereal, and other foods that contain gluten.
Infections
In some instances, bowel problems may be a sign of excess bacteria in your small intestine. Small intestinal bacterial overgrowth, a condition in which the bacteria in the small intestine grow out of control, shares many of the symptoms of EPI. These symptoms may include bloating, nausea, and diarrhea.
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What underlying condition led to your EPI diagnosis?
How EPI Is Diagnosed
When diagnosing EPI, your doctor will likely ask about your symptoms, perform a physical exam, and ask about your medical history, including any conditions linked to EPI, such as pancreatitis, or nutritional deficiencies that don’t seem to have a clear cause. Your doctor may use several tests to determine if you have EPI.
Stool tests assess the pancreas’s ability to produce and secrete fat-digesting enzymes.
Fecal elastase tests are the most common. Elastase is one of the enzymes produced by the pancreas to help the body digest fat. Low levels of this enzyme in the stool may mean that the pancreas is not producing a sufficient amount, which can be a sign of EPI. However, your doctor will consider several factors when analyzing your results. For example, runny stool can also result in low elastase levels.
Blood tests may be used to evaluate the level of fat-soluble vitamins. Low levels of these nutrients may signal EPI.
Less widely available tests for EPI include pancreatic function tests with imaging to check if your pancreatic ducts are functioning.
If you suspect that you have EPI, talk with your doctor to learn more about your testing options.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- Treatment for Exocrine Pancreatic Insufficiency. National Institute of Diabetes and Digestive and Kidney Diseases. January 2023.
- Steatorrhea. Cleveland Clinic. August 15, 2022.
- Irritable Bowel Syndrome (IBS). Cleveland Clinic. November 15, 2023.
- Crohn's disease. Mayo Clinic. December 4, 2025.
- Ulcerative colitis. Mayo Clinic. June 6, 2026.
- Celiac disease. Mayo Clinic. March 4, 2026.
- Small intestinal bacterial overgrowth (SIBO). Mayo Clinic. November 11, 2024.
- Diagnosis for Exocrine Pancreatic Insufficiency. National Institute of Diabetes and Digestive and Kidney Diseases. January 2023.
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