Review
Copyright ©The Author(s) 2017.
World J Gastroenterol. Oct 21, 2017; 23(39): 7059-7076
Published online Oct 21, 2017. doi: 10.3748/wjg.v23.i39.7059
Table 4 Symptoms and tests used in the diagnosis of exocrine pancreatic insufficiency[2,16,23,24]
Clinical symptoms
Steatorrhea
Diarrhea
Flatulence
Weight loss
Laboratory findings
Fecal fat > 7 g/d on a 100-g fat/d diet
Inconvenient; special high-fat diet and prolonged collection of feces
Considered gold standard
An abnormal coefficient of fat absorption is not specific for EPI
Fecal elastase-1 level ≤ 200 μg/g stool; < 100 μg/g stool = severe EPI
Simple, convenient, and widely available
Measured on a random stool sample
Liquid stools may lead to falsely low results due to dilution
Less accurate in mild stages of disease
Positive qualitative fecal fat (Sudan III) staining
Special high-fat diet
Less accurate; semi-quantitative microscopic method
Insensitive for mild disease
Fecal chymotrypsin ≤ 6 U/g stool
Less sensitive than fecal elastase for mild EPI
Fluorescein dilaurate (pancreolauryl test)
Easy to perform
Not widely available
13C-mixed triglyceride breath test
Well established
Not widely available
Imaging/endoscopy
Pancreatic duct dilatation
Main pancreatic duct calculi
Endosonographic criteria of chronic pancreatitis
Secretin-enhanced diffusion-weighted magnetic resonance cholangiopancreatography imaging
New
Not widely available
EPI: Exocrine pancreatic insufficiency.