How to test for pancreatitis?

Pancreas Function Tests

Secretin pancreatic function test

The secretin pancreatic function test measures the ability of the pancreas to respond to the hormone secretin. The small intestine produces secretin in the presence of partially digested food. Normally, secretin stimulates the pancreas to secrete a fluid with a high concentration of bicarbonate. This fluid neutralizes stomach acid and is necessary to allow a number of enzymes to function in the breakdown and absorption of food. People with diseases involving the pancreas (for example, chronic pancreatitis, cystic fibrosis, or pancreatic cancer) might have abnormal pancreatic function.

In performing a secretin pancreatic function test, a healthcare professional places a tube down the throat, into the stomach, then into the duodenum (upper section of small intestine). Secretin is inserted and the contents of the duodenal secretions are aspirated (removed with suction) for about an hour and analyzed.

Fecal elastase test

The fecal elastase test measures elastase, an enzyme found in fluids produced by the pancreas. Elastase digests and degrades various kinds of proteins. During this test, a patient’s stool sample is analyzed for the presence of elastase.

Computed tomography (CT) scan with contrast dye

This scan can help rule out other causes of abdominal pain and can also determine whether there is inflammation (swelling), scarring, or fluid collections in or around the pancreas.

Abdominal ultrasound

An abdominal ultrasound can detect gallstones and fluid from inflammation in the abdomen (ascites). It also can show an enlarged common bile duct, an abscess, or a pseudocyst.

Endoscopic retrograde cholangiopancreatography (ERCP)

During an ERCP, a healthcare professional places a tube down the throat, into the stomach, then into the small intestine. A small catheter is passed into the pancreas and bile ducts, and dye is injected to help the doctor see the structure of the common bile duct, other bile ducts, and the pancreatic duct on an X-ray.

Endoscopic ultrasound

During this test, a probe attached to a lighted scope is placed down the throat and into the stomach. Sound waves show images of organs in the abdomen. Endoscopic ultrasound might reveal gallstones and can be helpful in diagnosing severe pancreatitis when an invasive test such as ERCP might make the condition worse.

Magnetic resonance cholangiopancreatography

This kind of magnetic resonance imaging (MRI) can be used to look at the bile ducts and the pancreatic duct. MRI/MRCP gives very good imaging of the pancreas and does not use radiation. (These are imaging tests and not pancreatic function tests.)

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Blood and urine tests for the diagnosis of acute pancreatitis (sudden inflammation of pancreas)

Background

The pancreas is an organ in the abdomen (tummy) that secretes several digestive enzymes (substances that break down the food we eat) into the pancreatic ductal system, which empties into the small bowel. The pancreas also contains the islets of Langerhans, which secrete several hormones such as insulin (which helps regulate blood sugar). Acute pancreatitis is sudden inflammation of the pancreas, which can lead to damage of the heart, lungs, and kidneys and cause them to fail. Acute pancreatitis usually manifests as upper abdominal pain radiating to the back. However, there are several potential causes of upper abdominal pain. It is important to determine if someone with abdominal pain has acute pancreatitis or another illness in order to start appropriate treatment. Blood tests such as serum amylase and serum lipase, as well as urine tests such as urinary trypsinogen-2 and urinary amylase, can be used to determine if someone with abdominal pain has acute pancreatitis. It is usually the case that a patient is considered to have acute pancreatitis only when amylase or lipase levels are three times the upper limit of normal. With regard to urinary trypsinogen-2, a level of more than 50 ng/mL of trypsinogen-2 in the urine is considered an indication of acute pancreatitis. With regard to urinary amylase, there is no clear-cut level beyond which someone with abdominal pain is considered to have acute pancreatitis. At present it is unclear whether these tests are equally effective or if one of the tests is better than the other in the diagnosis of acute pancreatitis in people with sudden-onset abdominal pain. We determined to resolve this question by performing a literature search for studies reporting the accuracy of the above mentioned blood and urine tests. We included studies reported until 20 March 2017.

Study characteristics

We identified 10 studies reporting information on 5056 people with abdominal pain that started suddenly. The studies included pancreatitis due to all causes.

Quality of evidence

All of the studies were of unclear or low methodological quality, which may result in arriving at false conclusions. We excluded the study that contributed approximately two-thirds of the participants included in this review from the results of the analysis presented below due to concerns about whether the participants included in the study are typical of those seen in the emergency department.

Key results

The accuracy of serum amylase, serum lipase, and urinary trypsinogen-2 in making the diagnosis of acute pancreatitis was similar. About a quarter of people with acute pancreatitis fail to be diagnosed as having acute pancreatitis with these tests. The patient should be admitted and treated as having acute pancreatitis, even if these tests are normal, if there is a suspicion of acute pancreatitis. As about 1 in 10 patients without acute pancreatitis may be wrongly diagnosed as having acute pancreatitis with these tests, it is important to consider other conditions that require urgent surgery, even if these tests are abnormal. The diagnostic performance of these tests decreases even further with the progression of time, and additional investigations should be performed if there is a suspicion of acute pancreatitis.

What is an amylase blood test?

Share on PinterestAn amylase test requires a blood sample.

A variety of medical conditions can affect amylase levels in the blood.

The primary producers of amylase in the body are the pancreas and the salivary glands in the mouth. Approximately 40 percent of the amylase in the blood comes from the pancreas, which means that amylase blood tests can help diagnose conditions that affect the pancreas.

Doctors use amylase blood tests to diagnose or monitor the following conditions:

Pancreatitis

Doctors commonly use amylase blood tests to diagnose or monitor people with acute pancreatitis.

Pancreatitis is inflammation of the pancreas. Pancreatitis can be acute, meaning that a person has the condition for a short period, or chronic, which means that the inflammation is longer-term or recurring.

Pancreatitis can cause severe abdominal pain and swelling. Other symptoms can include:

  • nausea or vomiting
  • upset stomach
  • diarrhea
  • fever
  • jaundice, which is a yellowing of the skin and the whites of the eyes

To help diagnose pancreatitis, a doctor may order an amylase blood test. Abnormally high or low levels of amylase in the blood can be a sign that a person has pancreatitis.

Other tests for pancreatitis may include:

  • Imagining tests, such as a CT scan, MRI scan, or ultrasound. These tests create images of the inside of the body, allowing a doctor to look for signs of inflammation and determine its severity.
  • Lipase blood tests. The pancreas also produces a digestive enzyme called lipase. Abnormal levels of lipase can also be a sign of pancreatitis.

Pancreatic cancer

According to the American Cancer Society (ACS), there is an association between chronic pancreatitis and an increased risk of developing pancreatic cancer, particularly in people who smoke. However, the ACS also state that most individuals with pancreatitis do not get pancreatic cancer.

Amylase and lipase tests are useful in diagnosing or monitoring tumors and cancers that affect the pancreas.

Ovarian cancer

Some case studies suggest a potential link between higher-than-normal levels of amylase, particularly in the saliva, and ovarian tumors.

Lung cancer

Two case studies suggest that there may be an association between high amylase levels in the blood and lung cancer. Therefore, checking a person’s amylase levels may help doctors diagnose and monitor lung cancer.

Other conditions

Share on PinterestSome medication may affect amylase levels.

Other conditions and factors that can affect amylase levels in the blood may include:

  • gallbladder attacks
  • pancreatic cysts or sores
  • gastrointestinal or digestive problems
  • kidney problems
  • having had a recent kidney transplant
  • appendicitis
  • mumps, which is an infection of the salivary glands
  • diabetic ketoacidosis
  • eating disorders
  • pregnancy
  • some medications

Pancreatitis

Sources Used in Current Reviews

Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Available online at https://gi.org/guideline/acute-pancreatitis/. Accessed March 21, 2019.

Crockett S, et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. March 2018 Volume 154, Issue 4, Pages 1096–1101. Available online at https://www.gastrojournal.org/article/S0016-5085(18)30076-3/fulltext. Accessed June 2019.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA .

National Digestive Diseases Information Clearinghouse. Pancreatitis (Online information, accessed December 2006). Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/.

National Digestive Diseases Information Clearinghouse. ERCP (Endoscopic Retrograde Cholangiopancreatography). Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/ercp/.

Tietz NW and Shuey DF. Lipase in Serum — the elusive enzyme: an overview. Clin Chem 39 i5, Pp 746-756, 1993.

Tetrault GA. Lipase activity in serum measured with Ektachem is often increased in nonpancreatic disorders. Clin Chem 37 i3 Pp 447-451, 1991.

Lott JA and Lu CJ. Lipase isoforms and amylase isoenzymes: assays and application in the diagnosis of acute pancreatitis. Clin Chem 37 i3 Pp 361-368, 1991.

Gregory C. Sephel PhD FACB MT(ASCP). Lab Tests Online adjunct board member. Director Clinical Pathology, VA TN Valley Healthcare System; Associate Professor Pathology, Microbiology, Immunology, Vanderbilt University School of Medicine.

What is pancreatitis and how is it diagnosed? [Transcript]

Vikesh Singh, MD, MSc,
discusses pancreatitis.
Watch the video.

Watch the video.

Featuring Vikesh Singh, M.D., M.Sc., Assistant Professor of Medicine; Director, Pancreatitis Center

Describe what you do.

I am Vikesh Singh. I am a gastroenterologist at Johns Hopkins. I am the Director of the Pancreatitis Center and I am the Medical Director of the Islet Auto Transplantation Program. I specialize in inflammatory disorders of the pancreas as well as interventional endoscopy.

What is chronic pancreatitis?

Chronic pancreatitis is a long-standing inflammatory disorder of the pancreas, which results in gradual and progressive fibrosis of the gland, and that ultimately results in three common complications, which include chronic abdominal pain, exocrine insufficiency, as well as endocrine insufficiency. Chronic abdominal pain is the primary reason that patients seek medical attention for this problem. However in the later stages of the diseases, the exocrine insufficiency, which is typically manifested by voluminous diarrhea and endocrine insufficiency which is commonly known as diabetes often set in and these or other conditions typically need to be managed as part of the care of these patients.

What is acute pancreatitis?

Acute pancreatitis is a sudden inflammation of the pancreas which typically catches people off guard and its most commonly manifested by severe abdominal pain which requires medical attention. These patients typically present to emergency rooms and after the diagnosis, which is based on simple blood tests and sometimes a CT scan of the abdomen, these patients are usually admitted. They are given nothing by mouth. They are given IV fluids as well as pain medication. What typically sets apart acute from chronic pancreatitis is that acute pancreatitis usually gets better with these conservative measures. Chronic pancreatitis is really what sets in over a longer period of time with continuous bouts of acute pancreatitis.

Are there other types of pancreatitis?

There aren’t any other types of pancreatitis, but there are other forms of pancreatitis that can result in acute and chronic inflammation. Probably the one we most commonly think of is autoimmune pancreatitis where the body itself is attacking the pancreas and that leads not only to acute inflammation but over some period of time, it can also cause the changes of chronic pancreatitis. But other than that, there are no other true, pathologic forms of pancreatitis.

How is chronic pancreatitis diagnosed?

The diagnosis of chronic pancreatitis involves a combination of testing modalities. One is often a clinical history, but in addition to that, the physician might employ a range of tests including simple blood tests, stool tests, imaging studies and endoscopic procedures. Diagnosing moderate or severe chronic pancreatitis is actually very, very easy. A simple imaging study typically reveals changes in the gland which are common for chronic pancreatitis. In the earliest or mild stages of the disease, that is where the most difficulties are in diagnosing chronic pancreatitis. These are the patients who often have abdominal pain that’s chronic in nature and maybe quite debilitating, even to the point where they often require narcotics. However, pursuing simple imaging studies of these patients usually reveals a normal pancreas. It is those patients who, I think, form the greatest challenge for their providers. And I think that it’s those patients who are probably best served by being referred to a tertiary center where they can undergo more complex testing and evaluation in order to figure out whether they might really have mild or early chronic pancreatitis.

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Tests for Pancreatic Cancer

If a person has signs and symptoms that might be caused by pancreatic cancer, certain exams and tests will be done to find the cause. If cancer is found, more tests will be done to help determine the extent (stage) of the cancer.

Medical history and physical exam

Your doctor will ask about your medical history to learn more about your symptoms. The doctor might also ask about possible risk factors, including smoking and your family history.

Your doctor will also examine you to look for signs of pancreatic cancer or other health problems. Pancreatic cancers can sometimes cause the liver or gallbladder to swell, which the doctor might be able to feel during the exam. Your skin and the whites of your eyes will also be checked for jaundice (yellowing).

If the results of the exam are abnormal, your doctor will probably order tests to help find the problem. You might also be referred to a gastroenterologist (a doctor who treats digestive system diseases) for further tests and treatment.

Imaging tests

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests might be done for a number of reasons both before and after a diagnosis of pancreatic cancer, including:

  • To look for suspicious areas that might be cancer
  • To learn how far cancer may have spread
  • To help determine if treatment is working
  • To look for signs of cancer coming back after treatment

Computed tomography (CT) scan

The CT scan makes detailed cross-sectional images of your body. CT scans are often used to diagnose pancreatic cancer because they can show the pancreas fairly clearly. They can also help show if cancer has spread to organs near the pancreas, as well as to lymph nodes and distant organs. A CT scan can help determine if surgery might be a good treatment option.

If your doctor thinks you might have pancreatic cancer, you might get a special type of CT known as a multiphase CT scan or a pancreatic protocol CT scan. During this test, different sets of CT scans are taken over several minutes after you get an injection of an intravenous (IV) contrast.

CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle into a suspected pancreatic tumor. But if a needle biopsy is needed, most doctors prefer to use endoscopic ultrasound (described below) to guide the needle into place.

Magnetic resonance imaging (MRI)

MRI scans use radio waves and strong magnets instead of x-rays to make detailed images of parts of your body. Most doctors prefer to look at the pancreas with CT scans, but an MRI might also be done.

Special types of MRI scans can also be used in people who might have pancreatic cancer or are at high risk:

  • MR cholangiopancreatography (MRCP), which can be used to look at the pancreatic and bile ducts, is described below in the section on cholangiopancreatography.
  • MR angiography (MRA), which looks at blood vessels, is mentioned below in the section on angiography.

Ultrasound

Ultrasound (US) tests use sound waves to create images of organs such as the pancreas. The two most commonly used types for pancreatic cancer are:

  • Abdominal ultrasound: If it’s not clear what might be causing a person’s abdominal symptoms, this might be the first test done because it is easy to do and it doesn’t expose a person to radiation. But if signs and symptoms are more likely to be caused by pancreatic cancer, a CT scan is often more useful.
  • Endoscopic ultrasound (EUS): This test is more accurate than abdominal US and can be very helpful in diagnosing pancreatic cancer. This test is done with a small US probe on the tip of an endoscope, which is a thin, flexible tube that doctors use to look inside the digestive tract and to get biopsy samples of a tumor.

Cholangiopancreatography

This is an imaging test that looks at the pancreatic ducts and bile ducts to see if they are blocked, narrowed, or dilated. These tests can help show if someone might have a pancreatic tumor that is blocking a duct. They can also be used to help plan surgery. The test can be done in different ways, each of which has pros and cons.

Endoscopic retrograde cholangiopancreatography (ERCP): For this test, an endoscope (a thin, flexible tube with a tiny video camera on the end) is passed down the throat, through the esophagus and stomach, and into the first part of the small intestine. The doctor can see through the endoscope to find the ampulla of Vater (where the common bile duct empties into the small intestine).

X-rays taken at this time can show narrowing or blockage in these ducts that might be due to pancreatic cancer. The doctor doing this test can put a small brush through the tube to remove cells for a biopsy or place a stent (small tube) into a bile or pancreatic duct to keep it open if a nearby tumor is pressing on it.

Magnetic resonance cholangiopancreatography (MRCP): This is a non-invasive way to look at the pancreatic and bile ducts using the same type of machine used for standard MRI scans. Unlike ERCP, it does not require an infusion of a contrast dye. Because this test is non-invasive, doctors often use MRCP if the purpose is just to look at the pancreatic and bile ducts. But this test can’t be used to get biopsy samples of tumors or to place stents in ducts.

Percutaneous transhepatic cholangiography (PTC): In this procedure, the doctor puts a thin, hollow needle through the skin of the belly and into a bile duct within the liver. A contrast dye is then injected through the needle, and x-rays are taken as it passes through the bile and pancreatic ducts. As with ERCP, this approach can also be used to take fluid or tissue samples or to place a stent into a duct to help keep it open. Because it is more invasive (and might cause more pain), PTC is not usually used unless ERCP has already been tried or can’t be done for some reason.

Positron emission tomography (PET) scan

For a PET scan, you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells. A special camera is then used to create a picture of areas of radioactivity in the body.

This test is sometimes used to look for spread from exocrine pancreatic cancers.

PET/CT scan: Special machines can do both a PET and CT scan at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan. This test can help determine the stage (extent) of the cancer. It might be especially useful for spotting cancer that has spread beyond the pancreas and wouldn’t be treatable by surgery.

Angiography

This is an x-ray test that looks at blood vessels. A small amount of contrast dye is injected into an artery to outline the blood vessels, and then x-rays are taken.

An angiogram can show if blood flow in a particular area is blocked by a tumor. It can also show abnormal blood vessels (feeding the cancer) in the area. This test can be useful in finding out if a pancreatic cancer has grown through the walls of certain blood vessels. Mainly, it helps surgeons decide if the cancer can be removed completely without damaging vital blood vessels, and it can also help them plan the operation.

X-ray angiography can be uncomfortable because the doctor has to put a small catheter into the artery leading to the pancreas. Usually the catheter is put into an artery in your inner thigh and threaded up to the pancreas. A local anesthetic is often used to numb the area before inserting the catheter. Once the catheter is in place, the dye is injected to outline all the vessels while the x-rays are being taken.

Angiography can also be done with a CT scanner (CT angiography) or an MRI scanner (MR angiography). These techniques are now used more often because they can give the same information without the need for a catheter in the artery. You might still need an IV line so that a contrast dye can be injected into the bloodstream during the imaging.

Blood tests

Several types of blood tests can be used to help diagnose pancreatic cancer or to help determine treatment options if it is found.

Liver function tests: Jaundice (yellowing of the skin and eyes) is often one of the first signs of pancreatic cancer. Doctors often get blood tests to assess liver function in people with jaundice to help determine its cause. Certain blood tests can look at levels of different kinds of bilirubin (a chemical made by the liver) and can help tell whether a patient’s jaundice is caused by disease in the liver itself or by a blockage of bile flow (from a gallstone, a tumor, or other disease).

Tumor markers: Tumor markers are substances that can sometimes be found in the blood when a person has cancer. Tumor markers that may be helpful in pancreatic cancer are:

  • CA 19-9
  • Carcinoembryonic antigen (CEA), which is not used as often as CA 19-9

Neither of these tumor marker tests is accurate enough to tell for sure if someone has pancreatic cancer. Levels of these tumor markers are not high in all people with pancreatic cancer, and some people who don’t have pancreatic cancer might have high levels of these markers for other reasons. Still, these tests can sometimes be helpful, along with other tests, in figuring out if someone has cancer.

In people already known to have pancreatic cancer and who have high CA19-9 or CEA levels, these levels can be measured over time to help tell how well treatment is working. If all of the cancer has been removed, these tests can also be done to look for signs the cancer may be coming back.

Other blood tests: Other tests, like a CBC or chemistry panel, can help evaluate a person’s general health (such as kidney and bone marrow function). These tests can help determine if they’ll be able to withstand the stress of a major operation.

Biopsy

A person’s medical history, physical exam, and imaging test results may strongly suggest pancreatic cancer, but usually the only way to be sure is to remove a small sample of tumor and look at it under the microscope. This procedure is called a biopsy. Biopsies can be done in different ways.

Percutaneous (through the skin) biopsy: For this test, a doctor inserts a thin, hollow needle through the skin over the abdomen and into the pancreas to remove a small piece of a tumor. This is known as a fine needle aspiration (FNA). The doctor guides the needle into place using images from ultrasound or CT scans.

Endoscopic biopsy: Doctors can also biopsy a tumor during an endoscopy. The doctor passes an endoscope (a thin, flexible, tube with a small video camera on the end) down the throat and into the small intestine near the pancreas. At this point, the doctor can either use endoscopic ultrasound (EUS) to pass a needle into the tumor or endoscopic retrograde cholangiopancreatography (ERCP) to place a brush to remove cells from the bile or pancreatic ducts.

Surgical biopsy: Surgical biopsies are now done less often than in the past. They can be useful if the surgeon is concerned the cancer has spread beyond the pancreas and wants to look at (and possibly biopsy) other organs in the abdomen. The most common way to do a surgical biopsy is to use laparoscopy (sometimes called keyhole surgery). The surgeon can look at the pancreas and other organs for tumors and take biopsy samples of abnormal areas.

Some people might not need a biopsy

Rarely, the doctor might not do a biopsy on someone who has a tumor in the pancreas if imaging tests show the tumor is very likely to be cancer and if it looks like surgery can remove all of it. Instead, the doctor will proceed with surgery, at which time the tumor cells can be looked at in the lab to confirm the diagnosis. During surgery, if the doctor finds that the cancer has spread too far to be removed completely, only a sample of the cancer may be removed to confirm the diagnosis, and the rest of the planned operation will be stopped.

If treatment (such as chemotherapy or radiation) is planned before surgery, a biopsy is needed first to be sure of the diagnosis.

Lab tests of biopsy samples

The samples obtained during a biopsy (or during surgery) are sent to a lab, where they are looked at under a microscope to see if they contain cancer cells.

If cancer is found, other tests might be done as well. For example, tests might be done to see if the cancer cells have mutations (changes) in certain genes, such as the BRCA genes (BRCA1 or BRCA2) or NTRK genes. This might affect whether certain targeted therapy drugs might be helpful as part of treatment.

See Testing Biopsy and Cytology Specimens for Cancer to learn more about different types of biopsies, how the biopsy samples are tested in the lab, and what the results will tell you.

Genetic counseling and testing

If you’ve been diagnosed with pancreatic cancer, your doctor might suggest speaking with a genetic counselor to determine if you could benefit from genetic testing.

Some people with pancreatic cancer have gene mutations (such as BRCA mutations) in all the cells of their body, which put them at increased risk for pancreatic cancer (and possibly other cancers). Testing for these gene mutations can sometimes affect which treatments might be helpful. It might also affect whether other family members should consider genetic counseling and testing as well.

For more information on genetic testing, see Genetics and Cancer.

Diagnosing Exocrine Pancreatic Insufficiency

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Exocrine pancreatic insufficiency is a rare and relatively unknown digestive disorder caused by a decreased amount of pancreatic digestive juices — important enzymes needed to break down foods so the body can get the nutrients it needs. In exocrine pancreatic insufficiency, not enough of these essential juices get from the pancreas to the small intestine, and malnutrition and other health problems may develop.

“Actual information about people with exocrine pancreatic insufficiency isn’t well known,” says John Affronti, MD, a gastroenterologist at Loyola University Health System and a professor of medicine at the Stritch School of Medicine in Chicago. “According to Medicare statistics, the condition leads to 122,000 emergency department visits and 56,000 hospital visits per year, but it’s believed that these estimates are low, and the number of people with this condition is probably much higher.”

Symptoms of Exocrine Pancreatic Insufficiency

One of the main consequences of exocrine pancreatic insufficiency is the body’s inability to break down the fat in foods. This results in fatty stools, a symptom called steatorrhea. Fatty stools are oily, pale, bulky, smelly, and may be hard to flush because they float or stick to the toilet. Other symptoms include:

  • Abdominal discomfort with gas or bloating
  • Muscle cramps
  • Bone pain
  • Easy skin bruising or bleeding
  • Night blindness
  • Weight loss

How Exocrine Pancreatic Insufficiency Is Diagnosed

Symptoms of exocrine pancreatic insufficiency can range from very mild to severe. However, there currently aren’t reliable, non-invasive pancreatic tests that can determine mild to moderate pancreatic insufficiency. “Findings in lab tests can come back negative even if exocrine pancreatic insufficiency is present,” Dr. Affronti says. An X-ray or computerized tomography (CT) scan may help, and a fecal fat test can be effective, although it requires large stool samples.

These tests are commonly used to help diagnose exocrine pancreatic insufficiency:

  • A fecal fat test involves looking at a stool sample under a microscope. A stool sample can also be checked to see if the pancreatic enzymes trypsin and elastase are in the intestine as they should be.
  • Blood tests can measure trypsinogen, the pancreatic enzyme that converts to trypsin.
  • An endoscopic retrograde cholangio-pancreatography (ERCP) is a test that uses a flexible telescope inserted through the mouth and passed down through the stomach to take pictures of the pancreas and look for damage to it. A biopsy of the pancreas may be taken during ERCP to be used for additional testing.

Treatment for Exocrine Pancreatic Insufficiency

According to a review of the treatment options for exocrine pancreatic insufficiency published in the American Journal of Gastroenterology, treatment needs to be individually tailored because the condition can be caused by so many different diseases and circumstances that can damage the pancreas and keep it from functioning properly.

“Pancreatic surgery, diabetes, cystic fibrosis, autoimmune disorders, pancreatitis, inflammatory bowel diseases such as Crohn’s disease, and other digestive diseases can all cause pancreatic insufficiency,” Affronti says.

Treatment options your doctor may suggest include:

  • Taking pancreatic digestive enzyme medications, which is usually the most effective form of treatment.
  • Following a very low-fat diet.
  • Taking antioxidants, such as vitamins A, E, and C, as well as dietary supplements like methionine, selenium, and grape seed extract, which may help prevent further damage to the pancreas.

In particular, people with pancreatitis as the cause of exocrine pancreatic insufficiency need to take pancreatic enzyme replacements and supplements for vitamins A, D, E, and K, Affronti says.

If you’re diagnosed with exocrine pancreatic insufficiency, work closely with your doctor to find the best treatment for you.

Exocrine Pancreatic Insufficiency Diagnosis

What Is EPI?

Like other rare conditions, exocrine pancreatic insufficiency (EPI) is often difficult to diagnosis, especially if you’re only experiencing mild to moderate symptoms.

Keep reading to learn more about the diagnosis process and what tests you can expect.

How Is EPI Diagnosed?

Diagnosing EPI will likely begin with your doctor performing a physical examination and asking about your medical history. Your medical history will provide important clues for diagnosing EPI. For example, EPI is more common in those who’ve had digestive tract surgery or have a history of pancreatic disease. Your doctor will also ask questions about your family’s medical history.

Your doctor will also try to rule out other conditions that can cause similar symptoms such as:

  • Celiac disease
  • irritable bowel syndrome
  • pancreatic cancer
  • Crohn’s disease
  • ulcerative colitis

If you have symptoms of severe EPI, such as fatty, oily stools, unexplained diarrhea and weight loss, some doctors may diagnose you based on your physical exam and medical history alone. More likely, you’ll also undergo specific diagnostic tests to help your doctor identify any underlying condition that’s causing your EPI, such as pancreatitis or pancreatic cancer.

Imaging Tests

CT Scans

CT scans are a special type of X-ray used to examine soft tissue for damage or abnormalities, such as masses and tumors.

Endoscopic Ultrasound

In this test a probe is inserted into your mouth, down your esophagus, and into your stomach, until the probe reaches the first part of your small intestine. It provides a detailed image of the pancreas and lets your doctor look for pancreatitis, pancreatic tumors, and cysts.

MRI

If more information is needed about the appearance of your pancreas, your doctor may use an MRI instead of a CT scan to look for pancreatic cancer.

Abdominal X-ray

An X-ray may be used to look for damage in the pancreas.

Pancreatic Function Tests

In addition to imaging tests, you can also expect to undergo laboratory tests that measure the functionality of your pancreas.

Stool Tests

Fat in the stool is one of the first signs of EPI. This can be measured or looked for under a microscope.

The Van de Kamer test measures the amount of fat in the stool and is considered one of the most sensitive ways to diagnose EPI. However, the test is difficult to complete because it requires collecting stool samples for three days and keeping strict measurements of your fat intake. The test is challenging to do and the large volume of stool samples makes it unpleasant for the patient and laboratory staff. Because of this, doctors rarely use it.

A test called fecal elastaseis widely used for EPI. It measures levels of the enzyme elastase in a person’s stool, which people with EPI have in smaller amounts. While it’s easy to use, it’s only reliable for detecting moderate to severe EPI.

Breath Test

A breath test is the most reliable and practical way to diagnose moderate EPI. This test involves eating a meal with a special chemical signature in it. After you digest the meal and breathe out an air sample, the chemicals in the air are measured to see how much of the signature remains. The amount of the signature that you exhale is related to how well your pancreas is working.

The breath test is also the only test that can measure the success of therapy to replace your pancreatic enzymes. However, this test is not yet widely available due to its expense.

Secretin Test

While the secretin test is a direct measurement of how well your pancreas is working, it requires inserting a tube into the small intestine. Since it’s so invasive, it’s rarely used compared to other tests.

Blood Tests

Your doctor can order a blood test to determine nutrient shortages or signs of malnutrition caused by EPI.

The Takeaway

If you have symptoms of EPI it’s important that you talk with your doctor. Diagnosing EPI and any underlying conditions as early as possible will help improve your quality of life and prevent further complications.

What is the most important information I should know about ZENPEP?

  • ZENPEP® (pancrelipase) may increase your chance of having a rare bowel disorder called fibrosing colonopathy. This condition is serious and may require surgery. The risk of having fibrosing colonopathy may be reduced by following the dosing instructions your doctor gave you. Call your doctor right away if you have any unusual or severe: stomach area (abdominal) pain, bloating, trouble passing stool (having bowel movements), nausea, vomiting, or diarrhea.
  • Take ZENPEP exactly as prescribed. Do not take more or less ZENPEP than directed by your doctor.

Before you take ZENPEP, tell your doctor:

  • If you are allergic to pork (pig) products; have a history of blockage of your intestines, or scarring or thickening of your bowel wall (fibrosing colonopathy); have gout, kidney disease, or high blood uric acid (hyperuricemia); have trouble swallowing capsules; have any other medical condition; are pregnant or plan to become pregnant; are breastfeeding or plan to breastfeed.
  • About all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

How should I take ZENPEP?

  • Take ZENPEP exactly as your doctor tells you.
  • Do not crush or chew the ZENPEP capsule or its contents, and do not hold the capsule or contents in your mouth. This may cause irritation in your mouth or change the way ZENPEP works in your body. See Medication Guide and talk to your doctor for additional directions.

Side Effects

  • ZENPEP may cause serious side effects, including worsening of swollen, painful joints (gout) caused by an increase in blood uric acid levels and allergic reactions including trouble with breathing, skin rashes, or swollen lips. Call your doctor right away if you have any of these symptoms.
  • The most common side effects of ZENPEP include belly pain, gas, and headache.
  • ZENPEP and other pancreatic enzyme products are made from the pancreas of pigs, the same pigs people eat as pork. These pigs may carry viruses. Although it has never been reported, it may be possible for a person to get a viral infection from taking pancreatic enzyme products that come from pigs.
  • Tell your doctor if you have any side effect that bothers you or does not go away. These are not all the possible side effects of ZENPEP. For more information, ask your doctor or pharmacist.

What is ZENPEP?

    ZENPEP is a prescription medicine for people who cannot digest food normally because their pancreas does not make enough enzymes. ZENPEP may help your body use fats, proteins, and sugars from food. ZENPEP contains a mixture of digestive enzymes (lipases, proteases, and amylases) from pig pancreas. ZENPEP is safe and effective in children.

    Please also see Medication Guide within the full Prescribing Information.

    1. Wooldridge JL, Heubi JE, Amaro-Galvez R, et al. EUR-1008 pancreatic enzyme replacement is safe and effective in patients with cystic fibrosis and pancreatic insufficiency. J Cyst Fibros. 2009;8:405-417. 2. Al-Kaade S. Exocrine pancreatic insufficiency. Medscape website. http://emedicine.medscape.com /article/2121028- overview. Accessed March 16, 2017. 3. Hardt PD, Ewald N. Exocrine pancreatic insufficiency in diabetes mellitus: a complication of diabetic neuropathy or a different type of diabetes? Exp Diabetes Res. 2011;2011:1-7. 4. Domínguez-Muñoz JE. Pancreatic exocrine insufficiency: diagnosis and treatment. J Gastroenterol Hepatol. 2011;26(suppl 2):12-16. 5. Domínguez-Muñoz JE. Chronic pancreatitis and persistent steatorrhea: what is the correct dose of enzymes? Clin Gastroenterol Hepatol. 2011;9:541-546.

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