If your doctor suspects you may have exocrine pancreatic insufficiency (EPI), they’ll order a range of blood tests to check nutrient and enzyme levels.

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While blood testing can be helpful in diagnosing many health conditions, it can’t diagnose EPI.

This is a condition where the pancreas doesn’t produce or release sufficient digestive enzymes, preventing the body from properly absorbing necessary nutrients. Because this can cause nutrient deficiencies, your doctor may use a blood test to look for low nutrient levels.

However, only clinical symptoms, stool tests, and imaging tests can diagnose EPI. Blood tests are an additional tool, but a wide range of things can cause nutrient deficiencies — not just EPI.

EPI can make it harder for your body to absorb certain nutrients. One of these is iron, which your body uses to produce red blood cells that carry oxygen around your body.

Insufficient iron absorption can lead to iron deficiency and anemia, which can make you feel tired, fatigued, and dizzy.

Iron deficiency and low red blood cell counts can also point to micronutrient deficiency, which can happen when you don’t get enough vitamins and minerals over a prolonged period of time.

If you’re eating a balanced diet, micronutrient deficiency may be a sign of inadequate general nutrient absorption.

Older research observed that 30% of adults with EPI had malabsorption of vitamin B12.

While the researchers weren’t completely able to understand why this occurs, they theorized that EPI affects vitamin B12’s ability to bind to intrinsic factor, a protein that helps your intestines absorb nutrients.

If you have symptoms of a deficiency, testing vitamin B12 levels is also important because it’s an essential vitamin. Your doctor may recommend supplementation if you have a deficiency whether or not you receive an EPI diagnosis.

A 2019 study on dogs with EPI reports that 55% had high folate levels, but more research is necessary to determine how this correlates with humans.

High folate levels may be due to a vitamin B12 deficiency. This is because the body requires vitamin B12 to use folate, so low B12 levels mean your body can’t use the folate it already has.

Still, it’s important to note that nutritional supplements can raise folate levels and mask a vitamin B12 deficiency, so it’s important to let your doctor know if you’re taking any.

If you’re consuming a balanced diet, low levels of fat-soluble vitamins and minerals can be a sign of malabsorption. This is a sign of EPI because the body has insufficient enzymes to properly digest food.

Trypsinogen is a chemical produced by the pancreas to help the body digest food. If you have advanced EPI, levels of trypsinogen can be lower.

It’s important to remember that trypsinogen isn’t specific to EPI, though. Having low levels may be associated with a variety of conditions.

Your doctor may rely on a variety of direct and indirect testing to diagnose EPI.

Direct testing will attempt to evaluate how your pancreas works, while indirect testing will look for evidence of insufficient enzyme production.

In addition to looking for evidence of nutrient malabsorption and measuring the amount of exocrine pancreatic secretion, your doctor may wish to perform testing to rule out other conditions with similar symptoms. This is called differential diagnosis.

You should contact your doctor if you’re showing signs of EPI. These may include:

  • bloating
  • abdominal pain
  • diarrhea
  • greasy, smelly stools
  • excess gas
  • weight loss
  • difficulty with night vision
  • bone concerns like low bone density and osteoporosis

Learn more about the signs and symptoms of EPI.

Healthcare professionals often recommend pancreatic enzyme replacement therapy and lifestyle changes if you have EPI. Your doctor will likely recommend additional treatment, like supplements, to manage your symptoms.

Learn more about the treatment for EPI.

You may not be able to prevent EPI if it develops due to an inherited condition like cystic fibrosis. However, you can make lifestyle choices that support pancreatic health and reduce your chances of developing pancreatitis.

For example, you can:

  • reduce your alcohol consumption, if applicable
  • avoid smoking, if applicable
  • eat a balanced diet
  • get regular physical activity
  • find ways to manage or reduce stress

These can prevent pancreatitis and improve your overall health.

If your doctor suspects that you have EPI, they may order blood testing to determine if your body is showing signs of insufficient enzymes and nutrient malabsorption.

As part of these blood tests, they may check your folate, B12, iron, and trypsinogen levels. They may also test your stool and pancreatic function.

It’s important to let your doctor know about any symptoms you’re experiencing.