Diagnosing EPI: Crucial conversations with patients

DR. RANNEY: I was really interested to hear how you were diagnosed and how long it took to reach that diagnosis.

CAMILLE: When my gastroenterologist finally diagnosed me with EPI, it was because he listened to my story.

CAMILLE: It did take a while before they found the EPI. The symptoms are so similar to that of stomach issues. But by paying close attention to my body, that little light bulb turned on that said, “Hey, it's got to be something else.” So I went to the doctor after doing some research and I said, I think it could be my pancreas. But my doctor said “No, it's stomach issues,” which was frustrating.

DR. RANNEY: Yeah, I'm sorry to hear you went through that. You know, when it comes to frequent diarrhea, bloating, and abdominal pain, it's not uncommon to think of other GI issues, like IBS-D, first. These tend to be thought of first, because they are in fact more common. Especially in patients under 50.

DR. RANNEY: But it's important for practitioners to not have tunnel vision and to only think about IBS-D when patients report these symptoms. Thinking about only the more common GI diagnosis can be a tough habit to break. We should be looking at the whole picture, including family or personal history of any underlying conditions related to EPI, clinical features, and also considering stool tests that include a fecal elastase.

CAMILLE: I wish they would have ordered those tests for me initially. There were a lot of communication barriers in those early days—like only being asked “yes or no” questions or having limited time to fully tell my story.

DR. RANNEY: Unfortunately, I have seen that as well. Good communication is just so important in making a timely diagnosis. I can't emphasize that enough. In my opinion, it's so important to develop rapport with your patients. I think that includes making eye contact, you know, leaning in, and really hearing their story in their own words.

DR. RANNEY: You know, we should be looking for symptoms and clinical features, like having symptoms after eating certain foods, fatty or floating stools, urgent bowel movements, and unexplained weight loss.For many patients, it often takes far too long to make the proper diagnosis, which can affect a patient's overall health.

CAMILLE: I always tell people to keep track of their symptoms and write them down. If you have a good rapport with your doctor, they'll say “Okay, let's look into EPI.” If your doctor is reluctant to investigate things, then it's time to advocate for yourself. Find another option, and refuse to give up.

DR. RANNEY: I love the part about how you were persistent, you did your own research, and you continued to go back to your doctor to communicate what the issues were until they finally found the diagnosis for you. If EPI is missed, it can lead to some serious consequences. It is so important to include EPI in our differential early and to listen to our patients carefully as they describe their symptoms.

CAMILLE: The one thing that I really learned from this whole journey was to make sure and advocate for yourself.

SAFETY VOICE OVER:

Indication

CREON^® (pancrelipase) delayed-release capsules are indicated for the treatment of exocrine pancreatic insufficiency in adult and pediatric patients.

Important Safety Information

• Fibrosing colonopathy has been reported following treatment with pancreatic enzyme products. Do not exceed the recommended dosage of 2,500 lipase units/kg/meal (or 10,000 lipase units/kg/day) or 4,000 lipase units/g fat ingested/day in adult and pediatric patients greater than 12 months of age without further investigation.
• To avoid irritation of oral mucosa, care should be taken to ensure that CREON is not crushed, chewed, or retained in the mouth. CREON should always be taken with food.
• Pancreatic enzyme products contain purines that may increase blood uric acid levels. High dosages have been associated with hyperuricosuria and hyperuricemia. Consider monitoring blood uric acid levels in patients with gout, renal impairment, or hyperuricemia during treatment with CREON.
• There is theoretical risk of viral transmission with all pancreatic enzyme products, including CREON.
• Severe hypersensitivity reactions including anaphylaxis, asthma, hives, and pruritus have been reported with pancreatic enzyme products. Monitor patients with a known hypersensitivity reaction to proteins of porcine origin for hypersensitivity reactions during treatment with CREON.
• Adverse reactions that occurred in at least 2 cystic fibrosis patients (greater than or equal to 4%) receiving CREON were vomiting, dizziness, and cough.
• Adverse reactions that occurred in at least 1 chronic pancreatitis or pancreatectomy patient (greater than or equal to 4%) receiving CREON were hyperglycemia, hypoglycemia, abdominal pain, abnormal feces, flatulence, frequent bowel movements, and nasopharyngitis.

Please see the accompanying full Prescribing Information, including Medication Guide or visit https://www.rxabbvie.com/pdf/creon_pi.pdf