{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:37:29Z","timestamp":1787071049313,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Exocrine pancreatic insufficiency (EPI) is an underdiagnosed entity among patients with new-onset chronic diarrhea (CD). The aim of this study is to investigate the prevalence of EPI in patients with CD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>Patients with new-onset CD (\u22654 weeks) from 2018 to 2021 were enrolled in this single-center prospective study. If stool fecal elastase (FE) was &lt;200 \u03bcg\/g, patients were offered a confirmatory 72-hour fecal fat test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      FE testing was completed by 97 patients, of which 9 had low FE (9.3%). Average weight was significantly higher in patients with low FE (98.5 \u00b1 29.3 kg vs 82.2 \u00b1 22.2 kg;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.045). There was no significant difference in gender, age, race, presence of diabetes mellitus, and history of tobacco or alcohol use between the two groups. After controlling for other factors, patients with low FE had a statistically higher weight in comparison to those with normal FE. Nine patients in the entire cohort were started on pancreatic enzymes (three based on low FE and six empirically based on high pretest probability for EPI). Six of the nine patients had complete resolution of symptoms (including two of three patients with low FE).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Considering the 9.3% prevalence of EPI among patients with CD, we propose screening for EPI with stool FE as part of the initial workup for these patients.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      Clinicaltrial.gov number NCT03407534.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sjmms.sjmms_4_25","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:02:15Z","timestamp":1745280135000},"page":"99-105","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of Exocrine Pancreatic Insufficiency in Patients with Chronic Diarrhea"],"prefix":"10.4103","volume":"13","author":[{"given":"Tara","family":"Keihanian","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suneal","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabil","family":"Mansour","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Mercado","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hashem B.","family":"El-Serag","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed O.","family":"Othman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,21]]},"reference":[{"key":"R1-20250422","doi-asserted-by":"crossref","first-page":"e13066","DOI":"10.1111\/ijcp.13066","article-title":"Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician","volume":"72","author":"Othman","year":"2018","journal-title":"Int J Clin Pract"},{"key":"R2-20250422","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1111\/j.1365-2036.2006.03206.x","article-title":"Is exocrine pancreatic insufficiency in adult coeliac disease a cause of persisting symptoms?","volume":"25","author":"Leeds","year":"2007","journal-title":"Aliment Pharmacol Ther"},{"key":"R3-20250422","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1007\/s10620-007-9852-y","article-title":"Prevalence of pancreatic insufficiency in inflammatory bowel diseases. Assessment by fecal elastase-1","volume":"53","author":"Maconi","year":"2008","journal-title":"Dig Dis Sci"},{"key":"R4-20250422","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1080\/00365520510023116","article-title":"Prevalence and determinants of exocrine pancreatic insufficiency among older adults:Results of a population-based study","volume":"40","author":"Rothenbacher","year":"2005","journal-title":"Scand J Gastroenterol"},{"key":"R5-20250422","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.cgh.2009.09.032","article-title":"Some patients with irritable bowel syndrome may have exocrine pancreatic insufficiency","volume":"8","author":"Leeds","year":"2010","journal-title":"Clin Gastroenterol Hepatol"},{"key":"R6-20250422","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1136\/postgradmedj-2015-133262","article-title":"Exocrine pancreatic insufficiency, MRI of the pancreas and serum nutritional markers in patients with coeliac disease","volume":"91","author":"Vujasinovic","year":"2015","journal-title":"Postgrad Med J"},{"key":"R7-20250422","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1590\/S0004-28032014000400006","article-title":"Comparison of fecal elastase 1 for exocrine pancreatic insufficiency evaluation between ex-alcoholics and chronic pancreatitis patients","volume":"51","author":"Mattar","year":"2014","journal-title":"Arq Gastroenterol"},{"key":"R8-20250422","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1111\/jgh.13791","article-title":"Undiagnosed pancreatic exocrine insufficiency and chronic pancreatitis in functional GI disorder patients with diarrhea or abdominal pain","volume":"32","author":"Talley","year":"2017","journal-title":"J Gastroenterol Hepatol"},{"key":"R9-20250422","first-page":"48","article-title":"Role of alcohol metabolism in chronic pancreatitis","volume":"30","author":"Vonlaufen","year":"2007","journal-title":"Alcohol Res Health"},{"key":"R10-20250422","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1001\/archinternmed.2009.125","article-title":"Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis","volume":"169","author":"Yadav","year":"2009","journal-title":"Arch Intern Med"},{"key":"R11-20250422","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1111\/add.13556","article-title":"High-intensity drinking by underage young adults in the United States","volume":"112","author":"Patrick","year":"2017","journal-title":"Addiction"},{"key":"R12-20250422","first-page":"9","volume":"62","year":"2013","journal-title":"Morb Mortal Wkly Rep"},{"key":"R13-20250422","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1111\/apt.13746","article-title":"Validity and reliability of the bristol stool form scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome","volume":"44","author":"Blake","year":"2016","journal-title":"Aliment Pharmacol Ther"},{"key":"R14-20250422","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/1471-230X-8-30","article-title":"Evaluation of the birmingham IBS symptom questionnaire","volume":"8","author":"Roalfe","year":"2008","journal-title":"BMC Gastroenterol"},{"key":"R15-20250422","doi-asserted-by":"crossref","first-page":"7059","DOI":"10.3748\/wjg.v23.i39.7059","article-title":"Less common etiologies of exocrine pancreatic insufficiency","volume":"23","author":"Singh","year":"2017","journal-title":"World J Gastroenterol"},{"key":"R16-20250422","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1053\/j.gastro.2019.07.004","article-title":"AGA clinical practice guidelines on the laboratory evaluation of functional diarrhea and diarrhea-predominant irritable bowel syndrome in adults (IBS-D)","volume":"157","author":"Smalley","year":"2019","journal-title":"Gastroenterology"},{"key":"R17-20250422","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/MCG.0000000000001855","article-title":"Differential diagnosis of chronic diarrhea:An algorithm to distinguish irritable bowel syndrome with diarrhea from other organic gastrointestinal diseases, with special focus on exocrine pancreatic insufficiency","volume":"57","author":"Brenner","year":"2023","journal-title":"J Clin Gastroenterol"},{"key":"R18-20250422","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1053\/j.gastro.2023.07.007","article-title":"AGA clinical practice update on the epidemiology, evaluation, and management of exocrine pancreatic insufficiency:Expert review","volume":"165","author":"Whitcomb","year":"2023","journal-title":"Gastroenterology"},{"key":"R19-20250422","doi-asserted-by":"crossref","first-page":"588","DOI":"10.7861\/clinmed.2023-0185","article-title":"Are we missing pancreatic exocrine insufficiency in 'at-risk'groups?Prospective assessment of the current practice and yield of faecal elastase testing in patients with diabetes mellitus, HIV and\/or high alcohol intake","volume":"23","author":"Jalal","year":"2023","journal-title":"Clin Med (Lond)"},{"key":"R20-20250422","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1038\/nrgastro.2011.91","article-title":"The role of fecal elastase-1 in detecting exocrine pancreatic disease","volume":"8","author":"Leeds","year":"2011","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"R21-20250422","doi-asserted-by":"crossref","first-page":"102774","DOI":"10.1016\/j.eclinm.2024.102774","article-title":"Prevalence of exocrine pancreatic insufficiency at 12 months after acute pancreatitis:A prospective, multicentre, longitudinal cohort study","volume":"75","author":"Phillips","year":"2024","journal-title":"EClinicalMedicine"},{"key":"R22-20250422","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1373\/jalm.2018.026229","article-title":"Elimination of 72-hour quantitative fecal fat testing by restriction, laboratory consultation, and evaluation of specimen weight and fat globules","volume":"3","author":"Korostensky","year":"2018","journal-title":"J Appl Lab Med"},{"key":"R23-20250422","doi-asserted-by":"crossref","first-page":"5290642","DOI":"10.1155\/2019\/5290642","article-title":"Endoscopic ultrasound findings in patients diagnosed with exocrine pancreatic insufficiency by low fecal elastase-1","volume":"2019","author":"Shobassy","year":"2019","journal-title":"Gastroenterol Res Pract"},{"key":"R24-20250422","doi-asserted-by":"crossref","first-page":"3244","DOI":"10.1007\/s10620-021-07181-1","article-title":"Endoscopic ultrasound finding of diffuse echogenicity in the pancreas, is it relevant?","volume":"67","author":"Krill","year":"2022","journal-title":"Dig Dis Sci"},{"key":"R25-20250422","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1097\/MPA.0000000000001252","article-title":"Association of pancreatic steatosis with chronic pancreatitis, obesity, and type 2 diabetes mellitus","volume":"48","author":"Tirkes","year":"2019","journal-title":"Pancreas"},{"key":"R26-20250422","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.pan.2019.08.008","article-title":"Obesity and pancreatic cancer:An update of epidemiological evidence and molecular mechanisms","volume":"19","author":"Zhou","year":"2019","journal-title":"Pancreatology"}],"container-title":["Saudi Journal of Medicine &amp; Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sjmms.sjmms_4_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:40:46Z","timestamp":1787067646000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sjmms.sjmms_4_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":26,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/sjmms.sjmms_4_25","relation":{},"ISSN":["1658-631X"],"issn-type":[{"value":"1658-631X","type":"print"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2025-01-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-13","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}