James Alvarez, MD1, Neal Bhachawat, 2, Charles Randall, MD3, Deanna May, FNP3, John Vizuete, MD, MPH3 1UT Health San Antonio, San Antonio, TX; 2University of North Texas Health Science Center, Fort Worth, TX; 3Gastroenterology Clinic of San Antonio, San Antonio, TX
Introduction: Abdominal pain, diarrhea, and gas/bloating are among the most common gastrointestinal symptoms that bring patients to the clinic; comprising 21%, 25%, and 20% of presentations, respectively (1). Awareness of exocrine pancreatic insufficiency (EPI) has risen in recent years. Though some have underlying conditions such as cystic fibrosis, pancreatic surgeries, diabetes, chronic pancreatitis, and pancreatic cancer, most are idiopathic. In this study we reviewed 219 patients presenting with the aforementioned symptoms who were diagnosed with EPI without a predisposing condition. Previous reviews have discussed routine etiologies of gas/bloat syndrome with pain and perturbation of defecation (2,3). In this paper we describe the prevalence of comorbid disorders that contribute to this symptom complex.
Methods: We identified 219 patients (147 female, 72 male) with idiopathic EPI in the outpatient clinic with any combination of gas/bloat, pain, and diarrhea. Ages ranged from 18-90 years (median 64). We obtained standard chemistries, CBC, thyroid profile, celiac panel, stool elastase, lactoferrin, and hydrogen breath testing for carbohydrate malabsorption and SIBO. If an elevated lactoferrin, suspicious celiac panel, or persistent diarrhea were observed, endoscopic examinations were performed. Patients were also evaluated for IBS using Rome IV criteria.
Results: Of the 219 patients, we noted diagnoses that are associated with similar symptoms: 43 (19.6%) had SIBO, 43 (19.6 %) fructose intolerance, 28 (12.8%) lactose intolerance, 8 (3.7 %) with celiac, and 4 (1.8%) with sucrose intolerance. Notably, 14 (6.4 %) were diagnosed with microscopic colitis and 29 (13.2%) with IBS. Further analysis revealed that 24.7% had 2 conditions, 11% with 3, 6.8% with 4, and 2.3% with 5.
Discussion: EPI is a common and easily treated problem seen in clinic, but often is not a comprehensive diagnosis. A constellation of symptoms including gas/bloat, pain, and diarrhea are often indicative of a more complex and multifactorial phenomenon that requires meticulous evaluation.
1. CV Almario, et al. Prevalence of Gastrointestinal Symptoms in the General Population of the United States. Am. J. Gastroenterol. Oct 2018 2. J Niznete, et al .The Differential Diagnosis of Gas and Bloating. Am. J. Gastroenterol. Sept 2013. 3. CW Randall, et al . Testing for Lactose and Fructose Intolerance Should be Standard Protocol for Patients with Chronic Abdominal Complaints Gastroenterology 130 (4); April 2006
James Alvarez indicated no relevant financial relationships.
Neal Bhachawat indicated no relevant financial relationships.
Charles Randall indicated no relevant financial relationships.
Deanna May indicated no relevant financial relationships.
John Vizuete indicated no relevant financial relationships.
James Alvarez, MD1, Neal Bhachawat, 2, Charles Randall, MD3, Deanna May, FNP3, John Vizuete, MD, MPH3. P2091 - Is There More to Gas and Bloating, Abdominal Pain, and Diarrhea in Patients With Exocrine Pancreatic Insufficiency?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.