Pancreatic exocrine insufficiency

Pancreatic exocrine insufficiency (PEI) is a common but frequently under-recognised condition that often presents with non-specific gastrointestinal symptoms, which may be subtle in early stages. Evidence from studies published between 2000 and 2026 indicates that, although the leading causes of PEI are pancreatic diseases such as chronic or autoimmune pancreatitis, pancreatic cancer, and pancreatic surgery, it is also increasingly recognised in common conditions including diabetes mellitus and ageing. Clinically, PEI should be suspected in patients presenting with diarrhoea, steatorrhoea, bloating, weight loss, or abdominal discomfort, particularly when malnutrition or micronutrient deficiencies are present. These deficiencies are associated with clinically relevant complications, including osteoporosis and cardiovascular disease, highlighting the importance of timely diagnosis and appropriate management. Pancreatic enzyme replacement therapy remains the cornerstone of treatment, with currently available porcine-derived formulations demonstrating high efficacy, although future research should explore alternative enzyme sources and novel therapeutic approaches. Funding: The authors received no financial support for the research, authorship, and/or publication of this article.