High Frequency of Pancreatic Exocrine Insufficiency Among Patients with Abdominal Pain, Bloating, and Malodorous Flatus: Hidden Pancreatic Insufficiency

Background/Aims: Pancreatic exocrine insufficiency (PEI) is a condition characterized by impaired digestion and absorption resulting from insufficient exocrine secretion of the pancreas. The current study aimed to determine the prevalence, clinical characteristics, and associated risk factors of PEI in patients presenting to the gastroenterology outpatient clinic with common gastrointestinal complaints such as abdominal pain, dyspepsia, and defecation disorders. Materials and Methods: Three hundred ten symptomatic patients were retrospectively evaluated using demographic data, biochemical markers, the PEI Questionnaire, and fecal elastase-1 (FE-1) levels. PEI was defined as an FE-1 level <200 μg/mL, with levels <100 μg/mL indicating severe deficiency. Results: PEI was identified in 45.8% (n = 142) of the cohort, with 43% classified as severe. PEI was significantly more common in males (P = .024). Key comorbidities associated with PEI included diabetes mellitus, hypertension, hyperlipidemia, and prior gastric or pancreatic surgery. Abdominal pain, bloating, and particularly malodorous flatus (odds ratio = 3.705) were strong predictors of PEI. Severe PEI was associated with significantly lower hemoglobin and vitamin D levels. Sixty-five percent of patients with PEI had prior symptoms but had not been diagnosed. Conclusion: PEI is highly prevalent among patients with non-specific gastrointestinal (GI) symptoms and is frequently underdiagnosed. Clinicians should maintain a high index of suspicion, particularly in patients with metabolic comorbidities or prior GI surgeries.