Chronic pancreatitis (CP) is a progressive inflammatory disorder that irreversibly damages the pancreas, gradually eroding both its digestive and hormone-producing functions. Among its consequential complications is exocrine pancreatic insufficiency (EPI), a condition in which the pancreas can no longer produce enough digestive enzymes. EPI leads to fat malabsorption, weight loss, malnutrition, and deficiencies in fat-soluble vitamins, profoundly impairing patients’ quality of life. Yet despite its clinical significance, the true global burden of EPI, and the factors that drive it, have remained uncertain.
A new systematic review and meta-analysis published in the Journal of Pancreatology on July 16, 2026, now provides comprehensive global evidence to date. Researchers from the Naval Medical University and the Shanghai Institute of Pancreatic Diseases synthesized 14 studies published between 2004 and 2024, encompassing 7,663 patients with CP, to determine the pooled prevalence of EPI and identify its key risk factors.
The analysis found that EPI affects approximately 40% of patients with CP worldwide (pooled prevalence 40.0%; 95% confidence interval [CI]: 33.5%–46.7%). In other words, roughly four in ten people living with CP will develop exocrine insufficiency, a benchmark the authors say is critical for clinical practice.
Strikingly, the estimated prevalence depended heavily on how EPI was diagnosed. Studies using the fecal elastase-1 (FE-1) test reported the highest prevalence (52.1%), followed by the 13 C-mixed triglyceride breath test (31.6%), and the steatorrhea/fecal fat test (21.1%). The researchers attribute this gap to the FE-1 test’s greater sensitivity for detecting mild-to-moderate exocrine dysfunction, whereas fecal fat testing captures only overt malabsorption. This diagnostic variability—including inconsistent FE-1 cutoff values across studies—underscores the urgent need for unified diagnostic criteria.
Smoking emerged as the clearest modifiable risk factor. Pooling data from four studies, the team found smoking was significantly associated with higher odds of developing EPI (odds ratio 1.51; 95% CI: 1.25–1.76). Additional risk factors identified in individual studies included diabetes, low body mass index, male sex, and a history of pancreatic interventions such as stenting or resection.
The authors emphasize that early detection matters because effective pancreatic enzyme replacement therapy is available but remains underused and inadequately monitored. They call for harmonized diagnostic standards, routine EPI screening, especially for patients with smoking history, malnutrition, or advanced pancreatic damage, and further research into the natural history of EPI and the long-term benefits of smoking cessation. While the study’s substantial heterogeneity and reliance on observational data limit causal conclusions, the authors note that its pooled estimates offer a vital evidence base for improving the diagnosis and management of EPI worldwide.
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Reference
DOI: https://doi.org/10.1097/JP9.0000000000000263
About Dr. Zhuan Liao from Shanghai Institute of Pancreatic Diseases, China
Zhuan Liao, Shanghai Institute of Pancreatic Diseases, Shanghai 200433, China. E-mail: zhuanleo@126.com;
About Dr. Wenbin Zou from Changhai Hospital, China
Wenbin Zou, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China. E-mail: dr.wenbinzou@hotmail.com
Funding information
None.
Journal of Pancreatology
Systematic review
People
Prevalence and risk factors of exocrine pancreatic insufficiency in patients with chronic pancreatitis: A systematic review and meta-analysis
16-Jul-2026
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