. Author manuscript; available in PMC: 2024 Sep 1.

Published in final edited form as: Curr Opin Gastroenterol. 2023 May 11;39(5):428–435. doi: 10.1097/MOG.0000000000000951

Table 1 –

Staging of exocrine pancreatic dysfunction, adapted from Khan, et al.²

	Descriptive terminology	FE-1 levels (mcg/gm)	Coefficient of fat absorption (%)	Symptoms	Serum vitamin A and E levels	PERT indicated?
Stage I	Mild exocrine pancreatic dysfunction	100–200	≥93	None	Normal	NO
Stage II	Moderate pancreatic exocrine dysfunction	<100	≥93^a	None	Normal	NO
Stage III	Severe pancreatic exocrine dysfunction (EPI without micronutrient deficiency)	<100 (usually <50)	<85^a	Usually present	Normal / low normal	YES
Stage IV	Severe pancreatic exocrine dysfunction (EPI with micronutrient deficiency)	<100 (usually <50)	<85	Usually present	Low	YES and consider micronutrient supplementation

Patients with CFA <93 but >95 would fall into severe EPD if they had symptoms responsive to PERT or low normal vitamin levels. In the absence of these features, such patients can be managed without PERT.

Abbreviations: exocrine pancreatic insufficiency (EPI); fecal elastase (FE-1) pancreas enzyme replacement therapy (PERT)