The evolving definition of pancreatic exocrine insufficiency: Implications for diagnosis and treatment in clinical practice

Pancreatic exocrine insufficiency (PEI) is a syndrome of maldigestion caused by insufficient intraluminal pancreatic enzyme activity, leading to nutritional deficiencies and impaired quality of life. Recent European guidelines have redefined PEI, recognizing it as a multifactorial condition not limited to reduced pancreatic secretion, but also involving functional digestive failure in various clinical contexts, including pancreatic and non-pancreatic diseases. This editorial reviews the key implications of this revised definition for clinical practice, emphasizing a comprehensive diagnostic approach based on clinical context, pancreatic function tests, symptoms, and nutritional markers. Furthermore, it underscores the importance of rational prescription of pancreatic enzyme replacement therapy (PERT), aiming to optimize patient outcomes while avoiding unnecessary treatment. This updated perspective on PEI promotes more accurate diagnosis, targeted therapy, and improved healthcare resource allocation.