While EPI can exist alone, I am aware of surgical and non-surgical pancreatic cancer patients that after being prescribed a pancrealipase when fecal elastase test result indicated EPI, still had GI issues of malabsorption. It turned out that upon further diagnostic work-up, a co-morbidity existed or occurred at some point. Lactose intolerance and gluten intolerance (celiac disease) were the most frequently occurring. Other co-morbidities that can occur are Crohn’s disease, ulcerative colitis, IBD/IBS, small intestinal bacterial overload (SIBO). If problems are not resolved after optimizing a pancrealipase and evaluating a different brand, a GI specialist should be consulted for a further GI work-up.