u/AprilVInTheD

40F told I have EPI / acute pancreatis but no typical symptoms — mainly fatigue. Looking for input / next steps

Hi all — I’d really appreciate insight from anyone who has dealt with EPI or something similar.

I’m a 40F (~172 lbs) and have had gut issues for ~4 years. My current situation is confusing because I don’t have typical GI symptoms.

History:

• 2023 GI-MAP: H. pylori + elastase 115
• Treated H. pylori → improved
• 2025 GI-MAP: elastase 162 (still low), Salmonella (treated but not retested)
• No current stomach pain, no regular diarrhea

Current symptoms:

• Severe daily afternoon fatigue (sometimes need 3–4 hour naps)
• Worse if I do even light strength training
• Morning energy is usually fine
• Brain Fog
• Mild Gas

GI-wise:

• I have ~3 bowel movements/day
• No oily/floating stools
• No nausea, vomiting, or cramps
• I can eat normally
• I’ve actually gained weight due to fatigue limiting activity

Other:

• Gluten-free + dairy-free + pretty healthy eater
• Non smoker occasional drinker
• Salmonella had me REALLY sick
• Labs mostly normal (iron, thyroid, etc.)
• Vitamin D a bit low, B12 high from injections
• Mild lower back discomfort (not severe, but noticeable)

GI visit:

• Doctor saw elastase 162 and diagnosed EPI
• Prescribed Creon (trying to switch to Zenpep due to insurance) - haven't gotten it filled yet
• Ordered abdominal ultrasound + stool test to rule out infection
• No further explanation or workup

Questions:

1. Has anyone had fatigue as the main symptom of EPI without typical GI issues?
2. Is elastase around 160 enough to diagnose EPI on its own?
3. Would you push for additional testing (repeat elastase, fecal fat, SIBO, etc.)?
4. Is ultrasound the right next step, or should I be asking for something else?
5. Would you start something like Zenpep even if you’re unsure about the diagnosis? If so any advice when taking Zenpep that differs from Creon? I did most my research on Creon before my insurance stalled that.
6. Would you get a second GI opinion in this situation?

I feel like something might be getting missed and just want to make sure I’m heading in the right direction.

Really appreciate any insight.