Chronic giardiasis: a rare cause of exocrine pancreatic insufficiency

Exocrine pancreatic insufficiency (EPI) is a major cause of maldigestion/malabsorption syndromes. It is routinely diagnosed in clinical practice with the use of faecal elastase 1 levels, and pancreatic enzyme replacement therapy continues to be the mainstay of treatment. Numerous primary pancreatic and extrapancreatic causes for EPI have been established. Chronic giardiasis is a common condition with symptoms similar to EPI; however, it has also been described as an infrequent cause of EPI. Much remains to be understood about the pathobiology of this association. Here, we present our experience of an intriguing case of severe pancreatic insufficiency in the setting of chronic giardiasis. The patient showed improvement in symptoms over weeks after completion of treatment for chronic giardiasis.