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The relationship between low pancreatic enzyme output and malabsorption was described in 1973 in the New England Journal of Medicine.1 Over the last four decades, different consensus groups, expert reviews and societal group recommendations have attempted to conceptualise this condition. Older guidelines addressed pancreatic exocrine insufficiency (PEI) as an enzymatic deficiency generally occurring in late pancreatic injury. In recent years, the concept of PEI as a multifaceted syndrome has emerged.2