Pancreatic exocrine insufficiency (PEI) is a common yet frequently under-recognised cause of maldigestion, malabsorption, and malnutrition. Although traditionally associated with primary pancreatic disorders such as chronic pancreatitis, cystic fibrosis, pancreatic cancer, or pancreatic surgery, it is now evident that PEI also occurs in a wide range of extra-pancreatic conditions and clinical settings. Advances in diagnostic testing and expanding clinical awareness have improved detection; however, significant misconceptions persist regarding when to suspect PEI; how to interpret diagnostic tests; and how to initiate, optimise, and monitor pancreatic enzyme replacement therapy (PERT). In everyday practice, these errors may lead to delayed diagnosis, inappropriate treatment, persistent symptoms, and preventable nutritional deficiencies. This “Mistakes in…” article highlights common pitfalls in the diagnosis and management of PEI, focusing on inappropriate reliance on faecal elastase testing, failure to recognise secondary causes, undertreatment with PERT, and inadequate nutritional assessment. By addressing these frequent mistakes, we aim to promote a more structured, patient-centred, and evidence-informed approach to PEI that improves clinical outcomes and quality of life.

Parenteral nutrition (PN) is the intravenous delivery of nutrients, commonly used to treat intestinal failure (IF). IF occurs when gut function is insufficient to absorb macronutrients, water, or electrolytes, requiring IV supplementation to maintain health. The European Society for Clinical Nutrition and Metabolism (ESPEN) classifies IF into acute (type 1) and chronic (types 2 and 3), with chronic cases often needing long-term home parenteral nutrition (HPN). Although IF is rare, its prevalence in Europe is rising. PN formulations are complex, requiring skilled management by a specialized multi-disciplinary team to avoid complications.