Exocrine pancreatic insufficiency (EPI) occurs when the pancreas does not produce enough enzymes to aid digestion. EPI can lead to poor absorption of nutrients, weight loss, and a shortage of vitamins.
Two of the main causes of EPI are cystic fibrosis and chronic pancreatitis. Symptoms of EPI are similar to those of other common health problems affecting the stomach and intestine, and the condition can be hard to diagnose.
A healthcare professional can successfully treat EPI with prescription enzymes and lifestyle changes.
EPI is a digestive disorder where enzyme production is altered in the digestive system. In the small intestine, pancreatic enzymes convert the food into smaller molecules, which then travel into the bloodstream.
A correctly functioning pancreas enables effective digestion and absorption of important nutrients.
In EPI, the pancreas does not produce enough enzymes to digest food. Without this breakdown, an individual cannot absorb the necessary nutrients and vitamins. This leads to diarrhea, vitamin deficiency, and weight loss.
Without proper treatment, EPI
Symptoms of EPI can mimic other digestive conditions, but there are specific signs of this insufficiency. The most common signs
There are many causes of EPI. Any condition that damages the pancreas and either stops or blocks the release of its enzymes can result in EPI. The two most common causes are cystic fibrosis and chronic pancreatitis.
Cystic fibrosis is a life threatening genetic disorder that develops during childhood. It
In chronic pancreatitis, the pancreas becomes inflamed. Normal pancreatic tissue turns into scar tissue. The buildup of this scar tissue prevents the digestive enzymes from
Other medical conditions that
- pancreatic cancer
- surgical removal of the pancreas
- obstructions of the pancreatic duct
- celiac disease
- Crohn’s disease
- autoimmune pancreatitis
- Zollinger-Ellison syndrome, in which one or multiple pancreatic tumors lead to the production of too much gastric acid, eventually leading to gastric ulcers
- dumping syndrome, which is a collection of symptoms, including weakness and rapid bowel movements, that sometimes occurs following gastric surgery
- gastric bypass and other GI surgeries
A healthcare professional will often diagnose EPI based on the above symptoms, particularly when an individual describes fatty stools and weight loss and once the doctor rules out other, more common conditions.
Definitive testing for EPI is complicated, as tests
As part of a 72-hour fecal fat test, a person consumes a set amount of fat daily, and a lab measures the amount of fat in stool. High levels of fat in stool indicate malabsorption and possible EPI.
The fecal elastase test is where a lab measures the amount of pancreatic elastase 1 in a person’s stool sample.
Additionally, a doctor may order various tests to check for fat deposits, vitamin deficiencies, and other indicators of conditions that may also cause gastrointestinal (GI) symptoms. They may also request a CT scan to examine the underlying causes of EPI.
Pancreatic enzyme replacement therapy (PERT) is the standard treatment for EPI.
PERT medications are only available on prescription. They
This therapy takes over the role of the pancreas. The amount of medication a person receives will
A person on a course of PERT must take these medications with all meals and snacks.
While PERT is the primary treatment for EPI, it is beneficial to work with a registered dietitian to create a parallel healthy eating plan.
A balanced diet includes healthy fat, which is vital for absorbing nutrients from food. If EPI results from cystic fibrosis, a diet higher in fat can be especially beneficial. Moreover, consuming less fiber at the start of the therapy can help relieve discomfort or bloating.
The foods to avoid depend in part on the cause of EPI. If EPI stems from pancreatitis, a person should avoid substances and activities contributing to pancreatic inflammation, such as alcohol and smoking.
In addition to taking the replacement enzymes, individuals with EPI need to avoid activities that can worsen both the health of the pancreas and their overall quality of life.
Lifestyle changes include:
- quitting smoking, if applicable
- eating a balanced diet, often in consultation with a doctor about fat intake
- reducing meal sizes but increasing frequency
- not consuming alcohol
- taking vitamin supplements, primarily for fat-soluble vitamins A, D, E, and K, under the guidance of a medical professional
Treatment can help people with EPI eat and digest their food normally, allowing them to absorb nutrients and enjoy a better quality of life.
PERT therapy may, however, help increase survival rates for people with EPI. A
The review focuses on people with either cystic fibrosis, chronic pancreatitis, or pancreatic cancer and found positive results in all three groups. Further, PERT improved the patient’s quality of life by reducing GI symptoms and abdominal pain.
The researchers note, however, that there is a lack of long-term studies on survival rates for people taking PERT.
EPI is a pancreatic disorder that affects nutritional absorption in digestion. Without treatment, EPI can lead to severe malnutrition, lower quality of life, and potentially fatal outcomes.
Pancreatic enzyme replacement therapy (PERT) is the mainstay treatment for EPI. PERT involves prescription medications that include digestive enzymes. These enzymes replace those lacking in pancreatic production.
Causes of EPI include chronic pancreatitis and cystic fibrosis.