Exocrine pancreatic insufficiency (EPI) occurs when the pancreas does not produce enough of the enzymes that 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 involving the pancreas and the enzymes it produces. Enzymes are chemicals released to bring about a specific chemical reaction, and the pancreas secretes many different enzymes that serve different purposes.
Digesting food is a complicated process, starting in the mouth with chewing and the release of saliva. Once a person swallows food, acids in the stomach break it down.
After about 15 minutes, the food that has been broken down moves to the small intestine. Here, the pancreas provides the necessary enzymes to convert the food into smaller molecules. These molecules are then absorbed into the bloodstream and sent on to nourish the body.
The pancreas, along with the salivary and sweat glands, is one of the main exocrine glands. Exocrine glands release substances into another organ or the surface of the body through an opening called a duct.
Endocrine glands, such as the thyroid and pituitary, are different in that they release their hormones directly into the bloodstream. The pancreas serves as both. A correctly functioning pancreas enables effective digestion and absorption of important nutrients.
In EPI, the pancreas does not produce enough of the enzymes needed 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 can result in delayed or limited growth in infants and children, bone problems, a reduced life expectancy, and exposure to infections.
Symptoms of EPI can mimic other digestive conditions, but there are specific signs of this insufficiency. The most common signs include:
- greasy and oily stool
- foul-smelling stool
- abdominal pain
- unexplained, unintentional weight loss
EPI symptoms can be mild or severe.
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 per day, and doctors measure the amount of fat in stool. High levels of fat in stool indicate malabsorption and possible EPI.
Fecal elastase test is where a doctor measures the amount of pancreatic elastase 1 in a person’s stool sample.
Additionally, a doctor may perform 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.
Most people with EPI will receive treatment in the form of enzyme replacement therapy. Often with this supplement, it is possible and advisable to return to a regular diet that is healthy and balanced.
An EPI diet includes plenty of:
- whole grains
- healthy proteins
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 that contribute to pancreatic inflammation, such as alcohol and smoking.
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.
Without treatment, EPI can lead to severe malnutrition. This in turn can reduce life expectancy.
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 patients’ 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.
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
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.