Problems with the pancreas can cause exocrine pancreatic insufficiency (EPI). Symptoms can be similar to those of several other digestive conditions and include bloating, gas, pain, and fatty stools.

The pancreas plays an important role in digestion. It produces enzymes that help break down carbohydrates, fat, and protein, allowing the body to get the nutrients it needs to function.

Damage to the cells that produce these pancreatic enzymes can cause EPI. In people with the condition, the pancreas does not produce enough enzymes for the body to break down food and absorb nutrients.

Experts do not know how many people are living with EPI.

Without treatment, the condition can lead to several complications, such as malnutrition, bone problems, and reduced life expectancy. People who receive treatment will likely experience a general improvement in their symptoms, but they may still require nutritional supplements to avoid malnutrition.

In people with EPI, the body does not break down carbohydrates, proteins, and fats in foods into substances that it can absorb. As a result, undigested and unabsorbed food remains in the digestive tract, which can lead to a number of uncomfortable gastrointestinal symptoms.

The symptoms of EPI are generally nonspecific. In other words, a person or their doctor may not immediately recognize EPI as the cause of the symptoms.


Steatorrhea refers to excess fat in the stool. It is the most common sign of EPI.

A doctor can test for excess fat in the stool using a 72-hour stool test. They will diagnose steatorrhea if the stool contains 7 grams (g) or more of fecal fat in a 24-hour period while eating a diet that includes 100 g of fat a day.

Steatorrhea often causes stool that is:

  • bulky
  • pale
  • loose
  • bad-smelling
  • oily or greasy
  • hard to flush

Although EPI often causes steatorrhea, there are other possible causes, including medication side effects.

Other symptoms of EPI

People with EPI may experience unexplained weight loss because the body cannot absorb nutrients. They may also experience nutritional deficiencies, particularly of the fat-soluble vitamins A, D, E, and K.

Other common digestive symptoms of EPI include:

  • abdominal pain
  • bloating
  • excess gas
  • diarrhea

It is important to note that these symptoms do not necessarily mean that a person has EPI. Other conditions can also produce these symptoms. A person should speak with a doctor if they develop persistent gastrointestinal symptoms or suspect that something may be wrong.

The pancreas plays an important role in digestion. When functioning normally, it releases several different enzymes.

The enzymes that the pancreas secretes account for the majority of digestion that takes place in the small intestine. When the production of these enzymes is too low, this causes insufficient digestion and absorption of nutrients, which leads to the symptoms associated with EPI.

Causes and risk factors for EPI

Several underlying conditions can cause or put a person at higher risk of developing EPI.

The most common cause of EPI is chronic pancreatitis, or inflammation of the pancreas. A person has an increased risk based on the duration of the disease and the extent of calcification and ductal obstruction.

Other common causes and risks factors associated with EPI include:

  • heavy alcohol use
  • smoking
  • acute pancreatitis
  • autoimmune pancreatitis
  • benign pancreatic tumor
  • pancreatic cancer
  • cystic fibrosis
  • Shwachman–Diamond syndrome
  • pancreatic neoplasms after surgery

Treatment goals for EPI include improving the quality of life for the person and preventing complications associated with the condition, such as malnutrition.

The most common treatment involves the use of replacement enzymes known as pancreatic enzyme replacement therapy (PERT). PERT involves taking medications with every meal and snack to aid digestion and prevent symptoms from occurring.

A person should follow all instructions from their doctor or pharmacist when taking PERT. Some common advice includes:

  • avoiding taking the medication on an empty stomach
  • taking the medication toward the start of a meal after the first few bites
  • eating a diet consisting of fruits, lean proteins, vegetables, and whole grains
  • including fats in the diet
  • eating smaller, more frequent meals
  • taking the medication with a cool drink rather than a hot beverage
  • discussing new medications, supplements, and vitamins with a doctor before starting them
  • talking with a doctor about side effects

A person should talk with a doctor if they experience ongoing or distressing digestive symptoms. If the cause is not EPI, a doctor may find another underlying condition that they can address.

People living with chronic pancreatitis should keep an eye out for symptoms such as oily stool, excess gas, and other digestive issues. If these symptoms occur, they should talk with a doctor about the possibility of EPI.

A person undergoing treatment for EPI should seek medical advice if:

  • they experience side effects
  • their symptoms do not improve
  • they are considering taking a new medication or supplement

EPI causes nonspecific digestive symptoms that several other conditions can also cause. The most common symptom is excess fat in the stool, which can cause it to be loose, oily, and more odorous than usual.

A person should talk with a doctor about any ongoing or unusual symptoms. The symptoms may not be the result of EPI, but a doctor can help determine the underlying cause.

If EPI is the cause, treatment with PERT can manage the symptoms and reduce the risk of complications.