Triggers of exocrine pancreatic insufficiency (EPI) can include diet, alcohol, stress, infection, or a preexisting health condition. Managing flare-ups might require medication, avoiding triggers, and treating the root cause.

EPI occurs when the pancreas does not produce enough digestive enzymes, resulting in malnutrition and complications affecting the digestive tract. For people living with EPI, understanding what triggers their flare-ups and how to manage them is vital for maintaining optimal quality of life.

This article examines what triggers an EPI flare-up, the symptoms to look out for, how to treat one, and tips for preventing them. We also answer some frequently asked questions.

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When the pancreas cannot produce enough of the enzymes necessary for the digestion and absorption of nutrients from food, it is known as EPI. This insufficiency can lead to malabsorption and various gastrointestinal symptoms. EPI usually develops slowly and over many years.

An EPI flare-up consists of inflammation and swelling of the pancreas. This can damage the cells that produce digestive enzymes and can lead to irreversible damage to the pancreas.

EPI flare-ups primarily affect the digestive system, particularly the small intestine. The lack of enzymes disrupts the usual digestive process. In severe cases, EPI can affect the entire digestive tract, causing a lot of discomfort and nutritional deficiencies.

Preexisting conditions can cause EPI flare-ups. These conditions can include:

Having recently undergone surgery that affects the pancreas or how it functions can also cause EPI flare-ups.

Other common triggers for an EPI flare-up include:

  • Dietary choices: High fiber foods are particularly challenging for people with EPI to digest. The pancreas has difficulties producing enough enzymes to break down these foods.
  • Alcohol consumption: Alcohol can damage pancreatic cells and worsen EPI. Regular or excessive alcohol consumption is a significant trigger for flare-ups.
  • Smoking: Smoking can cause pancreatic damage and may worsen EPI symptoms.
  • Stress: Emotional and physical stress can affect digestive processes and exacerbate EPI symptoms.
  • Infections: Gastrointestinal infections can disrupt the balance of digestive enzymes.
  • Not adhering to treatment: Skipping or taking enzyme replacement therapy incorrectly can lead to inadequate digestion and absorption of nutrients.

The most common signs of an EPI flare-up include:

In rare cases, EPI may lead to low bone density, osteoporosis, or problems with vision at night.

People with EPI can manage flare-ups with a combination of the following measures:

Pancreatic enzyme replacement therapy (PERT)

PERT is a safe and effective medication for treating EPI and its flare-ups.

The method involves taking enzyme supplements with food to aid in the digestion of nutrients. It works by replacing the enzymes that the pancreas would usually make.

Individuals need to work closely with their doctor to determine the course of treatment, as the dosage and timing of PERT are crucial for its effectiveness.

Dietary adjustments

Making dietary adjustments can help prevent an EPI flare-up.

People with EPI require a varied, balanced diet that includes carbohydrates, fats, and protein. Where possible, they need to prioritize fresh and minimally processed foods.

A doctor or dietitian may also recommend nutritional changes, such as:

  • Low fiber diet: Reducing dietary fiber can lessen the burden on the pancreas and decrease symptoms.
  • Small, frequent meals: Eating smaller, more frequent meals can help manage symptoms by not overwhelming the digestive system.
  • Nutritional supplements: In cases of severe malnutrition, vitamin and mineral supplements may be necessary.

Find out more about what foods to eat with EPI.

Managing pain and discomfort

To manage the pain and discomfort that EPI may cause, a doctor may recommend medications. Over-the-counter pain relievers or prescription medications can help manage abdominal pain.

Staying hydrated also can help with symptoms such as diarrhea and fatigue.

Underlying conditions

Treating the root cause of EPI, such as chronic pancreatitis or cystic fibrosis, is essential. This can also help reduce the number of flare-ups.

Find out more about what causes EPI.

To prevent EPI flare-ups, doctors can recommend:

People with EPI may also find monitoring symptoms with a symptom diary helpful. This helps identify potential triggers and patterns, allowing for better management of EPI.

Below are some frequently asked questions about EPI flare-ups.

What triggers EPI?

Several things can trigger EPI. These include underlying health conditions, diet, alcohol, stress, smoking, or recent surgery involving the pancreas.

How do you treat an EPI flare-up?

Treatment for EPI flare-ups involves adhering to PERT treatment plants, adjusting the diet to reduce fiber intake, managing pain with medications, and addressing any underlying conditions that may exacerbate the symptoms.

What foods aggravate EPI?

Foods high in fat and fiber can aggravate EPI. These include:

  • fried foods
  • fatty meats
  • full fat dairy products
  • nuts
  • seeds
  • high fiber vegetables
  • grains

Alcohol is also a significant trigger for EPI symptoms.

What does EPI make you feel like?

EPI can cause a range of uncomfortable symptoms. These can include abdominal pain and feeling bloated and more gassy than usual. People with EPI may also feel tired.

Some triggers that can lead to EPI flare-ups include dietary choices, preexisting health conditions, infection, stress, and alcohol consumption, among others.

Various approaches can help people with EPI better control their symptoms and maintain overall health. These methods include adhering to pancreatic enzyme replacement therapy, making dietary adjustments, managing stress, and avoiding known triggers.