What Is EPI?

Your pancreas plays an important role in your digestive system. Its job is making and releasing enzymes that help your digestive system break down food and absorb nutrients. Exocrine pancreatic insufficiency (EPI) develops when your pancreas doesn’t make or deliver enough of those enzymes. That enzyme shortage makes it difficult for your body to convert food into forms your digestive system can use

The symptoms of EPI become most noticeable when production of the enzyme responsible for breaking down fat drops to 5 to 10 percent of normal. When this happens you may have weight loss, diarrhea, fatty and oily stools, and symptoms associated with malnutrition.

What Causes EPI?

EPI occurs when your pancreas stops releasing enough enzymes to support normal digestion.

A variety of conditions can damage your pancreas and lead to EPI. Some of them, such as pancreatitis, cause EPI by directly damaging the pancreatic cells that make digestive enzymes. Inherited conditions such as Shwachman-Diamond syndrome and cystic fibrosis can also cause EPI, as can pancreatic or stomach surgery.

Chronic Pancreatitis

Chronic pancreatitis is inflammation of your pancreas that doesn’t go away over time. This form of pancreatitis is the most common cause of EPI in adults. The ongoing inflammation of your pancreas damages the cells that make digestive enzymes. That’s why most people with ongoing pancreatitis also develop exocrine insufficiency.

Acute Pancreatitis

Compared to chronic pancreatitis, EPI is far less common in pancreatitis that comes and goes for short periods of time. Untreated acute pancreatitis can develop into the chronic form over time, increasing your chances of developing EPI.

Autoimmune Pancreatitis

This is a type of ongoing pancreatitis that occurs when your immune system attacks your pancreas. Steroid treatment may help people with autoimmune pancreatitis see improved enzyme production.

Diabetes

People with diabetes frequently have EPI. Researchers don’t fully understand the relationship between diabetes and EPI. It’s likely related to the hormonal imbalances the pancreas experiences during diabetes.

Surgery

EPI is a common side effect of digestive tract or pancreas surgery. According to a number of studies of gastric surgery, up to 80 percent of people who have had surgery on their pancreas, stomach, or upper small intestine will develop EPI.

When a surgeon removes all or part of your pancreas it may produce smaller enzyme amounts. Stomach, intestinal, and pancreatic surgeries can also lead to EPI by changing the way your digestive system fits together. For example, removing part of the stomach can disturb the gut reflexes needed to fully mix nutrients with pancreatic enzymes.

Genetic Conditions

Cystic fibrosis is an inherited disease that causes the body to make a thick mucus layer. The mucus clings to the lungs, digestive system, and other organs. About 90 percent of people with cystic fibrosis develop EPI.

Shwachman-Diamond syndrome is a very rare, inherited condition that affects your bones, bone marrow, and pancreas. People with this condition usually have EPI in early childhood. Pancreatic function improves in about half of children as they mature.

Celiac Disease

Celiac disease is associated with an inability to digest gluten. The disease affects about 1 percent of American adults. Sometimes, people who follow a gluten-free diet still have symptoms, like ongoing diarrhea. In this case, the symptoms may be caused by EPI that’s associated with Celiac disease.

Pancreatic Cancer

EPI is a complication of pancreatic cancer. The process of cancer cells replacing pancreatic cells can lead to EPI. A tumor may also block enzymes from entering the digestive tract. EPI is also a complication of surgery to treat pancreatic cancer.

Inflammatory Bowel Diseases

Crohn’s disease and ulcerative colitis are both inflammatory bowel diseases that cause your immune system to attack and inflame your digestive tract. Many people with Crohn’s disease or ulcerative colitis may also develop EPI. However, researchers have not identified the exact cause of this relationship.

Zollinger-Ellison Syndrome

This is a rare disease where tumors in your pancreas or elsewhere in your gut make large amounts of hormones that lead to excessive stomach acid. That stomach acid keeps your digestive enzymes from working properly, leading to EPI.

Can I Prevent EPI?

Many of the conditions related to EPI, including pancreatic cancer, cystic fibrosis, diabetes, and pancreatic cancer, can’t be controlled.

But there are some factors that you can control. Heavy, continual alcohol use is the most common cause of ongoing pancreatitis. Combining alcohol use with a high-fat diet and smoking may increase your chances of pancreatitis. People with pancreatitis caused by heavy alcohol use tend to have more severe stomach pain and develop EPI more rapidly.

Cystic fibrosis or pancreatitis running in your family also increases your chances of developing EPI.