Exocrine pancreatic insufficiency (EPI) is a condition in which the pancreas doesn’t produce enough digestive enzymes to break down foods and absorb nutrients.

EPI can occur with different types of disorders, such as:

  • celiac disease
  • inflammatory bowel diseases
  • pancreatic cancer

Symptoms can include:

  • abdominal pain
  • bloating
  • gas
  • fatty stools
  • constipation
  • diarrhea
  • unexplained weight loss

After a healthcare professional makes a diagnosis, they can recommend treatment to help improve your symptoms. As you go through this process, you might hear some terms that you aren’t familiar with.

Here are 10 words you need to know when living with EPI.

Your pancreas is a gland located behind your stomach. It is a vital organ because it affects digestion and blood glucose, or sugar.

The pancreas produces digestive juices (enzymes) that help your body break down food. In addition, it produces insulin. This is a hormone that allows your body to use glucose for energy.

Digestive enzymes are proteins produced by your body. They help break down the foods you eat. This allows your body to receive nutrients from foods.

Digestive enzymes produced by the pancreas include:

  • amylase, which breaks down carbohydrates
  • lipase, which breaks down fats
  • protease and elastase, which break down proteins

This refers to an inability to absorb nutrients from the foods you eat. More specifically, it is the inability of your small intestine to absorb nutrients.

This includes macronutrients like proteins, carbohydrates, and fats, as well as micronutrients like vitamins and minerals.

Malabsorption occurs with EPI due to a lack of digestive enzymes. However, it can occur with other conditions, too, such as celiac disease, pancreatitis, and cystic fibrosis.

Symptoms of malabsorption can vary depending on the nutrients your body has trouble absorbing. These symptoms may include:

  • gas
  • abdominal discomfort
  • diarrhea
  • unexplained weight loss

This type of therapy uses medication (tablets) to replace the digestive enzymes that your pancreas no longer makes. When taken before meals and snacks, PERT provides your body with the enzymes it needs to digest foods and break down carbohydrates, fats, and proteins.

PERT can relieve symptoms associated with EPI, such as diarrhea and abdominal pain. It can also help improve your quality of life and help you maintain a healthy weight for you.

This is inflammation, or swelling, of the pancreas. Inflammation occurs when digestive enzymes damage tissue within the pancreas.

Pancreatitis can be acute or chronic. Acute symptoms are sudden and short term, whereas chronic pancreatitis is an ongoing condition. Symptoms include:

  • pain in the upper abdomen that spreads to the back
  • pain that worsens after eating
  • nausea
  • vomiting
  • fever
  • unexplained weight loss

Chronic pancreatitis is the leading cause of EPI in adults, according to 2022 research.

Steatorrhea occurs when there’s too much fat in your feces, also known as your stool. Signs of steatorrhea include bulky stools, as well as oily or greasy stools caused by undigested fat.

An excess amount of fat can also cause foul smelling stools. Stools may float in the toilet and be difficult to flush.

Other symptoms that can accompany steatorrhea include:

  • chronic diarrhea
  • abdominal pain
  • bloating
  • weight loss

Steatorrhea is the most common sign of EPI.

Your doctor may use this test to help diagnose EPI. It measures the amount of elastase in your stool.

Elastase is a pancreatic enzyme that breaks down proteins in foods. If you have very little or no elastase in your stool, it is a sign that your pancreas isn’t working as expected.

Your doctor might schedule this test if you have abdominal pain, greasy stools, or unexplained weight loss. You’ll provide a stool sample for this test, which is sent to a laboratory for microscopic examination.

This test measures the amount of fat in your stool. Your doctor may use it to diagnose steatorrhea.

An increased amount of fat means that food passes through your digestive system without being completely broken down. This indicates that your pancreas is not producing digestive enzymes as expected and that your small intestine is not absorbing food.

Your doctor may request a single stool sample or collect multiple samples over several days.

This hormone, which is produced in the intestines, plays a role in healthy digestion. Secretin helps regulate water and other fluids in the body.

It also stimulates the secretion (release) of pancreatic fluid. Pancreatic fluid contains the digestive enzymes needed to break down carbohydrates, fats, and proteins.

This test measures how well your pancreas responds to the hormone secretin. During this test:

  1. A doctor will guide a tube down your throat and into your stomach, then into your small intestine.
  2. You’ll receive a dose of secretin through an IV.
  3. Your body releases pancreatic fluid during this procedure, which is then collected and tested for digestive enzymes.

A test that shows little or no presence of digestive enzymes is a sign that your pancreas isn’t working properly, which can help diagnose EPI.