People with EPI don’t produce enough pancreatic enzymes to digest food, which can cause symptoms such as bloating. Eating smaller meals, watching your fiber intake, and exercising are some of the steps that can help.

The pancreas has two important functions. Its endocrine activity helps regulate your blood sugar levels, and its exocrine role makes it possible for you to digest food and absorb nutrients.

Exocrine pancreatic insufficiency (EPI) occurs when your pancreas doesn’t supply the right amounts of digestive enzymes to break down fats and other nutrients. It might not produce or secrete enough, or the enzymes it does produce might be blocked in the pancreatic duct and be unable to reach your intestine.

The main cause of EPI in adults is chronic pancreatitis, and for children is cystic fibrosis. However, there are other conditions that can lead to EPI, such as cancer or diabetes.

EPI causes digestion and absorption problems that can lead to malnutrition. It can also cause uncomfortable symptoms, including stomach bloating, gas, and pain.

EPI can be asymptomatic at first. However, once the condition begins to interfere with fat absorption, you may begin experiencing certain signs, such as:

  • abdominal bloating and gas
  • abdominal tenderness or pain
  • diarrhea
  • oily, fatty stools
  • a feeling of fullness
  • weight loss
  • bone pain
  • impaired blood clotting

Other gastrointestinal disorders have similar characteristics, which can make EPI challenging to identify. However, getting a diagnosis can help lead to treatment and symptom relief.

Can other pancreas problems cause bloating?

Bloating can be a sign of several issues related to the pancreas, including:

  • EPI
  • acute pancreatitis
  • chronic pancreatitis
  • hereditary pancreatitis

Bloating and intestinal gas are common symptoms of EPI.

The human body uses enzymes to digest the macronutrients fat, carbohydrates, and protein. Many of these enzymes originate in the pancreas.

If your pancreas doesn’t produce enough digestive enzymes, undigested food can ferment in the colon. This can cause gas and bloating.

Fat is the macronutrient that EPI impacts the most. The pancreas produces lipase to digest fat, and there aren’t enough lipase sources outside the pancreas to compensate for the pancreatic lipase deficit found in EPI. The result is fat malabsorption that can lead to abdominal bloating and pain.

EPI also results in a pancreatic shortage of enzymes such as amylase and protease, which help digest carbohydrates and protein. However, there are enough other sources of these enzymes, such as the stomach, saliva, and small intestine, that carbohydrate and protein digestion can usually continue.

If you experience abdominal bloating and gas due to EPI, there may be ways you can help reduce these symptoms.

Adjust your treatment plan

The treatment for EPI is pancreatic enzyme replacement therapy (PERT). PERT helps ease EPI symptoms by replacing the enzymes the pancreas doesn’t produce.

Studies have shown that 30,000 IU (90,000 USP units) of lipase at each meal, which is about 10% of typical pancreatic output, can eliminate the EPI symptom of excess fat excretion in stool.

Your doctor will suggest a starting dose, which might be:

  • 30–40,000 IU for meals
  • 15–20,000 IU for snacks

Factors that influence the efficacy of your PERT dose include:

  • how much pancreatic function you have left
  • the size and fat content of each meal you eat
  • how much lipase your stomach produces
  • how well your body responds to treatment
  • dosage timing relative to food intake

A dose that works well for one person may not be as helpful for someone else. If you’re experiencing symptoms such as bloating, gas, or stomach pain, your dose might need adjusting.

Have smaller meals more often

Eating smaller meals results in less food to digest. This helps make it easier for your small intestine to absorb nutrients.

Choose the right fats

Even though EPI makes it difficult to digest fat, you still need this macronutrient to absorb some vitamins. It may help your symptoms if you reduce the amount of fat you have in each meal.

Choosing certain sources of dietary fats can help. Good choices include:

  • fatty fish
  • avocados
  • olives
  • seeds
  • nuts

You may want to limit or avoid fat from processed foods and red meat.

Stay hydrated

If diarrhea is one of your EPI symptoms, you may be at risk for dehydration. Drinking plenty of water can help.

Staying hydrated can also help prevent or relieve constipation, another potential cause of stomach bloating and pain.

Your doctor can help you decide on an appropriate daily target for fluid intake.

There are a variety of ways you can stay hydrated, including:

  • keeping a water bottle handy
  • setting reminders on your phone to drink
  • sipping water throughout the day

You can also eat foods that have a high water content, such as:

  • watermelon
  • celery
  • lettuce
  • cantaloupe
  • zucchini


Exercise may increase pancreatic enzyme excretion.

A 2015 review discussed the effects of physical activity on the pancreases of rats. The review found that regular swimming resulted in faster meal-stimulated pancreas secretions.

In addition, after 8 weeks of treadmill endurance exercise, the rats exhibited:

  • increased pancreatic weight
  • higher pancreatic protein content
  • more pancreatic enzyme activity
  • increased secretion of basal amylase (an enzyme for digesting carbohydrates)

The review authors concluded that regular, low intensity endurance training can improve the synthesis and secretion of pancreatic enzymes.

Research also shows that exercise, such as walking, can help ease stomach bloating. Regular physical activity has many other health benefits, such as helping to manage stress, which can worsen symptoms of EPI.

Watch your fiber intake

Fiber may inhibit the activity of pancreatic enzymes in people living with EPI, according to a 2019 review. It’s not clear why, although the review authors suggest that fiber might absorb and inactivate pancreatic enzymes.

Eating too much fiber or increasing your fiber intake abruptly may also cause bloating and gas.

Despite its role in exacerbating EPI symptoms, fiber has important health benefits. If you want to cut back to reduce EPI bloating, your doctor may have helpful suggestions to ensure that you still get the amount that you need.

EPI occurs when the pancreas is unable to produce enough digestive enzymes or when the enzymes are blocked from reaching the intestine.

When food sits undigested in your intestinal tract, it can ferment. The result is uncomfortable symptoms such as stomach bloating and gas.

There are steps you can take to reduce gas and bloating, such as adjusting your treatment plan and eating smaller, more frequent meals.