Signs and Symptoms of Exocrine Pancreatic Insufficiency

Medically reviewed by Mark R Laflamme, MD on February 3, 2016Written by Sarah Keller

What Is EPI?

When your pancreas is working well, you’re probably not even aware of its existence. One of its jobs 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 release enough of those enzymes. This enzyme shortage leads to difficulty converting food into forms your digestive system can use.

What Are the Symptoms?

Because EPI makes it harder for your body to break down food, you’ll have symptoms that overlap with other digestive conditions. Symptoms include:

  • bloating
  • flatulence
  • diarrhea
  • abdominal pain

Celiac disease, irritable bowel syndrome, Crohn’s disease, and ulcerative colitis can all cause similar symptoms. Since there’s no definitive symptom of EPI, it’s hard to detect in its early stages.

Your symptoms will become more severe when 90 percent of your pancreas’ normal enzyme production is gone. At this point, you’re more likely to have symptoms clearly associated with EPI. The hallmark symptoms of severe EPI are weight loss and loose, fatty stools called steatorrhea.

Steatorrhea

Stools that are fatty, pale, bulky, bad smelling, and difficult to flush are called steatorrhea. This is a common symptom of severe EPI.

Fatty stools occur when the pancreas’ fat digesting enzymes drop to 5 to 10 percent of normal. This means your digestive system is expelling much of the fat you eat instead of absorbing it. Sometimes steatorrhea isn’t evident, especially if you limit your fat intake because it causes digestive problems.

Diarrhea

When your digestive system fails to break down fats and other nutrients those particles cause excess water to enter the colon, leading to watery stools.

Stomach Pain

When partially digested food has to pass through the digestive system it causes abdominal pain or discomfort.

Flatulence and Bloating

When your gut bacteria ferment unabsorbed food they release hydrogen and methane, causing gas and bloating.

Malnutrition and Vitamin Deficiency

Normally, pancreatic enzymes break food into small molecules that your body can absorb into the bloodstream. When EPI prevents the digestive system from breaking down food, the body can’t use those nutrients and vitamins.

Fat and protein absorption are significant nutritional problems tied to EPI. You may also lack vitamins A, D, E, and K because the extra fat in your digestive tract absorbs the vitamins and they are then expelled from your body with the fat.

Malnourishment can lead to symptoms like muscle weakness and low body weight. Vitamin deficiencies can also cause vision problems, osteoporosis, and muscle weakness.

Weight Loss

Even when you’re eating a normal amount of food, EPI can lead to weight loss. This happens because your body isn’t breaking down food into the smaller forms your digestive system can use. You may also lose weight because you’re eating less to avoid the uncomfortable symptoms of EPI.

The Takeaway

The symptoms of EPI are similar to many other digestive conditions. However, if you have unexplained weight loss, diarrhea, and fatty stools, there’s a good chance that EPI might be causing your symptoms. Talk to your doctor about the symptoms you’re experiencing.

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