Talking to Your Gastroenterologist About Exocrine Pancreatic Insufficiency

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

Exocrine pancreatic insufficiency (EPI) is a rare condition. It’s possible that at the time of your diagnosis you’re hearing about EPI for the first time, which means you probably have a lot of questions.

Here are some ideas for where to start when you discuss EPI with your doctor or gastroenterologist.

Are other conditions causing my EPI?

EPI can be caused by conditions that affect your pancreas. These include conditions like:

Your doctor will talk to you about the underlying cause of your EPI and how it will affect your treatment.

How can you tell that I have EPI and not another condition?

Since the symptoms of EPI overlap with many other digestive conditions, your diagnosis may seem confusing. However, there are diagnostic tests that can help your doctor confirm your EPI diagnosis. Your doctor can walk you through how the results of your diagnostic testing helped them eliminate other possible causes.

What kind of diet should I follow?

In the past, doctors recommended a low-fat diet for people with EPI. That’s changed with the recognition that you need fat in your diet to help absorb certain vitamins. Still, some fats are better for you than others. If you’re not sure how to maintain a balanced, healthy diet, talk to your doctor and a nutritionist about planning healthy meals that will help alleviate your symptoms.

Are there certain foods that I should avoid?

Some dietary recommendations for EPI may seem counterintuitive. For example, high-fiber diets aren’t recommended if you’re taking enzyme replacements. Ask your doctor what kinds of hard-to-digest foods you should avoid.

What lifestyle changes do I need to make?

If ongoing pancreatitis is causing your EPI, certain lifestyle choices can make your condition worse. Alcohol, smoking, and fatty foods decrease your chances of successful treatment. It’s hard to make lifestyle changes, so ask your doctor for advice on how to form new healthy habits.

Do I need to take supplements?

If you have EPI, you may need to take vitamins to replace the ones your body is struggling to absorb. Ask your doctor what kinds of symptoms to expect if you’re malnourished, and what you can do to make sure you’re getting enough vitamins in your diet.

How much enzyme replacement should I take?

Your doctor will recommend how much enzyme replacement you should start taking. You’ll take less with snacks than at meals. You may need to take more enzyme replacement if you’re eating a high-fat meal.

How will I know if my treatment is working?

There’s no scientific agreement on how successful EPI treatment with pancreatic enzyme replacement therapy should be defined. The main measure of treatment success is improvement in symptoms like weight gain and nutrition. Almost half of people treated with enzyme replacement therapy don’t return to normal fat digestion.

Adhering to your enzyme therapy and taking enzymes with every meal will improve your chances of success. Ask your doctor about how to ensure you’re getting the maximum benefit from your treatment.

What should I do if my treatment isn’t working?

If your treatment isn’t working right away, don’t lose hope. There’s some amount of trial and error involved in enzyme replacement therapy. Your dose may be too low, or you may need extra medication. Remember that you have options if your symptoms aren’t going away.

When should I return for a follow-up?

It’s important that you and your doctor or gastroenterologist are working as a team and scheduling regular appointments. Regular appointments will ensure that your treatment plan can be monitored and complications of EPI can be caught early. 

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