What is EPI?

Exocrine pancreatic insufficiency (EPI) develops when your pancreas doesn’t make or release enough digestive enzymes. This leaves undigested food in your intestines and causes gut pain, bloating, and diarrhea. Severe EPI can cause fatty, loose stools and weight loss from malnutrition.

A variety of conditions can cause EPI including:

Your doctor will likely first recommend dietary and lifestyle changes to alleviate your symptoms, regardless of the underlying cause of your EPI. If you have severe EPI or have had digestive tract surgery, your doctor will prescribe enzymes to replace the ones your pancreas normally releases.

While there’s no cure for EPI, your doctor will work with you to find treatments that can ease your symptoms and treat any underlying conditions and, ultimately, improve your quality of life.

Dietary Changes

In the past EPI was treated with a low-fat diet. Low-fat diets are no longer recommended because they can make weight loss worse. A low-fat diet also makes it more difficult for your body to absorb the vitamins that dissolve in fat.

Instead, your doctor will advise you to eat healthy fats. Healthy fats are found in nuts, seeds, plant-based oils, and fish. You’ll be advised to avoid hard-to-digest and highly processed foods, especially those containing hydrogenated oils or large quantities of animal fat. Eating too much fiber can also tax your digestive system. Eating frequent, smaller meals and avoiding large, heavy meals will make it easier for your gut to break down fats and proteins.

Everyone is different, so it may take some time to find the diet that works best for you. You may wish to consult with a dietitian to learn more about planning healthy, affordable meals and snacks that ease your EPI symptoms.

Vitamin Supplements

Since EPI makes it harder for your body to use the fat in your food, you may have shortages of fat-soluble vitamins. If that is the case, you may need to take supplements for vitamins A, D, E and K.

Lifestyle Changes

Heavy alcohol consumption increases your chances of developing ongoing pancreatitis, which often causes EPI. Smoking is also associated with increased chances of developing pancreatic cancer, pancreatitis, and EPI. Your doctor will encourage you to avoid alcohol and cigarettes to help slow the progress of EPI and pancreatitis.

Pancreatic Enzyme Replacement Therapy

Enzyme replacement therapy helps your body break down and absorb fat and protein again. This prevents severe EPI symptoms like malnutrition and weight loss. If you have EPI along with fatty stools and weight loss, or if you’ve had upper gastrointestinal tract surgery, you’ll likely take pancreatic digestive enzymes along with each meal or snack.

Your doctor will tailor your enzyme doses to your body's abilities to digest food and the amount of fat you eat. The treatment works best if you spread the dose out as you eat a meal or snack. Fatty meals will require larger doses, and smaller meals will require less enzyme replacement therapy. 

If you have some loss of pancreatic function without the hallmark symptoms of severe EPI your doctor may still suggest enzyme replacement therapy. So far, clinical trials have found no serious side effects associated with enzyme replacement therapy. 

Proton Pump Inhibitors

Proton pump inhibitors help correct stomach acid imbalances that can keep enzyme replacements from doing their job. Your doctor may prescribe them if pancreatic enzyme replacement therapy isn’t working.

What If Treatment Isn’t Working?

Almost half of people treated with enzyme replacement therapy don’t fully return to normal fat digestion. This can happen for a number of reasons including incorrectly taking your enzyme replacements or doses that are too low. Acid imbalances in the gut or germ overgrowth in the intestines can also prevent the therapy from working.

If your treatment isn’t working, your doctor will check to make sure you’re sticking to your treatment plan. If you’re following the treatment guidelines, your doctor may need to change your treatment plan. Changes could include increasing your enzyme doses, prescribing proton pump inhibitors, or treating you for germ overgrowth in your intestines. If your symptoms still don’t improve your doctor may evaluate you for a condition other than EPI.