What Is Exocrine Pancreatic Insufficiency? What You Need to Know

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

The pancreas is an organ about 6 inches long located behind your stomach. It has two main jobs: making hormones and digestive chemicals.

As part of the endocrine system the pancreas makes hormones, such as insulin, that help control your blood sugar. The pancreas also plays an important role in your digestive system by releasing chemicals that help digest your food. When enzymes from your pancreas enter the upper part of your small intestine, they break down proteins, fats, and carbohydrates into forms your body can absorb. This is known as the pancreas’ exocrine function. 

Exocrine pancreatic insufficiency (EPI) occurs when your pancreas can’t make or release enough digestive enzymes to break down food and absorb nutrients. Fat digestion is impacted the most. As your body tries to expel partially digested fat, your gut will feel upset. You’ll likely experience symptoms like bloating, flatulence, abdominal pain, and diarrhea. Severe EPI can lead to weight loss, fatty diarrhea, and malnutrition. 

EPI is rare, and its symptoms and root causes overlap with other digestive disorders. For these reasons, it can be overlooked during diagnosis.

If you have symptoms that suggest EPI discuss them with your doctor. The symptoms may be a sign of underlying conditions like pancreatitis or diabetes. Treating EPI is important because it can improve your quality of life, prevent further damage to your pancreas, and prevent serious complications from malnutrition. 

What Causes EPI?

Anything that interrupts the normal process of digestive enzymes leaving the pancreas can cause EPI. There are a variety of conditions that can create that disruption. 

Pancreatitis that doesn’t improve with time and cystic fibrosis are the most common causes. Other conditions that cause EPI may be inherited, caused by other bowel disorders, or be the side effect of surgery.

Conditions associated with EPI:

  • cystic fibrosis
  • chronic pancreatitis
  • pancreatic or stomach surgery
  • diabetes
  • celiac disease
  • inflammatory bowel diseases like Crohn’s disease
  • autoimmune pancreatitis
  • pancreatic cancer
  • Zollinger-Ellison syndrome

Risk Factors

EPI is commonly associated with other conditions. Most people with chronic pancreatitis develop EPI. Heavy, continual alcohol use increases your chances of developing ongoing pancreatitis. Chronic pancreatitis can also run in families. In other cases, there’s no known cause for ongoing pancreatitis.

Cystic fibrosis is an inherited condition, so if you carry the gene your children are more likely to have it.

What Are the Symptoms of EPI?

The symptoms of EPI overlap with other conditions affecting the digestive system. These include:

  • celiac disease
  • irritable bowel syndrome
  • Crohn’s disease
  • ulcerative colitis
  • pancreatic cancer

The symptoms of EPI often go unnoticed. Some of the most common symptoms include:

  • stomach pain 
  • weight loss due to malnutrition 
  • symptoms of vitamin deficiency such as vision problems, muscle spasms, and osteoporosis
  • abnormally fatty and bulky stools due to reduced fat uptake in the intestine
  • diarrhea

How Is EPI Diagnosed?

Since the symptoms of EPI are similar to other digestive conditions there’s no single symptom that confirms an EPI diagnosis. Your doctor will likely use a variety of techniques to diagnose EPI and detect its underlying causes.

History and Physical Exam

Sometimes, doctors diagnose severe EPI based on your medical history and the presence of several hallmark symptoms including fatty stools, diarrhea, and weight loss.

Imaging Tests

Imaging tests including an X-ray, CT scan, or an MRI will help your doctor look for evidence of damage to your pancreas. 

Laboratory Testing

Laboratory tests will check the amount of fat in your stools to see if it’s not being digested properly. A breath test measures fat digestion indirectly by looking for certain chemicals when you exhale.

Testing for Related Conditions

You’ll be given additional tests to see if a related condition like pancreatitis or diabetes is the root cause of your EPI.

How Is EPI Treated?

If you’re diagnosed with EPI, your treatment will focus on relieving your symptoms and helping your body absorb nutrients normally.

Diet and Lifestyle Changes

Treatment often requires a combination of diet and other lifestyle changes to encourage smoother digestion. This means getting a healthy, balanced diet, which contains the right fats and doesn’t include other things, like high-fiber foods.

Medications and Supplements

You may also need to take vitamin supplements because EPI makes it harder for your body to absorb certain vitamins. Your doctor may prescribe enzyme supplements to replace the ones your pancreas isn’t making.

Can EPI Be Prevented?

There’s often no way to prevent EPI, especially if it’s the result of an inherited condition like cystic fibrosis. To decrease your likelihood of developing pancreatitis, and associated EPI, avoid heavy alcohol consumption, eat a balanced diet, and avoid smoking.

Outlook

Only about half of people with pancreatic endocrine insufficiency have fat digestion levels return to normal. Severe pancreatic endocrine insufficiency can be especially difficult to resolve. But compliance with your treatment plan and positive lifestyle changes can improve your chances of returning to normal digestion and improve your quality of life. 

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