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Exocrine Pancreatic Insufficiency (EPI)

WHAT IS EXOCRINE PANCREATIC INSUFFICIENCY (EPI)?

Exocrine pancreatic insufficiency is a condition where the pancreas does not supply the necessary enzymes needed to digest foods.  

At Loma Linda University Health, we treat more pancreatic disorders than any other center in the region. We have the ability to diagnose and treat exocrine pancreatic insufficiency in addition to other pancreatic and biliary conditions.   

WHAT ARE THE SYMPTOMS OF EXOCRINE PANCREATIC INSUFFICIENCY (EPI)?

Symptoms of exocrine pancreatic insufficiency (EPI) are similar to many those of other pancreatic conditions. Those symptoms include:  

  • Oily diarrhea
  • Steatorrhea (see below)
  • Bloating
  • Gas
  • Fatigue
  • Cramps
  • Pain in the center of the stomach that radiates to the back
  • Loss of muscle
  • Muscle cramps
  • Pain in the bones
  • Signs of vitamin deficiency (brittle nails, hair loss and skin problems)

Diarrhea in people with EPI is referred to as steatorrhea. Steatorrhea is different from standard diarrhea. Steatorrhea produces stools that are:

  • Watery
  • Pale or gray
  • Bulky
  • Frothy
  • Greasy
  • Extremely foul smelling

Because these stools contain oily droplets and consist of large amounts of undigested fat, they often stick to the toilet bowl or float on top of the water, making them hard to flush.

WHAT CAUSES EXOCRINE PANCREATIC INSUFFICIENCY (EPI)?

Medical conditions and diseases that can cause EPI are:

  • Chronic pancreatitis
  • Cystic fibrosis
  • A history of stomach, pancreas, or small bowel resection during surgery
  • Pancreatic duct obstruction
  • Shwachman-Diamond syndrome

Because EPI symptoms are similar to symptoms of other diseases of the stomach and intestine, the condition tends to be underdiagnosed.

HOW IS EXOCRINE PANCREATIC INSUFFICIENCY (EPI) DIAGNOSED?

Because a patient may not experience steatorrhea until after the pancreas loses 90 percent of enzyme production, it can be difficult to diagnose EPI. Physicians may rule out other, more common conditions before giving an EPI diagnosis.

However, it may be diagnosed based on the symptoms listed above. Tests to confirm the diagnosis include:

  • Stool samples for laboratory analysis
  • Blood tests to look for for fat deposits and vitamin deficiencies

The doctor may also request a CT scan to examine the underlying causes of EPI.

HOW IS EXOCRINE PANCREATIC INSUFFICIENCY (EPI) TREATED?

Exocrine pancreatic insufficiency is normally treated through a combination of lifestyle changes and pancreatic enzyme replacement therapy (PERT).

Lifestyle Changes

  • Don’t drink alcohol. Alcohol can make it even harder for your body to absorb fat, and can damage your pancreas over time.
  • Eat a well-balanced diet. Eat healthy fats only, and eat smaller, more frequent meals to aid digestion.  
  • Take vitamin supplements. However, do this only on the advice of a physician (fat-soluble vitamins A, D, E, and K).

Pancreatic Enzyme Replacement Therapy (PERT)

Pancreatic enzyme replacement therapy is medication designed to take over the role of the pancreas by replacing the digestive enzymes that the pancreas is no longer producing. When taken with food, PERTs help break down the nutrients in food.

The amount prescribed will vary from patient to patient; dosages are based on body weight and fat intake in the patient’s diet. PERT medications are only available by prescription.

These treatments can help people with EPI eat and digest their food normally, allowing them to absorb nutrients and enjoy a better quality of life.

WHAT ARE THE COMPLICATIONS OF EXOCRINE PANCREATIC INSUFFICIENCY (EPI)?

If left untreated, exocrine pancreatic insufficiency can lead to feeling malnourished, fatigued and weak. This is due to the poor absorption of vitamins and nutrients. Eventually, it can lead to thinning bones (osteoporosis) or anemia (a deficiency of red blood cells).

WHO IS AT RISK FOR EXOCRINE PANCREATIC INSUFFICIENCY (EPI)?

People most at risk for developing exocrine pancreatic insufficiency (ETI) include those with a damaged pancreas, or a health condition that keeps the pancreas from working as it should. Others at risk include people with:

  • Celiac disease
  • Stomach ulcers
  • Cystic fibrosis
  • Shwachman-Diamond syndrome
  • Chronic pancreatitis
  • Pancreatic cancer

Those who have had past surgeries on the stomach, pancreas or gallbladder may also be at risk.

NEXT STEPS

  • Stay aware. If you are in the risk category for this condition, stay aware of the symptoms of EPI and seek medical attention immediately if you begin experiencing them.  
  • Seek medical intervention. If left undiagnosed or untreated, EPI can lead to more serious complications. To request an evaluation at Loma Linda University Health, contact your provider or schedule the appointment through MyChart.