Exocrine pancreatic insufficiency (EPI) may be managed, but it cannot be cured. EPI is treated by a combination of lifestyle changes and pancreatic enzyme replacement therapy (PERT).
Lifestyle changes
- Do not drink alcohol. Alcohol is known to 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).
PERT
- This is a 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 person to person. Dosages are based on your body weight and the fat intake in your diet. PERTs 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.
Here are common tips for managing EPI.
- Take the right amount of digestive enzymes at the beginning of a meal or snack. Work with your doctor and/or dietician.
- Eat small but frequent meals.
- Find what foods work for you. Try to stay away from spicy foods. Each individual needs to find what works best for them to maintain good balance.
- Eat food with minimal fluids. This will help retain food in the digestive system longer, thus increasing absorption. After you eat, wait about 20 to 30 minutes before drinking anything.
- Exercises, yoga and walking may be helpful.
Even with treatment, the body may still have trouble absorbing certain nutrients, causing vitamin and mineral deficiencies. In these cases, vitamin and mineral supplements may be needed. Talk with your healthcare provider about whether you need supplements.
What is EPI?
Exocrine pancreatic insufficiency (EPI) is a long-lasting medical condition that affects the pancreas. It usually upsets the way the body breaks down (digests) food and can cause gastrointestinal problems. The pancreas is an organ that makes proteins called enzymes. These enzymes help people digest food (most importantly fats) so that their body can break down and absorb nutrients. In EPI, the pancreas doesn’t make enough enzymes. This means your pancreas can’t break down the food. Causes of EPI may be chronic pancreatitis, cystic fibrosis, hemochromatosis, pancreatic duct obstruction due to a tumor, Shwachman-Diamond syndrome and other conditions. Due to EPI, you may have the following symptoms.
- Diarrhea: EPI can cause undigested food to move too fast through the gastrointestinal system and this can lead to diarrhea.
- Losing weight: People with EPI can’t digest and absorb nutrients from the food they eat, so this can lead to weight loss.
- Steatorrhea: Because people with EPI aren’t able to absorb all of the fat that they eat, fat from their food is passed in their bowel movements. Bowel movements can look oily and greasy. Stools also float, have a foul smell and are hard to flush. Not all people with EPI have steatorrhea.
- Gas and bloating: Because people with EPI have trouble digesting food, they may feel gassy and bloated.
- Stomach pain: Gas and bloating from EPI can cause stomach pain.
- Other symptoms may include, tiredness, muscle cramps, bone pain and signs of vitamin deficiency.
Causes
- EPI normally occurs when there has been some kind of damage to the pancreas, which reduces its ability to produce the enzymes necessary for proper digestion.
- Pancreatitis (inflammation of the pancreas) can lead to EPI. Pancreatitis can be caused by alcohol, immune system disorders or inherited diseases such as cystic fibrosis.
- Pancreatic surgery may also cause EPI.
- Diabetes may also lead to EPI.
Diagnostic tests: A gastroenterologist may recommend several tests to help diagnose EPI.
- Abdominal imaging tests (ultrasonography, computed tomography [CT] scan or magnetic resonance imaging [MRI]) may show pancreatic duct calcifications, dilatation in the ducts and peripancreatic fluid collection.
- There may be blood tests to determine vitamin and nutrient levels and to see how well your pancreas is processing foods.
- Additionally, the doctor may order a fecal test. There are two main types of fecal tests:
- A fecal elastase test: This measures the amount of elastase, an enzyme produced by the pancreas, in the stool. A deficiency of elastase could be an indicator of EPI.
- A fecal fat test: This requires eating a prescribed diet and collecting stool samples over three days. This test can help determine how much fat the body is not absorbing.
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Medically Reviewed on 4/15/2021
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