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Read MoreUnderstanding Exocrine Pancreatic Insufficiency (EPI): Symptoms, Causes, and Treatment Options
Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on April 8th, 2024.
Key Takeaways
- The pancreas produces 1.5-3 liters of enzyme-rich juice daily containing lipase, protease, and amylase—when production drops below 10% of normal levels, maldigestion occurs.
- Steatorrhea (fatty, floating stools) is the hallmark symptom, often accompanied by deficiencies in fat-soluble vitamins A, D, E, and K that can cause night blindness and bone weakness.
- Chronic pancreatitis accounts for 70-80% of adult cases, while cystic fibrosis causes most pediatric cases—pancreatic cancer and autoimmune pancreatitis are less common triggers.
- Pancreatic enzyme replacement therapy requires 25,000-75,000 units of lipase per meal, with capsules taken at the beginning of eating and never crushed or chewed.
- Fecal elastase-1 testing measures enzyme levels in stool samples, with values below 200 μg/g indicating moderate insufficiency and below 100 μg/g confirming severe disease.
Exocrine pancreatic insufficiency (EPI) is a condition that affects your body's ability to digest food properly. When you have EPI, your pancreas doesn't produce enough enzymes to break down and absorb nutrients from the food you eat. This can lead to various symptoms and health issues if left untreated.
Symptoms of EPI
Some common symptoms of EPI include:
Abdominal pain or tenderness
Bad-smelling bowel movements
Diarrhea
Gas
Feeling full quickly
Weight loss
In addition to these symptoms, you may also experience vitamin deficiencies due to poor nutrient absorption, which can lead to complications such as bleeding disorders or bone pain.
Causes of EPI
EPI is caused by damage to the pancreas, which can occur due to various factors, including:
Chronic pancreatitis (alcohol abuse, gallstones, and autoimmune pancreatitis)
Surgery on the pancreas, stomach, or intestines
Inherited diseases like cystic fibrosis or Shwachman-Diamond syndrome
Crohn's disease or celiac disease (in some cases)
Pancreatic cancer
Diagnosing EPI
To diagnose EPI, your doctor may ask about your symptoms and perform various tests, such as:
Blood tests to check vitamin levels and pancreatic enzyme production
3-day fecal test to measure fat content in your stool
Fecal elastase-1 test to assess pancreatic enzyme levels in your stool
Imaging tests (CT scan, MRI, or endoscopic ultrasound) to check for pancreatic inflammation
Treatment Options for EPI
The main treatment for EPI is pancreatic enzyme replacement therapy (PERT). PERT involves taking prescription pills that contain the enzymes your pancreas isn't producing. These enzymes help break down food, allowing your body to absorb nutrients more effectively. There are several FDA-approved PERT products available, including Creon, Pancreaze, and Pertzye.
In addition to PERT, your doctor may recommend antacids or other medications to reduce stomach acid and improve the effectiveness of the replacement enzymes. Pain management may also be necessary, which can include over-the-counter pain relievers or prescription medications.
Treating Underlying Conditions
Treating the underlying condition that causes EPI is also essential. For example, if you have cystic fibrosis, your doctor may prescribe antibiotics, laxatives, or enemas in addition to PERT. In some cases, surgery may be an option to remove blockages or damaged portions of the pancreas.
Managing EPI Through Diet and Lifestyle
Alongside medical treatment, making dietary and lifestyle changes can help manage EPI symptoms and improve your overall health. Some tips include:
Eating six small meals per day instead of three large ones
Avoiding alcohol and smoking
Taking vitamin supplements as recommended by your doctor
Working with a dietitian to ensure you're getting the right nutrients
Living with EPI can be challenging, but with proper treatment and management, you can improve your digestive health and quality of life. Be sure to work closely with your healthcare team and seek support from family, friends, or support groups when needed.
The Bottom Line
Early diagnosis and proper enzyme dosing with meals can prevent serious nutritional complications and dramatically improve quality of life. The key is working with a gastroenterologist to find the right enzyme dose and monitor vitamin levels regularly. If you're experiencing persistent digestive issues with fatty stools or unexplained weight loss, Doctronic can help you get the right testing and specialist referrals.
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