Patient education: Exocrine pancreatic insufficiency (The Basics)

What is exocrine pancreatic insufficiency? — Exocrine pancreatic insufficiency, or "EPI," is when the pancreas is not working as well as it should.

The pancreas makes hormones and juices that help break down food (figure 1). The juices contain proteins called "enzymes." These flow into the small intestine to help the body digest food. In EPI, 1 of the following problems happens:

●The pancreas does not make enough enzymes.

●Not enough enzymes get from the pancreas to the small intestine.

●The enzymes don't work as well as they should.

As a result, the body cannot absorb the nutrients it needs from food.

What causes EPI? — Different health conditions can cause EPI. They include:

●Chronic pancreatitis – Pancreatitis is when the pancreas gets irritated or swollen. "Chronic" means that the pancreas get damaged by irritation over time. Often, this is related to heavy alcohol use or smoking.

●Cystic fibrosis – This is a disease that some children are born with. It causes thick mucus and other fluids to build up in the body. It can affect different organs, including the pancreas.

●Surgery to remove part of the pancreas, stomach, or small intestine

●A blockage in the "duct" or tube that drains fluid from the pancreas into the small intestine

What are the symptoms of EPI? — Some people have no symptoms. Often, EPI gets worse over time, and eventually does cause symptoms. These can include:

●Belly pain or cramping

●Bloating and gas

●Weight loss

●Diarrhea that is greasy, bad smelling, and floats in the toilet

These symptoms happen because the body cannot digest food properly. If your body cannot absorb enough vitamins from the foods you eat, this can lead to other problems, like weak bones.

Is there a test for EPI? — Yes. First, your doctor or nurse will ask about your symptoms and health. If they suspect that you have EPI, they can confirm it by testing a sample of your bowel movement. This test measures the level of an enzyme called "elastase."

If your doctor thinks that something else might be causing your symptoms, they might do other tests, such as:

●Different tests on a sample of bowel movement

●Blood tests

●Imaging tests, such as a CT scan or ultrasound – These create pictures of the inside of the body.

How is EPI treated? — Your doctor will prescribe enzymes to help your body digest food. These replace the enzymes that the pancreas normally makes. They come as pills you take during each meal and with snacks. Most people continue taking enzymes for the rest of their life.

EPI can cause you to have low levels of important vitamins that are necessary for your health. You might also need to take extra vitamins if your levels are low. Your doctors will check your bone health and vitamin levels every 1 to 2 years.

You will need to work with a dietitian (food expert) to make sure that you are getting the nutrients you need. People with EPI should generally eat a low- to moderate-fat diet and eat frequent smaller meals. Very low-fat diets should be avoided.

Depending on what caused your EPI, you might need other treatments, too.

More on this topic

Patient education: Chronic pancreatitis (The Basics)
Patient education: Cystic fibrosis (The Basics)

Patient education: Chronic pancreatitis (Beyond the Basics)