Gastrointestinal (GI) health is essential for overall well-being. However, up to 70 million Americans experience digestive diseases of the GI tract, including problems with digestion and nutrient absorption. While these conditions can be chronic, many are treatable. That’s a relief for patients who are struggling with symptoms ranging from constipation and bloating to stomach pain and diarrhea.
Many factors have been impacting the increase in GI health issues. People with diabetes may also have an increased chance of GI issues, including gastroparesis and Crohn’s Disease. Gastroparesis is when the stomach has difficulty emptying. Often, high blood sugar damages the stomach nerves in the digestive tract. Research links Crohn’s disease, a type of inflammatory bowel disease, with an increased risk of type 2 diabetes.
Understanding EPI and its impact on health
Another GI issue affects the pancreas, the organ that’s important for digestion. If the pancreas gets inflamed or swollen, a person may experience gas, bloating, diarrhea, and other GI issues. Every year, pancreatitis affects 87,000 people in the United States.
Exocrine pancreatic insufficiency (EPI) is a condition in which the pancreas cannot produce enough enzymes to digest food properly. The body needs these enzymes — lipase, protease, and amylase — to absorb essential nutrients. Without those nutrients, one may experience GI symptoms like bloating, greasy stools, diarrhea, and unintentional weight loss. EPI has a significant impact on patients’ quality of life, but it’s often misunderstood and misdiagnosed.
EPI can develop suddenly or over time, and its symptoms can be mild or severe. Diagnosing EPI can be challenging because it shares many of the same symptoms as other GI conditions.
Dr. Cynthia Rudert
Board-Certified Gastroenterologist
Dr. Cynthia Rudert, a board-certified gastroenterologist, explains that EPI is often confused with conditions like irritable bowel syndrome (IBS), making it one of the most misdiagnosed issues in gastroenterology. “Patients come in with gas, bloating, and even undigested food in their stool, and they’re often told they have IBS,” Dr. Rudert said. “But when we dig deeper, many are found to have EPI, which requires a completely different treatment approach.”
The condition doesn’t discriminate by age or body type. Dr. Rudert recalls treating patients as young as four and as old as 94, highlighting that “you don’t have to be thin to be malnourished.”
She advises patients to talk to their doctor about their symptoms and let the doctor know if they see undigested food in their stool, since that could be a sign of EPI.
Undiagnosed or untreated EPI could result in muscle loss since the patient isn’t absorbing the necessary nutrients. Fortunately, advancements in EPI diagnosis and treatment, such as pancreatic enzyme replacement therapy (PERT), offer new hope for patients. We’ll explain more about this treatment below.
The role of GLP-1 medications in GI health
Glucagon-like peptide-1 (GLP-1) receptor agonists are another factor impacting GI health. These are a class of medications frequently prescribed for managing diabetes, obesity, and weight-related health conditions. Medications like semaglutide, liraglutide, and dulaglutide work by mimicking a hormone that helps the body regulate blood sugar, appetite, and digestion.
The weight loss drugs are growing in popularity. Currently, 1.7% of Americans have been prescribed a GLP-1 — a 40% increase over the past five years.
Dr. Anthony Auriemma
Medical Director, Ascension Weight Loss Solutions
“These treatments are going to enable people to be healthier and have less heart disease, fewer strokes, less fatty liver, and perhaps even lower rates of alcoholism and substance abuse,” said Dr. Anthony Auriemma, medical director at Ascension Weight Loss Solutions.
Dr. Auriemma, an expert in his field, has treated thousands of patients with GLP-1 medicine since the drugs were introduced nearly 20 years ago.
While GLP-1 medications are widely regarded as effective, they can sometimes cause gastrointestinal side effects, such as nausea, vomiting, diarrhea, abdominal pain, or constipation. In rare cases, more complex GI conditions, including EPI, can arise, particularly in patients with a history of pancreatitis or pancreatic conditions.
Dr. Auriemma says doctors work to create individualized care plans for their patients. He encourages patients to talk with their doctors about their care and to monitor themselves for any ongoing GI symptoms, noting that early identification of underlying issues can improve patient outcomes.
Treating EPI
Patients may not know that there are effective FDA-approved treatments that may help them manage their EPI. Pancreatic enzyme replacement therapy (PERT) is the standard treatment for patients diagnosed with the condition. The prescription enzymes are taken at every meal and during snacks. They help break down food so the body can absorb necessary nutrients effectively, alleviating symptoms and preventing complications like malnutrition.
“EPI treatment is life-changing for many patients,” said Dr. Rudert, who shares the story of a 94-year-old man who had been misdiagnosed by top doctors for years. Once correctly diagnosed with EPI and getting started on enzymes, his condition improved dramatically. “You can turn somebody’s life around,” she added.
When to talk to your doctor
Patients experiencing persistent GI symptoms, including those on GLP-1 therapy, should talk with their doctor about their digestive health. It’s important for patients to track how they feel and to log their symptoms, such as greasy stools, bloating, or unexplained weight loss, all of which may signal an underlying condition like EPI. Early diagnosis and treatment are crucial to managing symptoms and preventing long-term complications.
“Your health is unique, and your treatment should be too,” Dr. Auriemma said. Working with a knowledgeable provider ensures symptoms are managed effectively, whether through dietary adjustments, PERT, or supplemental vitamins, such as A, D, E, and K, which are often deficient in EPI patients.
Patients may benefit from nutritional advice from a doctor or a dietician. Many GI health issues can be improved by drinking water, avoiding alcohol, avoiding processed foods, and eating a low-fat, protein-rich diet. Eating small meals throughout the day rather than a few large meals may also help make digestion more comfortable.
Take control of your digestive health
If you’re experiencing any of the symptoms of EPI, speak to a GI specialist or ask your doctor for a referral. Patients shouldn’t let undiagnosed GI conditions hold them back. With advancements in diagnostic tools and effective treatments, relief is within reach. By understanding the signs of EPI and taking proactive steps to address them, patients can regain control of their health and live their lives to the fullest.
To learn more, visit itcouldbeepi.com
