The pancreas is a key organ for digestion. When the pancreas is functioning properly, it makes enzymes that create a chemical reaction in the body that break down food and allow for nutrients in food to be absorbed.
Yasmin G. Hernandez-Barco, M.D.
Expert, American Gastroenterological Association (AGA); and Gastroenterologist, Massachusetts General Hospital
But in the case of exocrine pancreatic insufficiency (EPI), this process is disrupted, leaving patients at risk for malnutrition.
While symptoms of EPI can be confused with those of other digestive issues, greater awareness of this health issue can help affected individuals get a diagnosis and necessary treatment more quickly.
Causes of EPI
The main cause of EPI is damage to the pancreas. This can happen for multiple reasons, including:
- Chronic pancreatitis
- Recurrent acute pancreatitis
- Cystic fibrosis
- Pancreatic cancer
Extra-pancreatic causes, such as surgery of the digestive tract, can also cause EPI. Examples are procedures that remove some or all of the pancreas, and surgery of the stomach or intestines, as this disrupts the normal process of digestion required for pancreatic enzymes to work most effectively.
Symptoms of EPI
EPI signs vary by individual and can depend on the underlying cause of EPI. Sometimes, EPI symptoms may go unnoticed until nutrient deficiencies and their corresponding complications develop.
Some potential symptoms of EPI include: diarrhea, abnormal stool (may appear greasy, oily, or foul-smelling), gas and bloating, abdominal pain, and unexplained weight loss.
Nutrient deficiencies that commonly show up include those of fat-soluble vitamins A, D, E, and K.
EPI can cause maldigestive symptoms that overlap with other common digestive issues, including: irritable bowel syndrome, inflammatory bowel diseases, such as Crohn’s; Celiac disease; small intestinal bacterial overgrowth; and diabetes.
Although less common, the following conditions also share symptoms with EPI: bile acid diarrhea, giardiasis and other infectious diseases, and disaccharidase deficiencies.
Diagnosing EPI
There is no single test that can diagnose EPI. EPI diagnosis requires a combination of symptoms and/or abnormal testing. The testing used when EPI is suspected depends on the individual.
The following tests can be used to diagnose EPI:
- Fecal elastase test, which can detect the concentration of an enzyme called elastase that is released by the pancreas. This test must be done on solid stool and is only accurate when the diagnosis of EPI is highly suspected.
- Fecal fat test, which can determine whether there is excess fat in stool (a sign of EPI) and other conditions known as “steatorrhea”
- Secretin stimulation test (or pancreatic function test), which gauges whether the pancreas is responding normally to secretin, a hormone the body releases after eating that causes the pancreas to produce digestive enzymes
- Cross-sectional imaging, which may be ordered to determine if symptoms of steatorrhea are related to pancreatic disease or extra-pancreatic disease
How EPI is treated
Treatment for EPI can include pancreatic enzyme replacement therapy (PERT), which requires a person to take pancreatic enzymes whenever eating. PERT can be effective in improving the consistency and frequency of stool, and protecting one from nutritional symptoms; however, other changes may be required, including:
- Diet changes, as working with a registered dietician can be beneficial
- Staying in close contact with doctors to let them know whether side effects are happening so PERT can be adjusted or other conditions evaluated
In some cases, PERT may not address all nutrient deficiencies, and in these cases, taking supplements to replete deficiencies may be appropriate. It’s important to discuss this with a doctor before introducing a new vitamin or supplement to the diet.
Complications of untreated EPI
Nutrient deficiencies on their own are a complication, but leaving EPI untreated can also lead to:
- Skeletal issues, such as bone fractures and osteoporosis
- Muscle problems, such as muscle loss (called sarcopenia)
- Surgical complications
- Dangerous weight loss
- Reduced quality of life
- Increased risk of premature death
These are just some of the reasons recognizing the symptoms of EPI, and then getting a timely diagnosis and proper treatment, are so crucial.
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