Exocrine Pancreatic Insufficiency (EPI) Explained

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
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Exocrine pancreatic insufficiency (EPI) occurs when the pancreas does not make enough enzymes to digest your food or the enzymes do not work correctly. This may happen after an injury to the pancreas or if some or all of the organ has been removed. EPI can develop due to conditions such as chronic pancreatitis and cystic fibrosis. Symptoms of EPI may include atypical bowel movements, abdominal pain, and malnutrition.

Read on to learn more about the causes, symptoms, diagnostic process, and treatments for exocrine pancreatic insufficiency.

What is exocrine pancreatic insufficiency?

A man drinking alcohol
MEM Studio/Stocksy United (person appearing is a model and used for illustrative purposes only)

EPI results when the exocrine functions of the pancreas slow down or stop altogether. The pancreas’ exocrine functions are related to the production and release of enzymes that break down food into substances the body can use.

Your pancreas is an organ in your abdomen, behind your stomach, and beside your liver and gallbladder. It’s responsible for making and releasing substances that help your intestines digest, absorb, and use carbohydrates, fats, and proteins. The pancreas releases these enzymes into the first part of your intestinal tract as your food enters it from the stomach.

When the body can’t break down and absorb nutrients, especially fat, malnutrition can occur.

What are the causes of exocrine pancreatic insufficiency?

EPI occurs when the pancreas is damaged, part or all of it is removed, or it stops functioning correctly.

In adults, chronic pancreatitis is one of the most common pancreatic disorders leading to EPI in the United States. Chronic pancreatitis can result from heavy smoking and alcohol consumption, among other factors.

 In children, EPI commonly develops due to cystic fibrosis.

EPI may also occur due to other conditions, such as:

In addition, newborns and infants do not produce all the pancreatic digestive enzymes needed to break down fats for the first month of life. They typically receive all the enzymes they need to make up for this from their mother’s breast milk.

However, formula-fed infants may not have this advantage, and EPI may be a problem in critically ill newborns until the pancreas makes the necessary enzymes at around 1 month of age.

What are the symptoms of exocrine pancreatic insufficiency?

Symptoms of EPI are related to undigested or unabsorbed food and can range from mild to severe. 

The most frequent sign of EPI is steatorrhea, or bowel movements that are greasy, oily, and clay-colored. The stool may also be loose or foul-smelling.

Other symptoms may include:

How do doctors diagnose exocrine pancreatic insufficiency?

EPI diagnosis can be challenging because the signs and symptoms mimic other gastrointestinal conditions.

Your doctor will ask you about your health history and symptoms. In particular, they may ask you about the frequency and consistency of your bowel movements.

Your doctor will need you to provide a stool sample for analysis. Before collecting the sample, you may need to stop taking certain medications.

Your doctor may also run breath and blood tests to check for the presence of pancreatic enzymes.

Other tests that may help narrow down the diagnosis include:

  • endoscopic pancreatic function tests
  • secretin-cholecystokinin stimulation tests
  • secretin-stimulated magnetic resonance cholangiopancreatography (S-MRCP) 

One method for diagnosing EPI is a strict diet of 100 grams of fat for 5 days. Your doctor will collect all stools for analysis for the last 3 days of the test. Because this test can be inconvenient and difficult, your doctor may decide to try other tests first.

What are the treatments for exocrine pancreatic insufficiency?

Treatments for EPI focus on proper nutrition and improving quality of life. 

Pancreatic enzyme replacement therapy (PERT) is an important part of the treatment plan for people with EPI. This involves taking tablets or capsules to replace the pancreatic enzymes that your body can’t produce or release.

Your doctor may refer you to a dietician to fine-tune your diet. They may also recommend specific vitamins and supplements. Talk with your doctor before starting any new medications, vitamins, herbs, or supplements because they may affect your pancreas.

Treating underlying medical conditions and making some lifestyle changes will also help. For example, your doctor will likely recommend that you stop smoking if you smoke and reduce the amount of alcohol you drink.

You will need to follow up frequently with your doctor to keep track of your nutritional status. These visits may include tests such as:

  • screening for nutritional deficiencies
  • testing for overall nutritional status
  • fat soluble vitamin levels
  • bone densitometry

What is the outlook for exocrine pancreatic insufficiency?

The long-term outlook for people with EPI depends on how well the condition is managed and monitored. You can have optimal symptom relief and quality of life with proper treatment.

On the other hand, you may be at risk of severe complications without appropriate treatment, including malnutrition and death.

What are some potential complications of exocrine pancreatic insufficiency?

EPI can lead to poor quality of life due to uncomfortable symptoms, inability to work, and financial troubles. Other complications may develop due to malnutrition, decreased movement in the bowels, or changes in bone density, such as:

  • vitamin and trace element deficiencies
  • muscle spasms
  • osteoporosis 
  • weakened immune system
  • increased risk for heart problems

Can you prevent exocrine pancreatic insufficiency?

Preventing conditions that cause damage to the pancreas can help prevent EPI. The following steps may also lower your risk:

  • Stop smoking.
  • Reduce your alcohol consumption.
  • Seek prompt treatment for pancreatitis.
  • Eat a healthy, nutrient rich, and low fat diet.

Other frequently asked questions

These are a few other common questions people may ask about EPI. Cynthia Taylor Chavoustie, MPAS, PA-C, has reviewed the answers.

Is exocrine pancreatic insufficiency serious?

Without treatment, EPI can lead to serious complications such as malnutrition and osteoporosis. Following your doctor’s treatment plan is important to manage the condition.

Can you cure exocrine pancreatic insufficiency?

There is no known cure for EPI, but it can be manageable through PERT, dietary modifications, and addressing any underlying conditions.

Summary

EPI occurs due to damage or removal of part or all of the pancreas. If your pancreas does not produce or release certain enzymes into your intestinal tract, your body cannot efficiently digest, absorb, and use the food you eat.

This can lead to gastrointestinal discomfort, diarrhea, malnutrition, osteoporosis, and other symptoms and complications.

EPI can be difficult to diagnose, but proper treatment and lifestyle changes can improve quality of life and relieve uncomfortable symptoms.

Talk with your doctor about ways to manage EPI.

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 Oct 18
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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