A condition called exocrine pancreatic insufficiency (EPI) affects the pancreas, which helps regulate blood sugar levels and digestion. The pancreas produces enzymes that break down food and nutrients in the small intestine. The pancreas, however, does not produce enough of these enzymes in people with EPI, causing difficulties with digestion.
EPI can be caused by various diseases and conditions that damage the pancreas or interfere with its function. Some of the common causes of EPI are:
Chronic pancreatitis, which is a long-term inflammation of the pancreas that can scar and destroy the pancreatic tissue.
People with cystic fibrosis have thick and sticky mucus that can block the ducts of the pancreas and prevent enzymes from reaching the small intestine.
Pancreatic cancer, which is a malignant tumor that grows in the pancreas and can compress or invade the pancreatic tissue and ducts.
Surgery of the pancreas or the upper gastrointestinal tract, which can remove part of the pancreas or disrupt the flow of the enzymes to the small intestine.
Other less common causes of EPI include diabetes, celiac disease, inflammatory bowel disease, HIV, and some rare genetic disorders.
EPI is characterized by malabsorption, meaning the body has trouble absorbing nutrients from food. This can lead to gastrointestinal and non-gastrointestinal symptoms such as:
Gas, bloating, cramps, or pain in the abdomen
Diarrhea, loose, greasy, or foul-smelling stools
Weight loss or difficulty gaining weight
Fatigue, dizziness, dry skin, brittle nails, hair loss, depression, irritability, or problems with memory and concentration
Problems seeing at night or problems with bones, such as low bone mass or osteoporosis
The severity and frequency of the symptoms may vary depending on the cause and extent of EPI, the type and amount of food consumed, and the presence of other medical conditions.
It is important to see your doctor if you are experiencing symptoms of EPI. You will be asked about your medical history, symptoms, and medications. A doctor may also perform some tests to confirm your diagnosis and rule out other possibilities. Some of the most common tests for EPI are:
Fecal elastase test, which is a stool test that measures the amount of elastase, an enzyme produced by the pancreas, in your stool. A low level of elastase indicates EPI.
Fecal fat test, which is another stool test that measures the amount of fat in your stool. A high level of fat indicates malabsorption due to EPI or other causes.
A secretin pancreatic function test measures the pancreas' response to secretin, a hormone that stimulates the release of pancreatic enzymes. A low level of enzymes indicates EPI.
Your doctor may also order other tests, such as blood tests, imaging tests, or genetic tests, to determine the cause and severity of EPI and check for any complications or associated conditions.
The main treatment for EPI is pancreatic enzyme replacement therapy (PERT), a medication in which pancreatic enzyme supplements are taken with every meal and snack. These supplements contain the enzymes that your pancreas cannot produce, such as lipase, amylase, and protease. These help you digest and absorb the food and nutrients better and reduce the symptoms of EPI.
In order to be safe, your doctor prescribes the type, dose, and frequency of enzyme supplements that are appropriate for you. Make sure you follow your doctor's instructions carefully and take the supplements as directed. Check the expiration date of the supplements before using them and store them in a cool, dry place.
In addition to PERT, you may also need to make some dietary and lifestyle changes to manage EPI and improve your health and quality of life. Some of the tips are:
You may have to adjust the amount and type of fat, protein, carbohydrates, vitamins, and minerals in your diet according to your symptoms and nutritional status. Eat a balanced and nutritious diet that includes foods from all food groups. Vitamins and minerals supplements, particularly fat-soluble vitamins (A, D, E, and K), calcium, iron, and zinc, may also be necessary to prevent deficiencies.
Eat smaller and more frequent meals throughout the day to avoid overloading your digestive system and reduce the risk of malabsorption and diarrhea.
Drink plenty of fluids to stay hydrated and prevent dehydration and electrolyte imbalance due to diarrhea.
Avoid foods and drinks that may worsen your symptoms, such as alcohol, caffeine, spicy foods, fried foods, or foods that cause gas or bloating.
Quit smoking, as smoking can damage the pancreas and worsen EPI and its complications.
Exercise can improve your blood circulation, metabolism, mood, and bone health. However, you should consult your doctor before starting any exercise program, and you should avoid strenuous or high-impact activities that may cause abdominal pain.
Seek emotional and social support, as living with EPI can be challenging and stressful. You can join a support group, talk to a counselor, or reach out to your family and friends for help and guidance.
In some cases, such as genetic disorders or irreversible pancreatic damage, EPI cannot be prevented. However, some steps can be taken to reduce the risk or delay its onset, such as:
Avoid or limit alcohol consumption, as alcohol can irritate and inflame the pancreas and cause pancreatitis, which can lead to EPI.
Maintain a healthy weight, as obesity can increase the risk of pancreatitis and diabetes, which can cause EPI.
Control your blood sugar levels, as high blood sugar levels can damage the pancreas and cause EPI, especially in people with diabetes.
Treat and manage any underlying or associated conditions that may cause or worsen EPI, such as cystic fibrosis, celiac disease, inflammatory bowel disease, or HIV.
Follow your doctor's advice and recommendations regarding medications, supplements, diet, and lifestyle changes to manage EPI and prevent complications.
As a result of EPI, the pancreas is unable to produce enough enzymes to digest and absorb nutrients. Diarrhea, weight loss, and malnutrition can be caused by EPI. Pancreatic enzyme supplements, dietary changes, and pancreatic enzyme supplements can be used to diagnose and treat EPI. Chronic pancreatitis, cystic fibrosis, pancreatic cancer, and surgery are some of the diseases and conditions that can cause EPI. Although EPI cannot be prevented in some cases, it can be reduced or delayed in others by limiting or avoiding alcohol, maintaining a healthy weight, controlling your blood sugar levels, as well as treating and managing any underlying or associated conditions.
