Exocrine pancreatic insufficiency (EPI) is a condition characterized by deficiency of the exocrine pancreatic enzymes, resulting in the inability to digest food properly, or maldigestion. 

Who gets EPI? 

EPI is associated with certain diseases and conditions that affect the pancreas. Some of these diseases you are born with, like cystic fibrosis, while others may occur later in life, as is the case with chronic pancreatitis. EPI may be associated with chronic pancreatitis and cystic fibrosis. If you have one of these conditions and symptoms of EPI, we recommend that you talk to your doctor.

Chronic Pancreatitis 

Chronic pancreatitis (CP) is the most common cause of EPI in adults. Over the course of years, the inflammation can lead to irreversible damage to the pancreas, including the cells that secrete pancreatic digestive enzymes and the cells that produce insulin leading to diabetes. 

Cystic Fibrosis (CF)

Cystic fibrosis (CF) is an inherited genetic condition that leads to chronic disease that mainly affects the lungs and digestive and reproductive systems. In patients with CF, a thick, sticky mucus is produced in certain organs throughout the body, most commonly in the lungs and digestive system, including the pancreas. Many people living with CF are unable to properly digest food because they may also have EPI.

Diagnosing EPI 

If you have exocrine pancreatic insufficiency (EPI), your body cannot properly digest fats, proteins, and carbohydrates in the food you eat. In addition to preventing adequate digestion, EPI produces uncomfortable gastrointestinal (GI) symptoms. Only your doctor can tell if your GI symptoms are due to EPI or another digestive condition. That is why it is so important to talk to your doctor about your medical history and all of your medications including all vitamins and supplements you take. And make sure to open up and share all of your symptoms at your next visit.

Living with EPI 

Getting nutrition from food

The food you eat contains 3 main nutrients—fat, protein, and carbohydrates. Your body uses these nutrients to help give you energy to function. FAT is found in foods like nuts and cheese. PROTEIN comes from foods like meat, poultry and fish. CARBOHYDRATES can be found in bread and pasta. Carbohydrates are broken down into sugars. If you have EPI, your pancreas cannot properly break down foods, resulting in poor digestion of nutrients—especially fats. Eating healthy is important for all of us. But it’s especially important that people with EPI eat a nutrient-rich diet—along with taking pancreatic enzyme replacement therapy with every meal and snack—since EPI interferes with nutrient absorption. If you have been diagnosed with EPI, you should work with your doctor or nutritionist to make sure that all your dietary needs are being met.

Pancreatic Enzyme Replacement Therapies 

Your doctor may start you on a prescription treatment called pancreatic enzyme replacement therapy, or PERT. PERTs are the main treatment for EPI—they replace the digestive enzymes that your pancreas isn’t producing anymore. When taken with food, PERTs help break down the nutrients in food.

Vitamins and Supplements 

If you have exocrine pancreatic insufficiency (EPI), your body may not absorb the nutrients from the food you eat. Your doctor may prescribe vitamin and mineral supplements to help you maintain proper levels of the fatsoluble vitamins A, D, E, and K.

Eating healthy with EPI and cystic fibrosis (CF) 

A high-calorie diet with adequate amounts of fat is especially important to help patients with CF grow, develop, and thrive. Patients with CF should work with their dietitian or nutritionist to make sure their proper nutrition needs are met.


Animated Pancreas Patient on EPI
American Gastroenterological Association DigiReach
AGA whiteboard videos in English and Spanish.