What is Exocrine Pancreatic Insufficiency (EPI)? 

EPI  happens when the pancreas does not make enough digestive enzymes to properly break down food. EPI is often linked to conditions that affect the pancreas. Some people are born with conditions like cystic fibrosis, while others may develop EPI later in life due to chronic pancreatitis.

However, you can also have EPI without having pancreatitis or cystic fibrosis. EPI may also occur after pancreatic surgery or in people with conditions such as pancreatic cancer, diabetes, celiac disease, or other digestive disorders.

Common symptoms of EPI include bloating, gas, diarrhea, greasy or foul-smelling stools, stomach pain, unexplained weight loss, and vitamin deficiencies. Because these symptoms can look like other digestive problems, EPI is sometimes missed. If you have ongoing digestive symptoms or a condition that puts you at risk, talk with your doctor—EPI can be tested for and treated.

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 a 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 (PERT)

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 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 fat-soluble vitamins A, D, E, and K.

Resources

Essentials of EPI is a comprehensive resource for physicians (but we welcome patients to view the resources as well). The site provides information on EPI symptoms, diagnosis, treatment options, PERT FAQs, and much more.

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