What is Exocrine Pancreatic Insufficiency?

Exocrine Pancreatic Insufficiency, or EPI, is the medical term for a condition that occurs when the pancreas doesn’t produce enough digestive enzymes. As a result, the body cannot properly digest food into nutrients, which can lead to malabsorption.

Many people do not realize the pancreas plays an important role in digestion and that problems with the pancreas can result in digestive issues. When you have exocrine pancreatic insufficiency, your body is missing the enzymes it needs to digest food, which causes important nutrients to pass through the body unabsorbed.

This can lead to a number of signs and symptoms that may vary from person to person. People with EPI may have one, two, or several of the symptoms listed.

EPI symptoms may include:

• Foul-smelling, greasy stools (steatorrhea)-People with EPI cannot absorb all the fat that they eat. The undigested fat that passes through the digestive system may cause oily or greasy-looking stools. These stools may also smell really bad, float, and be difficult to flush.  Not all people experience steatorrhea, but it is the most common sign of EPI. You should tell your doctor if you notice oil droplets in the toilet bowl or if your stools have the appearance of salad dressing or motor oil.
• Unexplained weight loss-People with EPI cannot properly digest or absorb the fats, proteins, and carbohydrates found in food, which can result in weight loss.
• Gas and bloating-Because people with EPI cannot properly digest food, it can cause uncomfortable symptoms such as gas and bloating.
• Stomach pain-The gas and bloating that sometimes happen with EPI can cause stomach pain.
• Frequent diarrhea-Undigested food may move too quickly through the digestive system, resulting in diarrhea.

If you have one or more of these symptoms, make sure you let us, or your doctor, know.

EPI can occur in people with certain diseases and conditions that affect the pancreas. These diseases may be present when you’re born or develop over time.

Conditions that may be associated with EPI include:

• Cystic fibrosis (CF)-CF is an inherited genetic disorder that mainly affects the lungs, digestive, and reproductive systems. People with CF produce thick, sticky mucus. When the pancreas is clogged with mucus, it can’t properly release the digestive enzymes needed to properly break down food.
• Chronic pancreatitis (CP)-CP is a disease in which there is inflammation of the pancreas that lasts a long time. This is the most common cause of EPI in adults. CP may cause irreversible damage to the pancreas, including the cells that make digestive enzymes.
• Surgical removal of the pancreas (pancreatectomy)-Surgery involving the pancreas may affect its production of digestive enzymes. This, in turn, may lead to EPI. Removing part or all of the pancreas may be done as part of a treatment for pancreatic cancer, pre-cancerous pancreatic tumors, or chronic pancreatitis. It might also be done in cases where the pancreas has been severely damaged due to an injury.
• Pancreatic cancer-In patients with pancreatic cancer, blockage of the pancreatic duct is common. Treatment may involve surgically removing part or all of the pancreas, resulting in EPI.
• Gastrointestinal surgery-The digestive enzymes produced by the pancreas may be affected by certain types of abdominal surgeries, especially surgeries that involve the stomach and intestines.
• Diabetes (type I, type II and type IIIC)-The pancreas produces digestive enzymes and also produces insulin, a hormone that helps control blood sugar levels. People with diabetes have trouble producing or using insulin. Some people with diabetes (type I, type II and IIIC) may also have EPI.

If you think you could have EPI, the first step you should take is to make an appointment to talk to us here at Palmetto Endocrinology. It's important that you open up and tell us about any and all symptoms you may be experiencing.

You should remember to share the following information:

• Any conditions you’ve been diagnosed with
• Your eating habits
• Any and all symptoms you’ve been experiencing and the severity of your symptoms
• When your symptoms started
• If you've had unexplained weight loss
• Any differences in your stools and bowel movements
• Any medications or herbals you may be taking

Author

Joseph Mathews, MD, FACP, FACE, ECNU, CCD Joseph W. Mathews M.D., a board certified Endocrinologist and Medical Director of Palmetto Endocrinology, was born and raised in South Carolina. He earned his Bachelor of Science in Biology from the College of Charleston, Cum Laude. He then achieved his M.D. at the Medical University of South Carolina where he also completed his residency in Internal Medicine and a Fellowship in Endocrinology, Diabetes, and Metabolism. Dr. Mathews is also a Fellow of both the American College of Endocrinology and the American College of Physicians, holds an Endocrine Certification in Neck Ultrasound (ECNU) and is a Certified Clinical Densitometrist (CCD). He has extensive experience performing ultrasound guided fine needle aspiration biopsies. His practice includes a range of specializations including prescribing and fitting patients with insulin pumps. Dr. Mathews' practice has drawn patients from out of state to benefit from his expertise in thyroid disorders, diabetes, cortisol problems and their Endocrine disorders.