Exocrine Pancreatic Insufficiency

What is Exocrine Pancreatic Insufficiency?

Exocrine Pancreatic Insufficiency or EPI is an autoimmune disorder caused by insufficient production and secretion of digestive proteins from the pancreas. This disorder leads to malabsorption of nutrients, vitamins, and fats; leaving patients malnourished and at risk for an array of diseases and disorders.

Signs and Symptoms

Symptoms of EPI vary, depending on the severity of deficiency. The most common symptoms include:

  • Weight loss (often dramatic)
  • Pale stools/fatty or greasy stools
  • Abdominal Pain/bloating
  • Gas
  • Diarrhea
  • Generalized weakness, fatigue, and malnutrition

Causes of Exocrine Pancreatic Insufficiency

Exocrine pancreatic insufficiency is usually caused by a combination of genetic mutations and/or environmental factors, and is a systemic autoimmune condition often associated with autoimmune conditions in other organ systems. In some cases, it is part of a systemic disorder. Common causes are:

  • Chronic Pancreatitis - often caused by alcohol use
  • Celiac Disease
  • Cystic Fibrosis
  • Crohn’s Disease
  • Damage to the Pancreas from trauma or tumors
  • Type 1 Diabetes
  • Genetic Mutations
  • Certain medications

Diagnosis of EPI

The diagnosis of EPI is based on the collection of symptoms along with additional testing, such as a physical exam, a blood test, and a fecal elastase test. A fecal elastase test measures the amount of elastase, an enzyme released by the pancreas, in the stool. If the level is low, it indicates that the pancreas is not functioning correctly. Other more definitive tests may include imaging such as an abdominal CT or MRCP (Magnetic Resonance CholangioPancreatography). These tests can give your doctor visual confirmation of any blockages, scars, or inflammation in the pancreas.

Treatment of EPI

Treatment for EPI typically involves supplementing with enzymes to aid in digestion. Patients are typically prescribed a pancreatic enzyme replacement therapy (PERT) such as Creon or Viokace. PERT is taken with meals in order to improve digestion and absorption of nutrients.

As well as PERT, a high-fat diet is recommended to increase absorption of vitamins and minerals. The patient should also take a multivitamin to replenish any lost nutrients. Lastly, it is also important to stay hydrated to ease digestion and to replace lost fluids.