EPI Treatment: What to Expect

Exocrine pancreatic insufficiency (EPI) causes serious problems with how you digest your food.

Your pancreas makes enzymes that help break down the foods you eat so you can get nutrients, vitamins, and minerals from them. When you have EPI, your pancreas doesn’t make enough of these enzymes. To help you digest foods more easily, you can get treatments that replace them.

Other treatments help you manage symptoms like stomach pain or acid. Supplements can give your body extra doses of important vitamins and minerals to keep your weight up so you stay healthy.

You also can treat the health problem that causes your EPI, like cystic fibrosis, Shwachman-Diamond syndrome, or chronic pancreatitis. You may get chronic pancreatitis if you have alcoholism or pancreatic stones.

How Does Enzyme Replacement Work?

Pancreatic enzyme replacement therapies (the doctor might refer to them as PERTs) are coated pills often made from pig pancreas juices.

PERTs can help you better absorb fats from your foods, ease symptoms like stomach upset or oily stools, and just help you feel better overall.

There are several prescription enzymes. If your doctor prescribes this medication, take it at the start of meals or before you eat snacks, along with a liquid like water. Don’t dissolve the pill in a liquid like milk or take it with any over-the-counter stomach acid medicine that has calcium or magnesium. These products can break down the coating and enzymes in your pills.

The amount you take depends on your body weight. You’ll start with the lowest possible dosage and take more if you need it.

You may also take drugs to lower stomach acid along with your PERT. Your doctor can prescribe these, and they’re also available over the counter:

  • Proton pump inhibitors like esomeprazole (Nexium) or omeprazole
  • H2 blockers like cimetidine (Tagamet, Topcare), famotidine, or ranitidine

Drugs That Treat EPI Symptoms

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help you manage pain.

Emotional stress can also trigger pancreas inflammation. Tricyclic antidepressants like amitriptyline or nortriptyline (Pamelor) may help ease pain. Gabapentin (Neurontin, Gralise),, a drug that helps control seizures, can also help fight EPI pain. Pregabalin (Lyrica), which is used to treat seizures and nerve pain, also shows promise.

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Tips to Boost Your Nutrition

EPI makes it hard for you to get the right nutrients because your body can’t break down your foods. You might not get enough vitamin A, B12, D, E, and K, and you probably don’t take in enough fats.

Your doctor can prescribe vitamin supplements to help you get the right levels of these nutrients. She can also tell you which over-the-counter supplements and dosage to take.

It’s better for you to eat small meals more often than big ones that are hard to digest. Low fat may be easier on your system if you have a severe case. But if not, make sure you get enough calories and fats to help you stay at a healthy weight.

Talk to a dietitian or nutritionist to help you choose the right foods or create meal plans.

If you smoke or drink, it’s time to stop. Alcohol and tobacco both make it harder for your pancreas to work. Alcoholism is one possible cause of EPI. Smoking can lead to calcium buildup in your pancreas.

How to Treat Conditions That Cause EPI

Cystic fibrosis. Treatments include enzyme replacement therapy, antibiotics, laxatives, and enemas. You can also eat a high-calorie, high-fat diet or take supplements to get the nutrition you need.

If you have cystic fibrosis and EPI, you may also get diabetes. Keep your blood sugar levels under control, and take insulin or other medications if your doctor prescribes them.

Shwachman-Diamond syndrome. Your doctor may prescribe PERTs, a high-fat and high-calorie diet, and vitamins and supplements. Scientists are also working to see if stem cell transplants will treat this genetic disease.

Chronic pancreatitis: If you have alcoholic pancreatitis, it’s important to stop drinking. You may need to enter a treatment program or work with a counselor to stop. If you smoke, stop. If there are stones blocking your ducts, the doctor can remove them. If you have a systemic illness like lupus or cystic fibrosis, treatment for the underlying condition may help the chronic pancreatitis.

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Is Surgery an Option?

Yes. Surgery can open ducts that are clogged or blocked by gallstones, and decompression can widen a main pancreatic duct that’s too narrow.

Another option is to remove your pancreas and give you an autologous islet cell transplant. These are cells from your own body that make insulin. The doctor will get them into your body through a vein in your liver.

This surgery can ease severe chronic pancreatitis pain or prevent or ease diabetes caused by chronic pancreatitis. But it’s only used if other treatments haven’t worked.

If other treatments fail, the doctor might remove a portion of your pancreas, but this is usually a last resort.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on October 14, 2018

Sources

SOURCES:

National Pancreas Foundation: “Exocrine Pancreatic Insufficiency (EPI).”

Medical University of South Carolina Digestive Disease Center: “What is pancreatic insufficiency?”

Lindkvist, B. World Journal of Gastroenterology, published online November 2014.

National Organization for Rare Disorders: “Shwachman-Diamond Syndrome.”

Diabetes Association of the UK: “Exocrine Pancreatic Insufficiency.”

Pancreatic Cancer Action Network: “Pancreatic Enzymes.”

Raphael, K. Clinical and Experimental Gastroenterology, published online July 2016.

Johns Hopkins Cystic Fibrosis Center: “Pancreas/Gastrointestinal Tract.”

Olesen, S.S. Gastroenterology, August 2011.

UptoDate: “Etiology and pathogenesis of chronic pancreatitis in adultsEtiology and pathogenesis of chronic pancreatitis in adults," “Treatment of chronic pancreatitis.”

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