photo of woman holding stomach

People with exocrine pancreatic insufficiency (EPI) often have other medical conditions related to their digestive issues. These health problems can be the cause of EPI, or they may happen because of it. Sometimes they simply overlap with EPI and doctors don’t know why.

Work with your doctor to make sure you get the right diagnoses and treat all your health problems.

Chronic pancreatitis. It’s the most common cause of EPI in adults. When the pancreas becomes inflamed and stays that way for years, eventually its cells stop working the way they should, including those that can cause EPI. Many things can lead to chronic pancreatitis, including heavy alcohol use, smoking, genetic problems, and autoimmune disorders. Your doctor will want to start treatments to restore your digestion, help your pancreas work as well as it can, and ease any belly pain you might have.

Cystic fibrosis. This inherited disease is the second most common cause of EPI. Cells in the lungs and digestive system make thick, sticky mucus, which causes blockages in certain organs. In the pancreas, it keeps digestive enzymes from moving to the intestines, where they help break down fats and other nutrients. That leads to EPI. Good nutrition is important for treating cystic fibrosis and EPI. You’ll need to work with a dietitian to make sure you get what you need. You’ll also take vitamin supplements and get pancreatic enzyme replacement therapy.

Celiac disease. For people with this genetic condition, eating gluten (a protein found in wheat, barley, and rye) causes damage to the intestines. The pancreas works normally, but because of inflammation and damage to the intestines, it may not secrete enzymes in the way it should. If you switch to a gluten-free diet, however, EPI resulting from celiac disease usually will go away.

Tumors or cysts. They can lead to EPI by blocking the main duct of the pancreas, where enzymes would move into the intestines. You can have surgery to remove a tumor or cyst, but it may not always cure EPI, since the operation itself may damage the pancreas. So talk to your doctor about whether surgery is a good idea for you. If your tumor is cancerous, it may be the best option.

Diabetes. EPI and diabetes can go hand in hand. Often, the damage from chronic pancreatitis that causes EPI also affects the pancreas cells that make insulin, which leads to diabetes. But some recent studies suggest that EPI itself can cause diabetes.

Inflammatory bowel disease (IBD). It’s not clear why, but people who have ulcerative colitis or Crohn’s disease seem to be more likely to have EPI.

Short bowel syndrome. Like EPI, this rare condition causes diarrhea and keeps your body from absorbing the nutrients it needs. Other symptoms may include bloating and gas. Unlike EPI, it isn’t related to your pancreas. It happens in adults who’ve had surgery to remove part of their digestive tract or in babies who were born with an unusually short small intestine or with part of their bowel missing. Treatment involves medicines to ease symptoms, nutritional counseling, surgery, and sometimes an intestine transplant.

Zollinger-Ellison syndrome. This disorder happens when tumors grow in either the pancreas or part of the small intestine. The tumors make the body release extra amounts of a hormone called gastrin, which in turn makes the stomach release extra acid. Like EPI, it can lead to diarrhea. But unlike EPI, the most common symptom is burning pain between the chest and stomach. It’s treated with medicines to reduce stomach acid and surgery to remove the tumors.

Show Sources


BMC Medicine: “Practical guide to exocrine pancreatic insufficiency – Breaking the myths.”

American Journal of Managed Care: “A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities.”

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

Merck Manual: “Chronic Pancreatitis.”

Medscape: “Chronic Pancreatitis: Treatment and Management.”

Mayo Clinic: “Cystic Fibrosis.”

Celiac Disease Foundation: “What is Celiac Disease?”

Diabetes Care: “Is Pancreatic Diabetes (Type 3c Diabetes) Underdiagnosed and Misdiagnosed?”

Journal of Clinical Medicine Research: “Pancreatic Involvement in Inflammatory Bowel Disease: A Review.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Short Bowel Syndrome,” “Zollinger–Ellison Syndrome.”