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.

WebMD Medical Reference

WebMD Voices

Matt E., 58
Sinking Spring, PA
If you’re newly diagnosed, take comfort in knowing it typically takes weeks, if not months, to get your diet and enzyme dosing dialed in to where EPI symptoms may be under control. Don’t get too worried by bad days early on.
Jane C., 62
Phoenix, AZ
'No alcohol' goes without saying. If you’re socializing, try virgin drinks or simple club soda and lime. Fluid intake is important. I don’t go anywhere without my water bottle. I drink coffee on good mornings, tea in the evening, and ginger ale on tough days.
Roberta L., 63
Santa Ana, CA
When you're away from home, it’s good to know where restrooms are. There are apps out there like "Sit or Squat" and "Flush". You put in your location and it gives you the nearest bathrooms. Keep or carry an extra set of clothes in case of emergency.
Joe V., 79
Winneconne, WI
Look for a good support system -- friends, family, other survivors. Keeping positive people around you helps you get through the tougher days. It’s important to remain hopeful. I’m a 14-year pancreatic cancer survivor. A positive attitude and keeping my faith helps.
Jane C., 62
Phoenix, AZ
It’s easy to feel isolated with food restrictions. I eat before we go so I’m not hungry and tempted to eat something that may make me sick. With family or close friends, I bring my own meal. They’re happy to let me heat it up, and it takes pressure off them.
Roberta L., 63
Santa Ana, CA
It's not always easy, but a positive attitude really helps. Find a quote, write it down, and carry it with you. When things get tough, read it. My favorite is: Fate whispers to the warrior, ‘You cannot withstand the storm.’ The warrior whispers back, ‘I am the storm.
Liz J., 32
San Francisco
Some days are better than others -- and symptom severity can be influenced by our mental health and how we relate to the pain and discomfort. Meditation and deep breathing exercises have gotten me through some pretty intense episodes.

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