Your pancreas is a flat, pear-shaped organ that sits right behind your stomach. You need it to make the juices that aid your digestion and help hormones that keep your blood sugar steady. But when your pancreas isn't working right, you could get a condition called exocrine pancreatic insufficiency (EPI).
Your pancreas is made of two types of glands:
Endocrine Gland
It makes and releases hormones (insulin and glucagon) that raise and lower the amount of sugar in your bloodstream to keep it at the right level.
Exocrine Gland
When food enters your stomach, this gland sends it enzymes -- substances that trigger chemical reactions in your body -- that help you digest food and absorb nutrients.
There are three types of enzymes your exocrine gland makes to help you digest food:
When you have exocrine pancreatic insufficiency, it's because the exocrine gland is acting up. It doesn't make enough digestive enzymes, or sometimes these enzymes don't work the way they should. This means that after you eat, your food passes through your intestines without being digested fully. As a result, your body doesn't get the nutrients it needs from it.
What Causes EPI?
Typically you get EPI from another medical condition. For example you might get EPI if you already have:
- Pancreatitis
- Celiac disease
- Inflammatory bowel disease
- Pancreatic cancer
- Diabetes
Chronic pancreatitis -- inflammation and swelling of the pancreas -- is the most common cause of EPI in adults. As many as 8 in 10 people with pancreatitis go on to have EPI.
Sometimes EPI can happen after you have surgery on your pancreas or other parts of your digestive system, such as your stomach or intestines. Weight loss surgery can also cause it.
Kids who get EPI most often get it from cystic fibrosis, but may also get it from:
- Shwachman-Diamond syndrome
- Pearson Marrow syndrome
- Jeune syndrome
- Other abnormalities they have at birth
What Are Symptoms of EPI?
Most of the symptoms you have when you're dealing with EPI are with your digestion. They happen because you're not able to absorb fat. You may have a lot of discomfort after you eat and have abnormal, fatty poop that floats.
You may also get symptoms like:
- Oily diarrhea
- Bloating
- Gas
- Fatigue
- Cramps
- Pain in the center of your stomach that radiates to your back
- Weight loss you can't explain
You may also have a specific type of diarrhea called steatorrhea. Steatorrhea bowel movements are:
- Watery
- Pale or gray
- Bulky
- Frothy
- Greasy
- Extremely foul-smelling
EPI can also cause:
- Muscle loss
- Bone pain
- Brittle nails
- Hair loss
- Skin problems
How Is EPI Diagnosed?
Steatorrhea is one of the most tell-tale signs you have EPI. If your doctor suspects you have it, they'll usually try to rule out other more common conditions first.
Your doctor might give you tests such as:
Fecal Elastase Test (FE-1)
It checks for elastase in your stool. If you have little to none, it can be a sign you have EPI.
Fecal Fat Test
With this test, your doctor looks at how much fat is in your poop. Lots of fat can be a sign of EPI.
Secretin Pancreatic Function Test
During this test you get a hormone called secretin through an intravenous (IV) line. Secretin tells your body to release digestive enzymes. Your doctor collects fluid using an endoscopic ultrasound and tests it for enzymes. If they're low, it can be a sign that you have EPI.
Your doctor may also use imaging tests such as CT scan, X-ray, MRI, or ultrasound to look for any issues you might be having in your pancreas that could lead to EPI. Your primary care doctor may be able to diagnose your EPI, or you may need to see a digestive specialist called a gastroenterologist.
What Are the Treatments for EPI?
The main treatment is a therapy that replaces the enzymes your pancreas isn't making. It's called pancreatic enzyme replacement therapy (PERT).
It's a prescription medication you take by mouth every time you eat. It helps you break down your foods so your body can get the nutrients it needs.
Changing what you eat can also help. If you have EPI, it's important to keep up a healthy diet with plenty of nutrients. Fat helps your body absorb nutrients. Your doctor may recommend a dietitian or nutritionist to be sure you're getting enough calories per meal.
Vitamin and mineral supplements can be helpful. Fat-soluble vitamins such as vitamins A, D, E, and K can help replace some of the nutrients you have trouble getting through food.
Lifestyle changes, such as eating smaller frequent meals and quitting the tobacco habit if you have one, are also important.
What Are Complications of EPI?
When your body can't absorb fats, carbs, or proteins well, it's called malabsorption. It can lead to malnutrition -- poor nutrition that causes problems for your body.
If your organs and tissues can't get the nutrients they need, you might deal with:
Over time, EPI can lead to conditions such as osteoporosis (thinning bones) and anemia (low blood cell count).
Eating Well With EPI
Conditions Linked to EPI
How to Diagnose EPI