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A woman in a yellow t-shirt holding her stomach, as if in pain.

Understanding Exocrine Pancreatic Insufficiency

What is EPI Disease?

The pancreas is not typically what comes to mind when we think of the digestive system, but it plays a significant part in how the body breaks down food and processes nutrients. Exocrine pancreatic insufficiency, otherwise known as EPI disease, occurs when the pancreas does not produce or deliver the enzymes the body needs.

Because the body depends on the pancreas and its enzymes to digest food and use nutrients, the disease can severely affect a person’s overall health. Fatty and oily stools, malnutrition, weight loss and diarrhea are a few side effects of EPI disease.

What Causes EPI Disease?


There is a variety of disorders and conditions that can injure the pancreas and lead to this disease:

  • Acute and chronic pancreatitis
  • Autoimmune pancreatitis
  • Celiac disease
  • Crohn’s disease
  • Cystic fibrosis
  • Diabetes
  • Genetic conditions
  • Inflammatory bowel diseases
  • Surgical procedures in the digestive tract
  • Shwachman-Diamond syndrome
  • Pancreatic cancer
  • Zollinger-Ellison syndrome

Common Symptoms

The symptoms can be easy to write off when they are mild, and they can be very similar to the symptoms of other diseases. There are certain symptoms to look out for:

  • Bloating and a feeling of fullness in the abdomen, due to gas from undigested food.
  • Diarrhea caused by excess water retained by food that is not broken down.
  • Abdominal pain from gas or undigested food.
  • Weight loss due to the body’s inability to fully digest food. Weight loss may also occur because people with EPI disease tend to avoid food to avoid pain.
  • Signs of vitamin deficiency, like brittle hair and nails and skin issues.
  • Muscle loss due to the lack of calories, protein and nutrients.
  • Malnutrition may occur because the body can’t get the vitamins and minerals it needs from food.
  • Fatty and pale stools that are difficult to flush, which is also called “steatorrhea”. One of the hallmarks of EPI disease is the foul-smelling, fat-filled stools that arise because of the pancreas’ inability to process food and fat. These stools tend to float on top of the water or stick to the toilet’s sides, making them difficult to flush.

Getting a Diagnosis

Because the symptoms of EPI disease are similar to other disorders, it is essential to obtain a correct diagnosis. EPI disease is diagnosed using:

  • Endoscopic ultrasound using a thin tube through the mouth.
  • Magnetic Resonance Imaging (MRI) an MRCP.
  • Bloodwork to look for malnutrition and a trypsinogen. Trypsinogen aids in digestion and can become elevated when EPI disease occurs.
  • A fecal elastase test from a stool sample may show elastase. Elastase, in reduced amounts, may indicate EPI disease.

Treatment Options

Very often, the treatment calls for a multi-pronged approach involving dietary changes, medications and lifestyle modifications. A physician may prescribe pancreatic enzyme replacement therapy (PERT) to help replace the missing enzymes the body needs.

PERT also alleviates some of the symptoms, like abdominal pain and oily, odorous stools. PERT programs are determined by the cause of the EPI disease and the symptoms that occur along with it.

For PERT to be successful, the person taking it must follow the prescribed regimen. Much of the medications have a special coating which allows the tablets to dissolve in the right area of the digestive tract. Failure to take the medication at the prescribed time or with the appropriate drink can impact how well the medication works.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally considered to be safe to treat the pain. However, these medications should be taken only for short periods and with a physician’s approval.

In general, people should review over-the-counter medications with a physician before taking, because they can interfere with PERT or cause further injury to the pancreas.

A physician may recommend dietary changes to ensure adequate nutrition. Changes in diet may depend on whether a person is on PERT because it allows the body to obtain the nutrition it needs from a healthy diet.

Instead of banning fat or oil consumption, physicians may encourage healthy fats from nuts and plant-based oils over other fats. Smaller, more frequent meals can also keep from overworking the pancreas.

Lifestyle Changes and Prevention

A healthy lifestyle is almost always the best way to help prevent diseases and disorders, including EPI disease. Although some causes of EPI disease can’t be controlled, many can be prevented or mitigated.

For example, a balanced diet and exercise can prevent type 2 diabetes, which is a common cause of EPI disease. Routine heavy alcohol use, combined with a high-fat diet, increases the risk for pancreatitis and the development of EPI. Be aware of any family history of cystic fibrosis, pancreatitis, or diabetes.

By trying to prevent the causes of EPI disease, you can minimize your chances of developing the disease.