Symptoms of Exocrine Pancreatic Insufficiency

Exocrine pancreatic insufficiency, also known as EPI, is a condition that leads to a deficiency in exocrine pancreatic enzymes, and consequently an inability to digest food.

The pancreas releases enzymes, which are proteins that create chemical reactions in the body that break down food and allow it to be absorbed for use as energy. If the pancreas does not produce enough of these enzymes, the processes of digestion and absorption are disrupted, according to the American Gastroenterological Association (AGA).

EPI usually occurs in conjunction with diseases or conditions affecting the pancreas, according to the National Pancreas Foundation. These include cystic fibrosis and chronic pancreatitis.

Digestive Symptoms of EPI

Since EPI affects digestion and absorption, it’s no surprise that it can lead to a number of uncomfortable gastrointestinal symptoms. These can range in severity from mild to extremely painful.

According to the AGA, digestive symptoms of EPI include:

• Gas
• Bloating
• Diarrhea
• Abdominal pain
• Greasy, oily stools
• Foul-smelling stools
• Unexplained weight loss

Of course, these symptoms can be signs of other health conditions, as well, making EPI often difficult to diagnose, the AGA reports. Your doctor will be able to discern whether your symptoms are the result of EPI or another medical condition.

Nondigestive Symptoms of EPI

According to the AGA, EPI can sometimes lead to malnutrition. This is a condition in which the body is deprived of essential vitamins, minerals, and nutrients that keep it healthy and allow it to function properly.

Symptoms of malnutrition, according to Johns Hopkins Medicine, include:

• Pale, dry skin
• Changes in skin color
• Bruising easily
• Rashes
• Sensitivity to light
• Bleeding gums
• Achy joints
• Thinning hair or hair that falls out easily
• Swollen or cracked tongue

When food isn’t properly absorbed, a number of vitamin deficiencies can develop. Deficiencies in important vitamins and minerals can lead to a number of health problems.

Pancreatic enzymes help fat digestion, and without them the fat absorbable vitamins, such as vitamin A, vitamin D, vitamin E, and vitamin K, can’t get absorbed into the body. Another vitamin that commonly gets malabsorbed in EPI is vitamin B12.

A deficiency in vitamin K can lead to easy bruising, according to research.

A deficiency in vitamin E can cause ataxia (poor muscle control) and peripheral neuropathy.

A deficiency in vitamin B12 can cause neurological issues  as well as anemia.

A deficiency in vitamin A can lead to vision problems like night blindness, according to the American Academy of Ophthalmology. This occurs when the eyes have trouble adjusting to the dark. People who have night blindness have difficulty seeing in the dark, but they do not have any trouble if there is enough light. Night blindness is sometimes seen in patients with EPI, according to guidance published in 2021.

Vitamin D deficiency can lead to soft, weak bones, according to the Cleveland Clinic. Vitamin D, along with calcium, is essential for bone health. Too little of it is one of many causes of osteoporosis, or the loss of bone density.

Research has also found that too little calcium can lead to muscle cramps in people living with EPI.

Preventing Symptoms of EPI

Once you receive an EPI diagnosis, your doctor will work with you to develop a treatment plan. According to the AGA, the main treatment for EPI is pancreatic enzyme replacement therapy, or PERT, which will replace the enzymes no longer produced by the pancreas.

It’s also important to eat a nutritious diet rich in fruits, vegetables, whole grains, and healthy proteins. Follow your doctor’s instructions closely and report any new symptoms that arise so the two of you can best figure out how to manage your condition.