3 Steps to Treating Exocrine Pancreatic Insufficiency

If your pancreas doesn’t produce the enzymes needed for proper digestion, you have what’s called exocrine pancreatic insufficiency (EPI). It’s a treatable condition, and to best understand your options, it helps to learn some key basic facts about this condition.

“EPI is linked to the failure of the pancreas,” says David C. Whitcomb, MD, PhD, chief of the division of gastroenterology, hepatology, and nutrition and director of the Center for Genomic Studies at the University of Pittsburgh and University of Pittsburgh Medical Center. EPI can also cause gastric discomfort, including diarrhea, and weight loss, according to the National Pancreas Foundation (NPF).

The pancreas is located deep in your belly, surrounded by other organs, including the small intestine, liver, and spleen. One of its functions is to release enzymes that help break down the food you eat so your body can absorb its nutrients, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Some people have diseases or conditions that affect the ability of their pancreas to release these digestive enzymes. These include tumors, pancreatic surgery, chronic pancreatitis (inflammation of the pancreas), cystic fibrosis, and celiac disease, according to a review of EPI diagnosis and treatment.

Doctors can sometimes treat EPI by treating its underlying cause, says Timothy B. Gardner, MD, a professor of medicine at the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. For example, people with celiac disease — a condition in which the body can’t properly digest gluten, a protein found in wheat, rye, and barely — can eliminate gluten from their diet and see a reduction in their symptoms.

If it’s not possible to resolve the underlying condition or the treatment doesn’t relieve your symptoms, such as with poorly responsive celiac (i.e., symptoms persist even though the person with celiac is on a gluten-free diet), EPI needs to be treated with diet modifications, vitamin and mineral supplements, and pancreatic enzyme replacement therapy (PERT), according to Dr. Gardner. “The goal of EPI treatment is to replace the digestive function of the pancreas,” Gardner says. Here’s how the three elements of EPI treatment can help do this.

An EPI-Friendly Diet

Depending on what’s causing your symptoms, your doctor may recommend you stick to a healthy, well-balanced diet. According to StatPearls, optimal management and treatment for EPI should include eating a healthy diet that’s as close to normal as possible (which includes healthy fats rather than eliminating all fats, which used to be the recommendation) and being screened regularly to avoid nutritional deficiencies (such as by taking vitamins).

The exception for this recommendation is people with cystic fibrosis (CF). A high-fat diet with increased amounts of PERT has been shown to improve lung disease in people with CF, so low-fat diets are no longer recommended for them, according to research. A diet higher in fat, protein, and calories can also help children with CF and EPI maintain a healthy weight, according to the Cystic Fibrosis Foundation.

People with EPI are advised to eat plenty of fruits and vegetables, which are good sources of vitamins and minerals, Gardner says. Eating smaller meals more frequently may help reduce stomach pain, he adds.

Vitamin and Mineral Supplements for EPI

If you have EPI, you may have trouble digesting fat-soluble vitamins, including vitamins A, D, E, and K, Gardner says. Your doctor may recommend that you take them in the form of a daily supplement along with certain antioxidants — such as vitamin C and selenium — to help treat a pancreas that’s inflamed or under metabolic stress, according to Dr. Whitcomb.

That said, not everyone who has EPI will need vitamin supplements if they take a successful dose of pancreatic enzymes, he says.

Treating EPI With PERT

PERT can help you manage EPI and prevent malabsorption and gastric discomfort. You must work with your doctor to determine how much enzyme replacement you need, though, because everyone is different, according to Pancreatic Cancer Action, (PCA) a charity based in Hampshire, England, that focuses on early diagnosis of pancreatic cancer. “Start with a moderate dose and adjust as necessary, depending on your symptoms,” Gardner says. “You can be tested after a few months to see how you’re responding.”

It’s important that you take the enzymes just before and during meals or snacks, not after you eat, according to PCA. And take your medication with cold — not hot — drinks, because heat can damage the enzymes, notes PCA.

Pancreatic enzyme supplement capsules contain a mixture of digestive enzymes, including lipase to break down fat, protease to assist with digestion of protein, and amylase for carbohydrates, according to PCA. The more fat in your meal, the higher the dose of enzymes you’ll likely need, Whitcomb says.

PERT can cause diarrhea or constipation, nausea, and gastric upset. You may need to experiment and find the brand you can best tolerate, because different manufacturers use different coatings, according to PCA. If you take the enzymes with antacids, they may not be as effective, according to the Pancreatic Cancer Action Network.

What Else You Can Do for EPI

In addition to taking these three main EPI treatment steps, it’s a good idea to abstain from alcohol and smoking. Excessive drinking can damage the pancreas, according to the NIDDK, and smoking elevates your risk for pancreatic diseases, including cancer and pancreatitis, according to PCA.