5 Symptoms of Exocrine Pancreatic Insufficiency

As soon as you take your first bite of food, your pancreas is hard at work, secreting digestive enzymes that break down the food into small molecules your body can absorb.

But if you have long-term damage to your pancreas — from, for example, chronic pancreatitis, alcohol abuse, or another disease — the digestion process doesn’t always go smoothly. A breakdown in pancreatic function can lead to a condition called exocrine pancreatic insufficiency, or EPI, in which you lack the digestive enzymes needed to properly digest food.

“During exocrine pancreatic insufficiency, proteins, carbohydrates, and fats aren’t broken down,” says Deepak Agrawal, MD, MPH, chief of gastroenterology and hepatology and an associate professor in the internal medicine department at The University of Texas at Austin Dell Medical School. As a result, your body can’t absorb the nutrients you need, which can lead to diarrhea, loss of appetite, and weight loss or malnourishment.

Conditions that have been associated with EPI include chronic pancreatitis, cystic fibrosis, celiac disease, diabetes, and inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis. Also at risk are people who’ve undergone gastrointestinal (GI) surgery that involved removing parts of the pancreas or stomach.

Other digestive issues, such as irritable bowel syndrome, and autoimmune diseases, such as lupus, have also been linked to EPI.

If you have any of these conditions, you should be aware of EPI signs.

Symptoms of EPI

Because the symptoms of EPI can mimic those of more common digestive diseases and syndromes, the condition can be difficult to identify, both for you and your doctor. If you’re experiencing a number of these symptoms, EPI could be the culprit.

“Generally, when someone has diarrhea, weight loss, and trouble tolerating fatty foods, exocrine pancreatic insufficiency is a suspect,” Dr. Agrawal says.

Here are some of the most common EPI symptoms.

1. Diarrhea 

Diarrhea from EPI results from undigested food sitting in the small intestine. “When the pancreas fails to produce the necessary digestive enzymes, fats and other nutrients can’t be absorbed,” Agrawal explains. “Instead, they remain in the small bowel, drawing in water and causing diarrhea.”

2. Weight loss

If your body can’t absorb enough nutrients and fats, you could find yourself losing weight. This is also more common in people who have another digestive condition, such as Crohn’s disease, in addition to EPI.

3. Steatorrhea

Unabsorbed fat gets passed, causing fatty stools known as steatorrhea. “When people with exocrine pancreatic insufficiency eat fatty foods, the fat doesn’t get absorbed, so they excrete oily, foul-smelling stools that float,” says Frank Gress, MD, a senior professor of medicine and gastroenterology at Mount Sinai Hospital and chief of gastroenterology and hepatology at Mount Sinai South Nassau in New York.

4. Abdominal pain

“The pain is usually in the right upper quadrant of the abdomen, and it can either be vague or sharp,” Dr. Gress says.

5. Non-GI symptoms

If you can’t absorb vital nutrients, you may develop vitamin deficiencies that can trigger non-digestive symptoms.

“Some of the most common deficiencies associated with exocrine pancreatic insufficiency are in iron, vitamin B12, folate, and calcium,” Gress says. Because your body has difficulty digesting fat, you can also become deficient in the fat-soluble vitamins A, D, E, and K. “One sign of vitamin deficiency is a raised, scaly rash on the skin,” he says. Other symptoms include bone pain, muscle cramps, night blindness, paresthesia (tingling or pricking sensation in the skin), and easy bruising.

Additional symptoms may be related to the underlying cause of pancreatic damage, such as cystic fibrosis or pancreatitis, Agrawal adds.

If you’re experiencing digestive problems similar to those of EPI, Gress says your first step should be to contact your primary care doctor, who can perform an initial examination and then discuss the next steps.

If your doctor can’t find an explanation for your digestive symptoms, you’ll likely be referred to a doctor who specializes in digestive diseases, such as a gastroenterologist, for further testing. If you are diagnosed with EPI, you’ll probably be given pancreatic enzymes and possibly be advised to take vitamin supplements to manage the condition and better control your symptoms.