What Is Exocrine Pancreatic Insufficiency?

Most of us take digestion for granted. We eat when we’re hungry, and after the last bite, we move on to the next activity. But behind the scenes, a complex process is taking place to ensure our food is properly digested and absorbed.

If something repeatedly goes wrong in the pancreas — an important digestive organ in the body — you may develop exocrine pancreatic insufficiency (EPI), a condition characterized by a lack of digestive enzymes that can lead to problems such as malnutrition and weight loss.

“When the pancreas is damaged to the point of [EPI], fats, proteins, and carbohydrates aren’t digested properly, and the body doesn’t absorb important nutrients it needs,” says John Affronti, MD, a professor of medicine in the department of gastroenterology and hepatology at Johns Hopkins Medicine in Baltimore.

Symptoms of Exocrine Pancreatic Insufficiency

The pancreas has two main jobs, 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. It produces enzymes to help break down foods — particularly fats and carbohydrates — into smaller molecules that can be absorbed and releases the hormones insulin and glucagon, which help regulate blood sugar.

When food isn’t broken down into small enough molecules, it can remain in the small bowel, where it can draw in water and cause diarrhea, one of the primary symptoms of EPI, says Dr. Gress.

In addition to diarrhea, other symptoms of EPI include oily stools from unabsorbed fat (steatorrhea), vitamin deficiencies, loss of appetite, and unexplained weight loss. If you consistently experience these symptoms, Dr. Affronti advises discussing them with your doctor and asking about the possibility of EPI, especially if you’re at risk due to other conditions.

Who’s at Risk for EPI

Because the symptoms of EPI can mimic those of other gastrointestinal conditions, it’s hard to pinpoint how many people have the condition, according to a study published in November 2019 on the publishing platform F1000Research.

By identifying the conditions, complications, and procedures that significantly increase your risk of EPI, doctors can better diagnose it. According to another study published in March 2019 in the journal Clinical and Experimental Gastroenterology, these include:

• Inflammation of the pancreas (acute or chronic pancreatitis), which can result from alcohol abuse or pancreatic disease
• Pancreatic cancer, which can clog ducts in the pancreas and reduce pancreatic function
• Cystic fibrosis, a genetic disease that commonly begins in childhood and causes thick mucus to build up in the lungs and in the tubes that transport digestive juices from the pancreas. It can lead to EPI by blocking the pancreas from secreting digestive enzymes.
• Celiac disease, an autoimmune condition of the lining of the small intestine that affects the ability to digest wheat and, in turn, causes the pancreas to work overtime
• Inflammatory bowel disease, including ulcerative colitis and Crohn’s disease, which affect the lining of the digestive tract and impair the inability to absorb nutrients
• Diabetes, a condition in which the body produces too much blood sugar (glucose). It occurs when your body doesn’t properly make (or use) insulin, the hormone that regulates sugar in the bloodstream.
• Autoimmune pancreatitis, a rare condition where the body’s immune system can attack the pancreas, leading to pancreatic disease and, in some cases, EPI, according to a study published in December 2018 in the journal Pancreatology.
• Gastrointestinal surgery that involved removal of parts of the pancreas or stomach

If you experience symptoms of EPI, it’s important to speak with your doctor about it, according to the National Pancreas Foundation. If your doctor suspects you have EPI, they’ll likely refer you to a gastroenterologist, a doctor who specializes in diseases of the digestive system, for diagnosis and treatment.

The good news is that the condition is treatable. “One [treatment] option is pancreatic enzyme replacement therapy, which aids in digestion, helps improve malabsorption and vitamin deficiencies, and stimulates weight gain,” Gress says. Other treatment options include dietary changes, specialized food supplements that don’t require pancreatic enzymes for digestion, and transplantation of pancreatic cells.