Understanding Exocrine Pancreatic Insufficiency

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Exocrine Pancreatic Insufficiency (EPI) is a complicated condition and is difficult to diagnose. Learn about the common symptoms associated with EPI from Dr. Todd Eisner, and if you currently have a chronic condition that could potentially put you at risk for EPI.

What is EPI?

Exocrine pancreatic insufficiency is the inability to digest food due to a lack of digestive enzymes. It typically occurs when the pancreas loses its exocrine function. This typically occurs as a result of a chronic inflammation of the pancreas, or chronic pancreatitis.

What causes EPI?

The most common cause of chronic pancreatitis is alcohol. Typically, a daily intake of 150 grams per day or more is required. In most cases, there is a long history of alcohol consumption, either on a daily basis or multiple times a week. It typically occurs in 10-15 percent of such heavy drinkers. It is unclear why it occurs in some and not others.

What are the symptoms?

The symptoms of EPI typically do not develop until the pancreas has lost 80-90 percent of its exocrine function. The most common symptoms are weight loss and steatorrhea (fat in the stool). If there is a history of chronic pancreatitis, patients will likely have chronic abdominal pain.

Conditions that lead to EPI

Exocrine pancreatic insufficiency occurs in chronic pancreatitis, cystic fibrosis, autoimmune disorders such as Crohn’s disease and systemic lupus erythematosis and patients that have had parts of their stomach or pancreas removed surgically, including those with pancreatic cancer. Insufficiency has been shown to occur more frequently in patients with diabetes.

How is EPI treated?

The treatment of pancreatic exocrine insufficiency involves treating the symptoms of severe maldigestion and steatorrhea. Treatment is generally a low fat diet and pancreatic enzyme replacement. Generally restricting fat intake to 20 grams a day or less is sufficient. There are many different types of pancreatic enzymes available.

How is EPI diagnosed?

EPI is not an easy diagnosis. There are different laboratory tests used to assess patients for exocrine pancreatic insufficiency. They fall under the category of exocrine pancreatic function tests. Exocrine pancreatic function can also be measured indirectly by obtaining levels of fecal elastase in the stool.