Exocrine pancreatic insufficiency (EPI) occurs when the pancreas does not produce enough enzymes to aid digestion. EPI can lead to poor absorption of nutrients, weight loss, and a shortage of vitamins.

Two of the main causes of EPI are cystic fibrosis and chronic pancreatitis. Symptoms of EPI are similar to those of other common health problems affecting the stomach and intestine, and the condition can be hard to diagnose.

A healthcare professional can successfully treat EPI with prescription enzymes and lifestyle changes.

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The pancreas, along with the salivary and sweat glands, is one of the main exocrine glands. Exocrine glands release substances into another organ or the surface of the body.

EPI is a digestive disorder where enzyme production is altered in the digestive system. In the small intestine, pancreatic enzymes convert the food into smaller molecules, which then travel into the bloodstream.

A correctly functioning pancreas enables effective digestion and absorption of important nutrients.

In EPI, the pancreas does not produce enough enzymes to digest food. Without this breakdown, an individual cannot absorb the necessary nutrients and vitamins. This leads to diarrhea, vitamin deficiency, and weight loss.

Without proper treatment, EPI can resultTrusted Source in delayed or limited growth in infants, bone density problems, reduced life expectancy, and exposure to infections.

Symptoms of EPI can mimic other digestive conditions, but there are specific signs of this insufficiency. The most common signs includeTrusted Source:

There are many causes of EPI. Any condition that damages the pancreas and either stops or blocks the release of its enzymes can result in EPI. The two most common causes are cystic fibrosis and chronic pancreatitis.

Cystic fibrosis is a life threatening genetic disorder that develops during childhood. It producesTrusted Source thick, sticky mucus that affects both the lungs and the digestive system. The mucus builds up and plugs the opening of the pancreas, preventing the natural release of enzymes during digestion.

In chronic pancreatitis, the pancreas becomes inflamed. Normal pancreatic tissue turns into scar tissue. The buildup of this scar tissue prevents the digestive enzymes from leavingTrusted Source the duct.

Other medical conditions that can causeTrusted Source EPI are:

A healthcare professional will often diagnose EPI based on the above symptoms, particularly when an individual describes fatty stools and weight loss and once the doctor rules out other, more common conditions.

Definitive testing for EPI is complicated, as tests varyTrusted Source in their reliability and availability. Some tests may not be specific or sensitive enough to capture EPI in its early stages.

A doctor may orderTrusted Source one of two tests to measure how well the pancreas works: a 72-hour fecal fat test and a fecal elastase test.

As part of a 72-hour fecal fat test, a person consumes a set amount of fat daily, and a lab measures the amount of fat in stool. High levels of fat in stool indicate malabsorption and possible EPI.

The fecal elastase test is where a lab measures the amount of pancreatic elastase 1 in a person’s stool sample.

Additionally, a doctor may order various tests to check for fat deposits, vitamin deficiencies, and other indicators of conditions that may also cause gastrointestinal (GI) symptoms. They may also request a CT scan to examine the underlying causes of EPI.

Pancreatic enzyme replacement therapy (PERT) is the standard treatment for EPI.

PERT medications are only available on prescription. They containTrusted Source pancrelipase, which is a combination of the digestive enzymes amylase, lipase, and protease.

This therapy takes over the role of the pancreas. The amount of medication a person receives will differTrusted Source depending on anatomy, body weight, how much pancreatic function remains in the body, and the fat content of meals.

A person on a course of PERT must take these medications with all meals and snacks.

PERT is safe and has very fewTrusted Source side effects. The Food and Drug Administration (FDA)Trusted Source has approved the following six PERT medications:

While PERT is the primary treatment for EPI, it is beneficial to work with a registered dietitian to create a parallel healthy eating plan.

A balanced diet includes healthy fat, which is vital for absorbing nutrients from food. If EPI results from cystic fibrosis, a diet higher in fat can be especially beneficial. Moreover, consuming less fiber at the start of the therapy can help relieve discomfort or bloating.

The foods to avoid depend in part on the cause of EPI. If EPI stems from pancreatitis, a person should avoid substances and activities contributing to pancreatic inflammation, such as alcohol and smoking.

In addition to taking the replacement enzymes, individuals with EPI need to avoid activities that can worsen both the health of the pancreas and their overall quality of life.

Lifestyle changes include:

  • quitting smoking, if applicable
  • eating a balanced diet, often in consultation with a doctor about fat intake
  • reducing meal sizes but increasing frequency
  • not consuming alcohol
  • taking vitamin supplements, primarily for fat-soluble vitamins A, D, E, and K, under the guidance of a medical professional

Treatment can help people with EPI eat and digest their food normally, allowing them to absorb nutrients and enjoy a better quality of life.

Without treatment, EPI can lead to severe malnutrition. This, in turn, can reduce life expectancyTrusted Source.

PERT therapy may, however, help increase survival rates for people with EPI. A 2019 reviewTrusted Source of studies on the effectiveness of PERT found that it increased body weight by preventing malnutrition.

The review focuses on people with either cystic fibrosis, chronic pancreatitis, or pancreatic cancer and found positive results in all three groups. Further, PERT improved the patient’s quality of life by reducing GI symptoms and abdominal pain.

The researchers note, however, that there is a lack of long-term studies on survival rates for people taking PERT.

EPI is a pancreatic disorder that affects nutritional absorption in digestion. Without treatment, EPI can lead to severe malnutrition, lower quality of life, and potentially fatal outcomes.

Pancreatic enzyme replacement therapy (PERT) is the mainstay treatment for EPI. PERT involves prescription medications that include digestive enzymes. These enzymes replace those lacking in pancreatic production.

Causes of EPI include chronic pancreatitis and cystic fibrosis.