EPI Disease: A Rare Illness that Affects the Digestive Tract

Brittni Devlin |Jan 27, 2021

What is Exocrine Pancreatic Insufficiency?

Eating is a vital activity for all living things, including humans. Everything we ingest breaks down into important nutrients and energy to keep us active and healthy. Unfortunately, behaviors as instinctual as eating do not come easy to everyone. So, what is exocrine pancreatic insufficiency? Let's find out.

There are some individuals that suffer from conditions that interfere with their ability to properly digest food. While these diseases are rather rare, there are individuals who have exocrine pancreatic insufficiency (EPI).

What is EPI?

EPI is a medical condition that causes digestive problems. EPI disrupts an individual’s natural ability to obtain nutrition from the food they eat. While the disease is not uncommon in dogs and cats, it is rather rare in humans.

What Causes Exocrine Pancreatic Insufficiency?

EPI is the result of pancreas malfunction. The pancreas is the organ responsible for producing chemicals, called enzymes, which are responsible for helping the body break down food. If your body produces too little of these chemicals, it cannot properly extract nutrients from the food you eat.

There are several different ways in which your pancreas can incur damage that results in EPI. Some more common explanations include the following:

  • Chronic pancreatitis: When those enzymes start activating while they are still inside the pancreas, it can cause inflammation. When this happens too often, your pancreas is vulnerable to permanent damage. Some risk factors for chronic pancreatitis include having an immune system disorder or being a heavy drinker.
  • Surgery: Some individuals experience EPI following surgical procedures on their pancreas, stomach, or intestines.
  • Cystic Fibrosis: This condition forces the body to create large amounts of sticky mucus. Sometimes, this unusually thick substance can trap the enzymes in the pancreas, resulting in the enzymes activating inside of the pancreas.
  • Schwachman-diamond syndrome: Those who suffer from Schwachman-diamond syndrome may not have the appropriate cells in their pancreas. Missing these vital cells means your pancreas simply can’t produce the enzymes at all.
  • Diseases of the digestive system: Other diseases that may cause EPI are those which directly impact the digestive system. Although not everyone suffering from celiac disease or Crohn’s disease has EPI, these diseases may lead to EPI.

What are the Symptoms of Exocrine Pancreatic Insufficiency?

Initially, individuals suffering from EPI may not notice anything out of the ordinary. It is only when the pancreas damage advances to a certain level that individuals may start exhibiting symptoms. These may be a direct result of pancreas damage or indirect effects of the inability to absorb certain vitamins.

Symptoms may include (but are not limited to):

  • Stomach pain
  • Foul-smelling stools
  • Diarrhea
  • Constant gas
  • Feeling full
  • Bone pain
  • Weight loss
  • Bleeding disorders
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Treatment for Exocrine Pancreatic Insufficiency

A major component of EPI treatment includes lifestyle changes. Everyone can stand to benefit from a balanced diet and an overall healthy lifestyle. Avoiding substances, like alcohol, is a must. Alcohol adds extra stress on your body and can further damage the pancreas.

Changes in eating behavior are also recommended. Try to replace the “tradition" three large meals with six smaller ones. Those with EPI may struggle with having large meals.

Another main treatment includes pancreatic enzyme replacement therapy (PERT). The goal of PERT is to replenish missing enzymes that your own pancreas no longer makes. These products are ingested orally, often in combination with an antacid, to prevent your stomach acid from breaking them down too early. Additional vitamins are also recommended to supplement vitamin deficiencies.

The FDA approved six prescription drugs for PERT treatment: Creon, Pancreaze, Pertzye, Ultresa, Viokace, and Zenpep.

Doctors may prescribe additional medications to treat pain. Often, over-the-counter pain killers are effective.

When to See a Doctor

Try to remember that exocrine pancreatic insufficiency is a very rare disease and troubling symptoms are likely due to another underlying condition. There are several tests that are conducted to diagnose an individual with EPI:

  • Blood tests are performed to measure the levels of vitamins and enzymes in your body. These tests can also test for other diseases that put you at risk for EPI.
  • Fecal tests are used to calculate levels of fat in bowel movements as well as the concentration of enzymes your pancreas is producing.
  • Imaging tests, such as CT scans, MRIs, and endoscopic ultrasounds, may be performed to determine whether or not the pancreas is inflamed.

If diagnosed, your doctor will work with you to create a treatment plan which works best for you.

It’s important that you discuss any worry symptoms with your primary care physician. Only they can offer the expert observation and testing needed to receive a concrete diagnosis.

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