Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentNext in Exocrine Pancreatic Insufficiency GuideExocrine Pancreatic Insufficiency (EPI) Symptoms
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Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Next in Exocrine Pancreatic Insufficiency Guide
Exocrine pancreatic insufficiency (EPI) is a condition that occurs when the pancreas fails to produce important digestive enzymes. Without these enzymes, the body cannot properly digest food and absorb nutrients through the small intestine, particularly fat. EPI most often occurs in people who have conditions affecting the pancreas, though they frequently don’t have symptoms until the condition has become advanced.
This article will take you through the symptoms, possible causes, diagnostic methods, and treatments for EPI.
Verywell / JR Bee
What Are the Symptoms of Exocrine Pancreatic Insufficiency?
The initial symptoms of exocrine pancreatic insufficiency can be vague, mild, and similar to other gastrointestinal illnesses.
Common gastrointestinal symptoms of EPI include:
Othersymptoms of EPIdepend on the underlying cause of the condition. For example, a person with cystic fibrosis may also have respiratory symptoms.
Many symptoms a person with EPI experiences later in the course of the condition are related to malnutrition and specific nutritional deficiencies. Some of the dietary deficiencies commonly seen in people with EPI include:
EPI Can Be Life ThreateningSerious health complications and even death can result from prolonged, severe cases of malnutrition. Untreated deficiencies and electrolyte imbalances can lead to kidney failure,neuropathy, severe anemia, seizures,ascites, infections, slow wound healing, andheart arrhythmias.
EPI Can Be Life Threatening
Serious health complications and even death can result from prolonged, severe cases of malnutrition. Untreated deficiencies and electrolyte imbalances can lead to kidney failure,neuropathy, severe anemia, seizures,ascites, infections, slow wound healing, andheart arrhythmias.
Malnutrition: What You Need to Know
Causes of Exocrine Pancreatic Insufficiency
In EPI, it’s the exocrine function that becomes compromised. This can happen because of physical damage to the pancreas or disruption of the signals to the organ.
Reduced production of three key digestive enzymes—amylase, protease, and lipase—leads to the maldigestion of food, malabsorption of nutrients, and (eventually) signs and symptoms of malnutrition.
Chronic pancreatitis is the mostcommon cause of EPI. Inflammation causes the pancreas to become damaged over time, reducing its ability to produce enzymes.
Conditions commonly associated with EPIinclude:
It’s not clear why some people with these conditions develop EPI and others do not. There are likely many reasons a person develops EPI, including genetic and lifestyle factors.
For example, excessive alcohol use can lead to inflammation of the pancreas, which in turn may make the pancreas less effective at producing enzymes, eventually leading to EPI.
People who have had gastrointestinal surgery, particularly weight-loss surgery that removes part of the stomach or intestine, may also be more likely to develop EPI.
Diagnosis of Exocrine Pancreatic Insufficiency
The exact number of people with EPI is not known.The condition is considered rare in the general population, but it may be underdiagnosed.
People with mild symptoms may not seek medical treatment. Those who do seektreatmentmay not be correctly diagnosed with EPI until the condition has become more advanced. EPI may be misdiagnosed, particularly in the early stages, as a functional gastrointestinal disorder such as irritable bowel syndrome (IBS).
In people already diagnosed with another gastrointestinal condition, such asCrohn’s, the symptoms of EPI may initially be attributed to that condition. It may take many years for EPI to be correctly diagnosed, as pancreatic function can take a long time to become so compromised that the body can no longer overcompensate.
A diagnosis of EPI is typically made after other more common causes of gastrointestinal symptoms have been ruled out.
If your healthcare provider suspects you could have EPI, you will likely be asked about:
After carefully reviewing your medical history and symptoms, your healthcare provider may want to order tests. While there is no specific test for EPI, your practitioner can use different tests to rule out other conditions that could be causing your symptoms.
Tests your healthcare provider might order to help diagnose EPI include:
Your healthcare provider will want to see how well your pancreas is working. Two different types of pancreatic function tests can be used:directandindirect.
Many of the tests listed above, particularly those that examine stool, are examples of indirect testing of pancreatic function.
The most direct way to test pancreatic function and potentially detect exocrine dysfunction is through a special type ofendoscopy.
To directly test the pancreas, it is stimulated with the hormones that signal it to produce digestive enzymes. Then, a tube is placed in the small intestine to collect digestive secretions, which are then analyzed to look for enzymes.
While the procedure can be very helpful, it is generally only performed at specialized hospitals or clinics. Because it is not widely available and can be costly, it may not be accessible to all people with suspected EPI.
Exocrine Pancreatic Insufficiency Explained
Exocrine Pancreatic Insufficiency Treatment
If EPI is suspected, pancreatic enzyme replacement therapy (PERT) may be prescribed along with nutritional supplements (such as vitamin B12) even before the diagnosis is confirmed. If symptoms improve after startingoral enzymeswith meals, it’s a good indicator of EPI.
Can your pancreas recover from EPI?EPI has no cure and, once diagnosed, must be continually treated to maintain balanced nutrition. Treatment includes pancreatic enzyme replacement therapy (PERT), which substitutes for missing digestive enzymes.
Can your pancreas recover from EPI?
EPI has no cure and, once diagnosed, must be continually treated to maintain balanced nutrition. Treatment includes pancreatic enzyme replacement therapy (PERT), which substitutes for missing digestive enzymes.
Approved Medications
The Food and Drug Administration (FDA) has approved six prescription medications for treating EPI.It’s necessary to work with a healthcare provider to establish a dosing schedule that takes into consideration any other medical problems, the extent of pancreatic function loss, and the severity of symptoms.
There are different types of pancreatic enzyme replacement therapy (PERT)—not a single enzyme; Each person with EPI will need to find the PERT that works best for them.
Pancreatic Elastase: A Critical Factor for Understanding Digestive Health
Determining Dosing
Most people taking PERT do not experience any serious side effects.Occasionally, people report some bloating and gas when starting the enzymes, as their digestive system gets accustomed to them, though these side effects are usually mild.
When paired with lifestyle and dietary changes, as well as other nutritional supplementation to address deficiencies, many people can effectively manage the symptoms of EPI.
Monitoring Changes
If you are diagnosed with EPI, your healthcare provider may also recommend dietary and lifestyle modifications such as cutting back or quitting smoking or drinking alcohol, as these lifestyle choices can promote inflammation.
Long-term treatment goals for people with EPI will be dependent on properly diagnosing and appropriately treating the underlying cause. Your healthcare provider may want to periodically test your pancreatic function. Your weight and nutritional status will continue to be monitored to ensure you are well-nourished and do not have any deficiencies.
Many people with EPI are referred to the care of a nutritionist who can help them maintain a healthy weight and make dietary choices that won’t exacerbate their symptoms.
People with underlying conditions such as celiac disease and diabetes may need to adhere to special diets.
Summary
People with EPI often experience a range of symptoms related to specific nutritional deficiencies. When properly diagnosed, EPI can be treated with oral supplementation of the enzymes needed for digestion that the pancreas is no longer making. It’s also important that any underlying or associated conditions are also diagnosed and appropriately treated.
The prognosis depends on what is causing the EPI. With pancreatic enzyme replacement therapy, dietary and lifestyle modifications, as well as ongoing monitoring for nutritional deficiencies and any need for supplementation, most people with EPI can effectively manage the condition.
The Anatomy of the Pancreas
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Othman MO, Harb D, Barkin JA.Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician.Int J Clin Pract. 2018;72(2). doi:10.1111/ijcp.13066Alkaade S, Vareedayah AA.A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities.Am J Manag Care. 2017;23(12 Suppl):S203-S209.National Heart, Lung, and Blood Institute.What Is Cystic Fibrosis?Barkin JA, Delk TB, Powell VJ.Symptoms, burden, and unmet needs of patients living with exocrine pancreatic insufficiency: a narrative review of the patient experience.BMC Gastroenterol. 2024;24(1):101. Published 2024 Mar 14. doi:10.1186/s12876-024-03188-wThompson AS, Giri N, Gianferante DM, et al.Shwachman Diamond syndrome: narrow genotypic spectrum and variable clinical features.Pediatr Res. 2022;92(6):1671-1680. doi:10.1038/s41390-022-02009-8Singh VK, Haupt ME, Geller DE, Hall JA, Quintana diez PM.Less common etiologies of exocrine pancreatic insufficiency.World J Gastroenterol. 2017;23(39):7059-7076. doi:10.3748/wjg.v23.i39.7059Cedars Sinai.Chronic pancreatitis.Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG.Exocrine pancreatic insufficiency: prevalence, diagnosis, and management.Clin Exp Gastroenterol. 2019;12:129-139. doi:10.2147/CEG.S168266Struyvenberg MR, Martin CR, Freedman SD.Practical guide to exocrine pancreatic insufficiency - Breaking the myths.BMC Med. 2017;15(1):29. doi:10.1186/s12916-017-0783-yShandro BM, Nagarajah R, Poullis A.Challenges in the management of pancreatic exocrine insufficiency.World J Gastrointest Pharmacol Ther. 2018;9(5):39-46. doi:10.4292/wjgpt.v9.i5.39Ní chonchubhair HM, Bashir Y, Dobson M, Ryan BM, Duggan SN, Conlon KC.The prevalence of small intestinal bacterial overgrowth in non-surgical patients with chronic pancreatitis and pancreatic exocrine insufficiency (PEI).Pancreatology. 2018;18(4):379-385. doi10.1016/j.pan.2018.02.010:National Cancer Institute.Pancreatic function test.Whitcomb DC, Buchner AM, Forsmark CE.AGA Clinical Practice Update on the Epidemiology, Evaluation, and Management of Exocrine Pancreatic Insufficiency: Expert Review.Gastroenterology. 2023;165(5):1292-1301. doi:10.1053/j.gastro.2023.07.007Struyvenberg MR, Martin CR, Freedman SD.Practical guide to exocrine pancreatic insufficiency - Breaking the myths.BMC Med. 2017;15(1):29. Published 2017 Feb 10. doi:10.1186/s12916-017-0783-yColumbia Surgery.What You Need to Know About Pancreatic Enzymes.Lindkvist B.Diagnosis and treatment of pancreatic exocrine insufficiency.World J Gastroenterol. 2013;19(42):7258-66. doi:10.3748/wjg.v19.i42.7258Additional ReadingDiMagno, Matthew J.Exocrine pancreatic insufficiency and pancreatitis associated with celiac disease.Pancreapedia: Exocrine Pancreas Knowledge Base, 2018. doi:10.3998/panc.2018.19
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Othman MO, Harb D, Barkin JA.Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician.Int J Clin Pract. 2018;72(2). doi:10.1111/ijcp.13066Alkaade S, Vareedayah AA.A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities.Am J Manag Care. 2017;23(12 Suppl):S203-S209.National Heart, Lung, and Blood Institute.What Is Cystic Fibrosis?Barkin JA, Delk TB, Powell VJ.Symptoms, burden, and unmet needs of patients living with exocrine pancreatic insufficiency: a narrative review of the patient experience.BMC Gastroenterol. 2024;24(1):101. Published 2024 Mar 14. doi:10.1186/s12876-024-03188-wThompson AS, Giri N, Gianferante DM, et al.Shwachman Diamond syndrome: narrow genotypic spectrum and variable clinical features.Pediatr Res. 2022;92(6):1671-1680. doi:10.1038/s41390-022-02009-8Singh VK, Haupt ME, Geller DE, Hall JA, Quintana diez PM.Less common etiologies of exocrine pancreatic insufficiency.World J Gastroenterol. 2017;23(39):7059-7076. doi:10.3748/wjg.v23.i39.7059Cedars Sinai.Chronic pancreatitis.Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG.Exocrine pancreatic insufficiency: prevalence, diagnosis, and management.Clin Exp Gastroenterol. 2019;12:129-139. doi:10.2147/CEG.S168266Struyvenberg MR, Martin CR, Freedman SD.Practical guide to exocrine pancreatic insufficiency - Breaking the myths.BMC Med. 2017;15(1):29. doi:10.1186/s12916-017-0783-yShandro BM, Nagarajah R, Poullis A.Challenges in the management of pancreatic exocrine insufficiency.World J Gastrointest Pharmacol Ther. 2018;9(5):39-46. doi:10.4292/wjgpt.v9.i5.39Ní chonchubhair HM, Bashir Y, Dobson M, Ryan BM, Duggan SN, Conlon KC.The prevalence of small intestinal bacterial overgrowth in non-surgical patients with chronic pancreatitis and pancreatic exocrine insufficiency (PEI).Pancreatology. 2018;18(4):379-385. doi10.1016/j.pan.2018.02.010:National Cancer Institute.Pancreatic function test.Whitcomb DC, Buchner AM, Forsmark CE.AGA Clinical Practice Update on the Epidemiology, Evaluation, and Management of Exocrine Pancreatic Insufficiency: Expert Review.Gastroenterology. 2023;165(5):1292-1301. doi:10.1053/j.gastro.2023.07.007Struyvenberg MR, Martin CR, Freedman SD.Practical guide to exocrine pancreatic insufficiency - Breaking the myths.BMC Med. 2017;15(1):29. Published 2017 Feb 10. doi:10.1186/s12916-017-0783-yColumbia Surgery.What You Need to Know About Pancreatic Enzymes.Lindkvist B.Diagnosis and treatment of pancreatic exocrine insufficiency.World J Gastroenterol. 2013;19(42):7258-66. doi:10.3748/wjg.v19.i42.7258Additional ReadingDiMagno, Matthew J.Exocrine pancreatic insufficiency and pancreatitis associated with celiac disease.Pancreapedia: Exocrine Pancreas Knowledge Base, 2018. doi:10.3998/panc.2018.19
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Othman MO, Harb D, Barkin JA.Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician.Int J Clin Pract. 2018;72(2). doi:10.1111/ijcp.13066Alkaade S, Vareedayah AA.A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities.Am J Manag Care. 2017;23(12 Suppl):S203-S209.National Heart, Lung, and Blood Institute.What Is Cystic Fibrosis?Barkin JA, Delk TB, Powell VJ.Symptoms, burden, and unmet needs of patients living with exocrine pancreatic insufficiency: a narrative review of the patient experience.BMC Gastroenterol. 2024;24(1):101. Published 2024 Mar 14. doi:10.1186/s12876-024-03188-wThompson AS, Giri N, Gianferante DM, et al.Shwachman Diamond syndrome: narrow genotypic spectrum and variable clinical features.Pediatr Res. 2022;92(6):1671-1680. doi:10.1038/s41390-022-02009-8Singh VK, Haupt ME, Geller DE, Hall JA, Quintana diez PM.Less common etiologies of exocrine pancreatic insufficiency.World J Gastroenterol. 2017;23(39):7059-7076. doi:10.3748/wjg.v23.i39.7059Cedars Sinai.Chronic pancreatitis.Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG.Exocrine pancreatic insufficiency: prevalence, diagnosis, and management.Clin Exp Gastroenterol. 2019;12:129-139. doi:10.2147/CEG.S168266Struyvenberg MR, Martin CR, Freedman SD.Practical guide to exocrine pancreatic insufficiency - Breaking the myths.BMC Med. 2017;15(1):29. doi:10.1186/s12916-017-0783-yShandro BM, Nagarajah R, Poullis A.Challenges in the management of pancreatic exocrine insufficiency.World J Gastrointest Pharmacol Ther. 2018;9(5):39-46. doi:10.4292/wjgpt.v9.i5.39Ní chonchubhair HM, Bashir Y, Dobson M, Ryan BM, Duggan SN, Conlon KC.The prevalence of small intestinal bacterial overgrowth in non-surgical patients with chronic pancreatitis and pancreatic exocrine insufficiency (PEI).Pancreatology. 2018;18(4):379-385. doi10.1016/j.pan.2018.02.010:National Cancer Institute.Pancreatic function test.Whitcomb DC, Buchner AM, Forsmark CE.AGA Clinical Practice Update on the Epidemiology, Evaluation, and Management of Exocrine Pancreatic Insufficiency: Expert Review.Gastroenterology. 2023;165(5):1292-1301. doi:10.1053/j.gastro.2023.07.007Struyvenberg MR, Martin CR, Freedman SD.Practical guide to exocrine pancreatic insufficiency - Breaking the myths.BMC Med. 2017;15(1):29. Published 2017 Feb 10. doi:10.1186/s12916-017-0783-yColumbia Surgery.What You Need to Know About Pancreatic Enzymes.Lindkvist B.Diagnosis and treatment of pancreatic exocrine insufficiency.World J Gastroenterol. 2013;19(42):7258-66. doi:10.3748/wjg.v19.i42.7258
Othman MO, Harb D, Barkin JA.Introduction and practical approach to exocrine pancreatic insufficiency for the practicing clinician.Int J Clin Pract. 2018;72(2). doi:10.1111/ijcp.13066
Alkaade S, Vareedayah AA.A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities.Am J Manag Care. 2017;23(12 Suppl):S203-S209.
National Heart, Lung, and Blood Institute.What Is Cystic Fibrosis?
Barkin JA, Delk TB, Powell VJ.Symptoms, burden, and unmet needs of patients living with exocrine pancreatic insufficiency: a narrative review of the patient experience.BMC Gastroenterol. 2024;24(1):101. Published 2024 Mar 14. doi:10.1186/s12876-024-03188-w
Thompson AS, Giri N, Gianferante DM, et al.Shwachman Diamond syndrome: narrow genotypic spectrum and variable clinical features.Pediatr Res. 2022;92(6):1671-1680. doi:10.1038/s41390-022-02009-8
Singh VK, Haupt ME, Geller DE, Hall JA, Quintana diez PM.Less common etiologies of exocrine pancreatic insufficiency.World J Gastroenterol. 2017;23(39):7059-7076. doi:10.3748/wjg.v23.i39.7059
Cedars Sinai.Chronic pancreatitis.
Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG.Exocrine pancreatic insufficiency: prevalence, diagnosis, and management.Clin Exp Gastroenterol. 2019;12:129-139. doi:10.2147/CEG.S168266
Struyvenberg MR, Martin CR, Freedman SD.Practical guide to exocrine pancreatic insufficiency - Breaking the myths.BMC Med. 2017;15(1):29. doi:10.1186/s12916-017-0783-y
Shandro BM, Nagarajah R, Poullis A.Challenges in the management of pancreatic exocrine insufficiency.World J Gastrointest Pharmacol Ther. 2018;9(5):39-46. doi:10.4292/wjgpt.v9.i5.39
Ní chonchubhair HM, Bashir Y, Dobson M, Ryan BM, Duggan SN, Conlon KC.The prevalence of small intestinal bacterial overgrowth in non-surgical patients with chronic pancreatitis and pancreatic exocrine insufficiency (PEI).Pancreatology. 2018;18(4):379-385. doi10.1016/j.pan.2018.02.010:
National Cancer Institute.Pancreatic function test.
Whitcomb DC, Buchner AM, Forsmark CE.AGA Clinical Practice Update on the Epidemiology, Evaluation, and Management of Exocrine Pancreatic Insufficiency: Expert Review.Gastroenterology. 2023;165(5):1292-1301. doi:10.1053/j.gastro.2023.07.007
Struyvenberg MR, Martin CR, Freedman SD.Practical guide to exocrine pancreatic insufficiency - Breaking the myths.BMC Med. 2017;15(1):29. Published 2017 Feb 10. doi:10.1186/s12916-017-0783-y
Columbia Surgery.What You Need to Know About Pancreatic Enzymes.
Lindkvist B.Diagnosis and treatment of pancreatic exocrine insufficiency.World J Gastroenterol. 2013;19(42):7258-66. doi:10.3748/wjg.v19.i42.7258
DiMagno, Matthew J.Exocrine pancreatic insufficiency and pancreatitis associated with celiac disease.Pancreapedia: Exocrine Pancreas Knowledge Base, 2018. doi:10.3998/panc.2018.19
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