EPI disease – Symptoms, Diagnosis, and Prevention

Exocrine Pancreatic Insufficiency or EPI occurs when there is an acute deficiency of the enzymes secreted by the pancreas. The various enzymes are necessary for the digestion of food, but when a patient is suffering from EPI the body becomes unable to produce the fluids. This results in maldigestion because the food consumed does not get digested properly. Patients suffering from EPI experience conditions like bloating, oily diarrhea, and gas. Since the pancreas does not work properly and the food fails to get digested, the patients suffer from the lack of proper nutrition.

According to worldwide statistics, the united states of America is the leading nation in the number of patients suffering from EPI. The market for EPI is supposed to be followed by the Asia-Pacific region and Latin America in the next few years. Patients suffering from Chronic Pancreatitis and Cystic Fibrosis are likely to develop exocrine pancreatic insufficiency. In the US, around 28 to 42 people per 100,000 of the population suffer from Chronic Pancreatitis and are likely to develop EPI in the next 10 years or so.


The symptoms of exocrine pancreatic insufficiency may not be noticeable initially. Many of them resemble those of GI and cannot be easily recognised. Other gastrointestinal diseases which have similar symptoms are Irritable Bowel Syndrome, Crohn’s Disease, Celiac Disease, and Small Intestinal Bacterial Overgrowth.

Pancreatic insufficiency, in simpler terms, is the body’s inability to break down the food and digest it properly.

Here are a few symptoms of EPI disease:

  • Frequent diarrhea:Since the food particles remain undigested they easily get passed through the digestive tract resulting in diarrhea.
  • Stomach ache: people suffering from EPI cannot easily digest food which causes gas, bloating and stomach ache.
  • Bloating: Again undigested food always creates gas and bloating.
  • Foul-smelling stool: Many peopleexperience steatorrheawhichis the excretion of oily and foul-smelling stool that refuses to get flushed easily. These people are unable to absorb all the fat consumed with the food.
  • Weight loss: People suffering from EPI disease looses weight remarkably because the body does not get any nutrient whatsoever with the food. The body cannot digest proteins, minerals or carbohydrates. The body also suffers from the lack of various vitamins like Vitamin A,E,D, and K.
  • Feeling full: People suffering from EPI disease always feel full becausethey have gas and bloatedness which makes them feel heavy and unnaturally full.

Who can get EPI?

EPI results from various other diseases like pancreatic cancer, cystic fibrosis, chronic pancreatitis, HIV/AIDS, diabetes or even cytomegalovirus infection.

Chronic pancreatitis may be considered as the foremost damage of the pancreas organ because it causes an inflammation that through the years majorly damages the organ. It also damages the cells that produce insulin, thereby leading to diabetes. Excessive smoking, alcohol consumption, and genetic mutations have been known to cause chronic pancreatitis.

Cystic Fibrosisare inherited and can affect the lungs, reproductive organs and digestive parts. The condition produces a thick mucus in different organs of the body including the pancreas. These patients have difficulty in digesting food which may also be due to EPI.

Pancreatic cancer often leads to EPI and can be treated with pancreatectomy.

Pancreatectomy means the removal of the pancreas, surgically. It can be performed due to various reasons like an injury, tumor, or even cancer. Whether removed partially or fully, the condition is likely to create trouble in digestion.

Gastrointestinal Surgeries also affect the way the pancreas can produce the digestive juices.

Diabetes is caused when the pancreas gets affected and the organ faces trouble in producing insulin, which aids in controlling blood sugar. Diabetics may also have endocrine pancreatic insufficiency.

How is EPI diagnosed?

A visit to the doctor is important in case the patient notices any of the symptoms. Some tests like the fecal fat test, fecal elastase test, and pancreatic function test may be advised to diagnose the conditions properly because many of the symptoms resemble other diseases.

Treatment of Exocrine Pancreatic Insufficiency

Treating EPI is crucial for the health of the people suffering from the disease. Since the digestive system does not function properly patients need to select proper food which can be easily broken down and digested.

  • Doctors will always recommend a diet which contains low-fat because it will cause less gas and bloat.
  • Consuming a lot of fruits and vegetables is important because people suffering from EPI disease can’t get sufficient nutrients from food.
  • Eating smaller meals is necessary so that the body can digest it somewhat easily and without much stomach ache.
  • Abstaining from smoking and drinking is important for preventing further damage to the pancreas.
  • Pancreatic enzyme replacement therapy can help in the management of the exogenic pancreatic insufficiency along with gastric discomfort and the malabsorption of nutrients. This must be done under the expert guidance of a doctor because every patient needs varying quantities of enzymes depending on the condition of the patient. The enzymes have to be taken before or during the meals and never after eating. The medications should be taken along with cold water rather than the hot one because it can cause a reaction with enzymes and damage their effect. These medications contain digestive enzymes which aid in breaking down the fat and digest the carbohydrate andprotein. More fat in the food will require more enzymes to digest the same.
  • Patients suffering from pancreatic insufficiency have to be kept under long-term observation and all allied conditions which are leading to the problem should be treated at the earliest to cure the condition.

Can EPI be prevented?

Preventing this disease is possible if the underlying causes are treated in time. Genetic reasons or unknown causes cannot be avoided of course. The prognosis of the disease also depends on the underlying cause. Patients can live with EPI if the diet is controlled and the medication is taken on time. Preventing weight loss can be a bit of a challenge, but patients can always take the help of a nutritionist to eat the foods that help in retaining weight.