• What Is EPI (Exocrine Pancreatic Insufficiency)?

    What Is EPI (Exocrine Pancreatic Insufficiency)?

    You have been having abdominal pain, bloating, and weight loss problems for a while. Some time ago you began eating better and being more careful about your diet. No matter what you eat, though, it seems like things aren’t getting better. What could be happening?

    Most of us think that eating a healthy balanced diet should help us live healthier lives, and normally it will. What happens if the food you eat isn’t being digested properly? If you have a condition called exocrine pancreatic insufficiency or EPI, your body won’t digest food properly and you may not be getting the nutrients you need regardless of how healthy your diet is. 

    What is exocrine pancreatic insufficiency (EPI)?


    Many disorders and conditions that result in malabsorption of nutrients or maldigestion of your food are caused by something going wrong with your stomach or small intestine. EPI, on the other hand, is a result of a problem with the often-overlooked pancreas. This small organ is responsible for several crucial tasks related to digestion, and when it stops working properly, the whole process of digestion can stop working properly. 

    One of the jobs of the pancreas is to supply the rest of your GI tract with the enzymes it needs to break down and digest fats, minerals and vitamins in your food. If you have EPI, you are suffering from the ongoing loss of pancreatic cells responsible for making the digestive enzymes you need to process the food you eat. 

    Common symptoms of exocrine pancreatic insufficiency are bloating, weight loss, oily bowel movements, and abdominal pain. You may also have bone pain, intestinal blockages, and even diarrhea.

    What causes exocrine pancreatic insufficiency (EPI)?


    The most common cause of EPI in adults is chronic pancreatitis. This ongoing inflammation of pancreatic tissue can eventually lead to structural changes in your pancreas or blockage of the pancreatic duct. Cystic fibrosis is also a common cause of EPI, with as many as 80% of people suffering from cystic fibrosis eventually developing exocrine insufficiency syndrome as well.  

    EPI is also associated with other serious medical conditions including Shwachman-Diamond syndrome or even food-related digestive issues such as celiac disease. It can also be caused by extensive gastric or small bowel resection. Alcoholism can also be related to the formation of EPI. 

    EPI Treatment: What to Expect


    The good news is, even if your body isn’t producing the enzymes it should be, there are ways to help bolster your vitamin intake and even synthesize or augment your natural digestive juices. From pills to pig products, there are many ways to manage your EPI.

    If you are suffering from EPI it is important to know that nailing down a diagnosis can take some time. There are a host of different conditions and diseases that share common symptoms with EPI and your doctor will need to perform a variety of tests to ensure he or she is identifying your condition properly. 

    Pancreatic enzyme replacement therapies (or PERTs) are common drugs in helping to treat EPI. These drugs are designed to supplement the enzymes your body is missing to help you digest fats and minerals from your food. It can also help ease some of the more troublesome symptoms of EPI such as oily stools and upset stomach.

    Your treatment program will be determined by the cause of your symptoms. In many cases, your doctor will likely prescribe a combination of medication and lifestyle changes to help manage your symptoms. For bile duct blockages, trials have begun to see if endoscopic treatments can provide by physically treating the bile duct itself.  

    How Does Enzyme Replacement Work?


    Enzyme replacement therapy works by providing the enzymes in the form of medication to replace what your body is not producing. There are several different kinds of these medications, but many of them share one common ingredient. Enzymes sourced  

    These drugs require a bit more care than some other kinds of medications. To ensure the protective coating is not damaged and the enzymes are preserved until the point in the digestive process when they are needed, you will have to be careful about following dosing guidelines. This typically means taking PERTs as directed at the start of a meal. It is also important to take them with clear liquids rather than dissolving the pills in other liquids which could damage the enzymes. 

    Drugs That Treat EPI Symptoms


    EPI can cause a variety of symptoms, and treating them all can require an equally large set of medications. Some of these drugs will need to be used carefully to ensure you do not cause harm in other ways. Treatment of your exocrine pancreatic insufficiency symptoms will inevitably be related to the severity of your symptoms and the cause of your EPI. 

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly recommended to manage the pain associated with EPI. These drugs are typically considered to be safe if taken for short periods of time and within recommended dosage limits. Long-term use of NSAIDs is not recommended, though, as prolonged use can lead to damage to the lining of the stomach and the formation of peptic ulcers. 

    If long-term pain management is needed, your doctor may prescribe more specialized drugs to help you find relief. Drugs like Gabapentin (Neurontin, Gralise) are typically used to reduce seizures, but can sometimes be prescribed to help with your pain. This is also true of Pregabalin which is showing promise in relieving pain from EPI. 

    Tips to Boost Your Nutrition


    If you have EPI, your body is going to be starved for nutrients even when you are maintaining a healthy diet. Since your body can’t process fats and other foods properly, it will be difficult for you to maintain proper levels of vitamins A, B12, D, E, and K. It is also likely your levels of healthy fat intake will be lower than normal. 

    Consulting your doctor or dietitian will be an important step in getting the nutrients you need. They will be able to help you understand where your nutritional deficiencies lie and the proper dosages of various supplements it will take to get you back to healthy levels.

    Lifestyle changes will also likely be a part of your ongoing treatment for EPI. Changing what you eat through dietary modification is an important part of the process. This may include a careful balancing of the amount of fat in your diet. People suffering from severe EPI may need to be on restricted fat intake, but this is not going to be the solution for everyone suffering from EPI. In many cases, your doctor may recommend you maintain a higher fat intake to ensure you get enough calories and maintain a healthy weight. 

    Changing when you eat can also be important. Smaller meals are typically easier to digest than larger meals, so eating smaller meals more frequently can help improve your nutritional intake from the foods you are eating. 

    Talking to Your Doctor About Exocrine Pancreatic Insufficiency


    If you have been experiencing a long period of bloating, excess gas, stomach pain, and oily stools, it is time to talk to your doctor. There are many different gastrointestinal conditions that could cause these and other similar symptoms, and it is crucial to get an accurate diagnosis. 

    Getting your diagnosis right is a job for trained healthcare professionals, and for good reason. Several conditions affecting the stomach GI tract can become life-threatening if they are not addressed in time.  If you are concerned you may have EPI, book an appointment with GI Associates today. No matter what the cause of your symptoms, if they have become life-impacting, it is time to get treatment. You owe it to yourself to get answers and begin taking steps toward health.