Watery Diarrhea - Not Always Due to Food Poisoning

Introduction:

A person having watery diarrhea may think it is simply a tummy flu. But things can be even more serious than just a gastrointestinal tract infection. Exocrine Pancreatic Insufficiency (EPI) means indigestion of food caused by the lack of digestive enzymes that normally are produced by the pancreas. Exocrine Pancreatic Insufficiency causes indigestion leading to watery diarrhea and hence also known as pancreatic maldigestion.

What is Fat Malabsorption?

EPI may also present with fat maldigestion, a condition known as steatorrhea. In steatorrhea, there are very foul smelling, pale and bulky stools that float on water in the toilet pan and is due to excess gas and undigested fat seen as oil droplets in the stools. In EPI induced steatorrhea, there may be an oily material leakage from the anal opening and there may also be mild to moderate levels of fecal incontinence (loss of control on feces). A lot of patients present with this oily leakage and fecal incontinence problems and they do not even know that they may be having a problem of exocrine pancreatic insufficiency induced steatorrhea.

What Are the Side Effects of EPI?

• Other problems may be loss of fluid and electrolytes deficiency, mineral and other important nutrient loss. This combined with loss of fats, leads to severe weakness, loss of body weight, fatigue and malaise. There ensues dehydration due to fluid and electrolytes deficiency.

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• EPI causes night blindness and seizures.

• Also there may be manifestations of loss of fat soluble vitamins (A, D, E, K) that starts to appear along with other symptoms of malabsorption of nutrients.

• Low levels of calcium and magnesium in the serum may also lead to tetany (intermittent muscular spasms).

• Flatulence and abdominal cramps is another problem due to indigestion.

• Swelling (edema) of the peripheral limbs may result from protein depletion that are lost with other nutrients in the intestinal lumen.

• Mouth ulcers and change in color of the tongue, abdominal distention, hair fall, weakened muscle movements are also amongst the common symptoms.

• Anemia (pale skin and nails) due to iron deficiency or vitamin B12 deficiency is also associated with EPI.

• Vitamin K malabsorption causes bleeding disorders in the patients. Blood in urine or in stools is a common manifestation.

• Bone disorders (osteopenia and osteomalacia) due to lack of vitamin D and low calcium levels in the body are commonly diagnosed as Metabolic Bone Disease (MBD). Bone aches and easy fractures are very common.

For normal digestion to take place, we need normal secretions of the pancreas consisting of proteins (3 percent) and a lot of water and electrolytes (97 percent). If due to diseases like long history of the infection of pancreas, there is a damage to the parts of the pancreas, it causes loss of function of pancreas that is associated with the digestion of the lipids and other nutrients in food.

Fats, we know, make a lot of bulk of our food and the resulting energy from food is largely dependent on the digestion of this fat content properly. Pancreas does all this digestion of the fats in the small intestinal lumen through its well formed secretions. 1 gram of fats when metabolized yield 9 Calories of energy which is more than double produced by the metabolism of 1g of carbohydrates (which is 4 Calories for 1 gram).

So, it is obvious that patient will feel lack of energy and fatigue too, along with diarrhea if he has the EPI. People usually know only one condition associated with the pancreatic insufficiency and that is diabetes mellitus. It is our duty to inform and guide the patients regarding other diseases too. Because, a well informed patient will never go for self medication and will not become a prey of the quakes if he/she gets any indigestion issues.

Who Is at a Greater Risk of Developing EPI?

If considerable damage to the tissues of pancreas occurs due to any reason, it may lead to EPI. The concomitant disorders may be hepatitis A, diabetes mellitus, SLE or lupus, previous surgery of the gastrointestinal tract, cystic fibrosis, celiac disease of the gut, Crohn's disease, hyperacidity in stomach due to any underlying disease, heavy smokers, chronic alcoholics, etc. So, if anyone has one of these diseases, and he also gets frequent indigestion, weight loss, lack of energy and some issues with the brain functioning, please do visit your primary care physician to rule out the chances of EPI.

What Are the Clinical Manifestations of EPI?

Exocrine pancreatic insufficiency (EPI) symptoms might include bloating, abdominal discomfort or cramps, and diarrhoea. Pancreatitis, cystic fibrosis, pancreatic cancer, and surgeries on the pancreas or upper gastrointestinal tract are only a few of the illnesses and ailments that can result in EPI.

What Is the Treatment of EPI?

Doctors use pancreatic enzyme replacement therapy (PERT) and dietary adjustments, such as abstaining from alcohol and stopping smoking, to treat exocrine pancreatic insufficiency (EPI). For the illness or condition that led to EPI, the doctor could suggest further therapies.

The small intestine can't properly digest food if a person has exocrine pancreatic insufficiency (EPI), which can result in malabsorption and malnutrition. The patient could be advised to take pancreatic enzyme replacement therapy (PERT) as well as to eat and consume small, frequent meals by the physician or certified dietitian.

Conclusion

Exocrine pancreatic insufficiency patients typically have vague symptoms when they visit their primary practitioner. With a thorough medical history, clinical examination, and early action for borderline patients, a diagnosis must have a high degree of suspicion.