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Facts of Exocrine Pancreatic Insufficiency

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Facts of Exocrine Pancreatic Insufficiency

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Watery diarrhea can be due to a severe condition called exocrine pancreatic insufficiency. Read the article to know more about this condition.

Medically reviewed by

Dr. K. Shobana

Published At October 20, 2015
Reviewed AtMarch 18, 2024

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, very foul-smelling, pale, and bulky stools float on water in the toilet pan and are 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 of 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 with exocrine pancreatic insufficiency-induced steatorrhea.

What Are the Causes of EPI?

The pancreas, integral to the digestive system, produces enzymes crucial for digestion, facilitating the absorption of nutrients by the body. In cases of EPI (Exocrine Pancreatic Insufficiency), digestive enzymes are deficient, leading to undigested food passing through the intestines. Consequently, the body fails to obtain essential nutrients from ingested foods.

Various pancreatic enzymes encompass:

  • Amylase: Responsible for carbohydrate breakdown.

  • Lipase: Functions in fat digestion.

  • Protease and Elastase: Essential for protein breakdown.

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 the loss of fats, leads to severe weakness, loss of body weight, fatigue, and malaise. There ensues dehydration due to fluid and electrolyte deficiency.

  • EPI causes night blindness and seizures.

  • Also, there may be manifestations of loss of fat-soluble vitamins (A, D, E, K) that start 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 are another problem due to indigestion.

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

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

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

For normal digestion to occur, 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 the long history of infection of the pancreas, there is damage to the parts of the pancreas, it causes loss of function of the 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. The pancreas does all this digestion of the fats in the small intestinal lumen through its well-formed secretions. One gram of fats when metabolized yields 9 Calories of energy which is more than double produced by the metabolism of 1 gram of carbohydrates (which is 4 Calories for 1 gram).

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

Who Is at a Greater Risk of Developing EPI?

If considerable damage to the tissues of the 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 the stomach due to any underlying disease, heavy smokers, chronic alcoholics, etc. So, if anyone has one of these diseases, and 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?

Individuals suffering from EPI encounter challenges in absorbing fats, resulting in distressing digestive issues, including:

  • Abdominal discomfort, flatulence, and bloating.

  • Irregular bowel movements such as constipation or diarrhea.

  • Excretion of fatty stools characterized by their pale, oily, and malodorous nature, often floating.

  • Unexplained weight loss or failure to thrive is observed particularly in infants and children.

How Is EPI Diagnosed?

EPI diagnosis involves pancreas function tests like fecal elastase and fat tests, and secretin test to assess enzyme release. Imaging tests like computed tomography scans or ultrasounds may also identify pancreas issues.

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 cannot 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.

Frequently Asked Questions

1.

What Is the Reason for Watery Diarrhea Without Any Other Symptoms?

A person having watery diarrhea may think it is simply tummy flu. But things can be even more serious than just a gastrointestinal tract infection. Watery diarrhea is usually caused due to stomach infection, but it may also be symptomatic of other conditions. Watery diarrhea may also occur from lactose intolerance, caffeine, laxative foods, and alcohol use which other symptoms may not accompany.

2.

Is Watery Diarrhea Always Related to Food Poisoning?

Watery diarrhea usually occurs through food poisoning and may also be frequently caused by several underlying diseases that may or may not have been diagnosed. Certain side effects of drugs may additionally lead to an episode of diarrhea. Mentioned below are a few of them.
- Lactose intolerance.
- Celiac disease.
- Crohn's disease.
- Irritable bowel syndrome.
- Antibiotics.
- Antidepressants.
- Proton pump inhibitors.
- chemotherapeutic drugs.

3.

What Is the Reason for the Occasional Occurrence of Watery Diarrhea?

Watery diarrhea is a short-term sickness that arises commonly from a gastrointestinal infection. Sometimes the gut biome may be sufficiently strong to neutralize the infectious cause, while the etiology may overpower the gut immunity in other cases. This imbalance in the reaction is responsible for the occasional occurrence of watery diarrhea.

4.

When Does Watery Diarrhea Become Worrisome?

Watery diarrhea lasting more than two days without any improvement can be worrisome. The condition may be accompanied by other clinical manifestations, such as those mentioned below.
- Polydipsia.
- Polyuria.
- Anuria.
- Skin rash.
- Weakness.
- Abdominal pain.
- Fever.
- Rectal pain.
- Bloody stools.

5.

Can Diarrhea Be Let to Run Its Course?

A person having watery diarrhea may think it is simply stomach flu. But things can be even more serious than just a gastrointestinal tract infection. Letting diarrhea run its course makes the individual lose excess fluids and salts, resulting in weakness and tiredness. Hence, it is better to treat the condition if it does not improve within 2 to 4 days.

6.

What Can Be Done to Stop Watery Diarrhea?

The following steps can be taken to treat diarrhea:
- Sufficient hydration.
- Semi-solid and low-fiber food.
- Avoid high-fiber, dairy, and highly seasoned foods.
- OTC antidiarrheal drugs (Loperamide, Bismuth subsalicylate, etc.).
- Prebiotics.
- Antibiotics.

7.

Is It Possible to Have Watery Diarrhea Without Being Sick?

 
Diarrhea is one of the most common conditions of the digestive system and can occur due to an array of causative agents which can be either harmful or merely an adverse reaction in the body. It is possible to have watery diarrhea without being sick from ingesting laxative foods or certain medications. Stress has also been associated with diarrhea.

8.

What Other Condition Mimics Gastroenteritis?

The following conditions can mimic gastroenteritis:
- Amebiasis.
- Appendicitis.
- Campylobacter Infections.
- Clostridioides (Clostridium) Difficile Colitis.
- Escherichia coli (E coli) Infections.
- Food Poisoning.
- Giardiasis.
- Peritonitis and Abdominal Sepsis.
- Salmonella Infection (Salmonellosis).
- Shigellosis.

9.

What Is the Cause of Yellow Watery Diarrhea?

Yellow watery diarrhea can be an indication of several underlying diseases. Yellow watery diarrhea most commonly indicates the malfunctioning of the individual’s liver or gallbladder. On the other hand, bright yellow watery stool may be due to giardiasis. Yellow watery diarrhea almost always has mucus present.

10.

After How Long, Watery Diarrhea Be Considered Serious?

Diarrhea may be resolved within 2 to 4 days. If the condition does not improve by then, it requires medical attention. Persistent diarrhea beyond four weeks is a sign of chronic diarrhea. The presence of symptoms mentioned below is another signal of a serious case of diarrhea.
- Excessive thirst.
- Weakness.
- Dizziness.
- Decreased urinary output.
- Dark-colored urine.
- Rectal pain.
- Dry mouth.
- Scaly skin.
- Severe dehydration.

11.

What Is the Time Gap Between Eating Something and Getting Diarrhea?

Diarrhea can occur between 30 minutes to 8 hours of consuming infected food. This time varies from person to person. Other factors that influence the time difference between ingestion of food and the beginning of an episode of diarrhea include the patient’s age, an underlying gastrointestinal condition, the onset of abdominal pain, the temperature of the environment, mental stress, and the amount of water intake.

12.

What Can Be Done to Reset the Stomach After Diarrhea?

Diarrhea refers to increased frequency of the bowels. To reset the gut to its normal condition, one can follow certain steps:
- Removing offending food from the diet.
- Take prebiotics.
- Sufficient diet and exercise.
- Follow a Mediterranean diet.
- Stress management.
- Diagnosis of the underlying cause and apt therapies.

13.

Are the Good Gut Bacteria Removed by Diarrhea?

The gut bacterial biome is seriously affected by infectious diarrhea. The population of good bacteria is depleted, along with a heavy loss of fluids, salts, and minerals. Dehydration is the immediate aftermath of diarrhea that requires correction as soon as possible. There must be a quick recovery of the gut biome as well.

14.

What Is the Cause of Paradoxical Diarrhea?

Paradoxical diarrhea is caused due to hard impaction of stool in the colon around which leakage of watery diarrhea occurs. The hard impacted stool is an aftermath of long-standing and untreated constipation. There are several medications that can aid in dislodging the impacted stool and at times physical maneuvers may be required.
Dr. Muhammad Majid Hanif
Dr. Muhammad Majid Hanif

Cardiology

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fecal incontinencefacts of exocrine pancreatic insufficiencytummy flugastroenteritis
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