What Is Exocrine Pancreatic Insufficiency?
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Exocrine Pancreatic Insufficiency

Published on Dec 21, 2022 and last reviewed on Dec 04, 2023   -  5 min read


Exocrine pancreatic insufficiency is when the pancreas does not release enzymes to break down food. Read the below article to know more.


The pancreas is a gland located in the abdomen. It produces essential hormones and enzymes that perform various functions. The hormones produced by the pancreas include insulin and glucagon, which help regulate blood sugar levels. Enzymes are chemical substances produced by the digestive tract that aid in breaking down food particles into smaller pieces that the body can easily absorb. Amylase (an enzyme that breaks down carbohydrates), lipase (an enzyme that breaks down fat), protease and elastase (which breaks down proteins), trypsin, and chymotrypsin are the enzymes produced by the pancreas. These enzymes are then released into the small intestines, where they act on the food.

What Is Exocrine Pancreatic Insufficiency?

EPI is when the pancreas does not produce sufficient enzymes, or the enzymes do not act the way they should. Therefore, the body does not receive enough nutrients and vitamins, leading to malnutrition. Both adults and children can be affected by the condition.

What Are the Causes of Exocrine Pancreatic Insufficiency?

Different conditions that cause damage to the pancreatic cells can cause EPI. The conditions include the following:

  • Chronic Pancreatitis: EPI is commonly caused due to chronic pancreatitis. Alcohol, infection, trauma, and certain medications cause long-standing inflammation that leads to chronic pancreatitis. The inflammation that lasts long damages the pancreatic cells that produce enzymes, thereby affecting digestion.

  • Acute Pancreatitis: The chances of developing EPI in people with acute pancreatitis, a condition where the inflammation lasts only for a short period, are less. However, untreated acute pancreatitis that develops into chronic pancreatitis also increases the risk of developing EPI.

  • Autoimmune Pancreatitis: Autoimmune pancreatitis develops when the body's cells destroy its pancreatic cells. Steroid therapy is helpful for people to boost enzyme production.

  • Diabetes: Though the exact relationship between diabetes and EPI is unclear, a hormonal imbalance in diabetes can trigger EPI.

  • Genetic Conditions: Genetic conditions like cystic fibrosis and Shwachman-Diamond syndrome can cause EPI. Cystic fibrosis is a genetic disorder in which the digestive system and lungs get blocked with thick mucus. Shwachman-Diamond syndrome is a rare genetic abnormality affecting bones, bone marrow, and pancreas.

  • Surgery: Surgery of any part of the digestive system, like the stomach, intestines, or pancreas, can cause EPI, as the system gets disturbed due to surgery.

  • Celiac Disease: Celiac disease is a reaction produced in the body due to the consumption of foods containing gluten, which causes symptoms like diarrhea, bloating, and weight loss. People may continue having diarrhea even when following a gluten-free diet, which can occur due to EPI.

  • Zollinger-Ellison Syndrome: The stomach produces large amounts of acid, restricting the pancreatic enzymes from working correctly and causing EPI.

  • Inflammatory Bowel Diseases: Diseases like ulcerative colitis and Crohn's disease can attack and inflame the digestive system, causing EPI.

What Are the Symptoms of Exocrine Pancreatic Insufficiency?

People with EPI have difficulty digesting foods, especially fats, which may cause uncomfortable digestive issues. The symptoms become noticeable when the enzymes that break down foods reduce by five to ten percent. The symptoms include:

  • Abdominal pain.

  • Gas and bloating.

  • Fatty stools (oily, pale, foul-smelling feces, which float and are difficult to flush down the toilet).

  • Diarrhea.

  • Constipation.

  • Unexplained loss of weight.

  • Failure to thrive, especially in infants and children.

What Are the Complications of Exocrine Pancreatic Insufficiency?

People with EPI have a problem digesting carbohydrates, proteins, and fats, which causes a deficiency of nutrients. Inadequate nutrient absorption leads to malnutrition, the symptoms of which include:

  • Dry skin.

  • Hair loss.

  • Brittle nails.

  • Tiredness.

  • Edema.

  • Depression.

  • Irritability.

  • Difficult to concentrate.

  • Poor memory.

  • Muscle loss.

  • Dizziness or fainting.

  • A feeling of cold.

How to Diagnose Exocrine Pancreatic Insufficiency?

Doctors may advise various tests that help diagnose EPI, as many digestive system issues have similar symptoms as those of EPI. They may order the following pancreatic function tests, which include:

  • The fecal elastase test (FE-1) helps check for elastase enzymes in stools. Elastase helps the body digest proteins. Therefore, little or no elastase in stools indicates EPI.

  • The fecal fat test helps assess fat in stools. A high-fat level can mean EPI.

  • The secretin pancreatic function test helps the doctor know how the pancreas works and releases enzymes in response to the hormone secretin. It is an invasive test done only in cases where the other tests indicate pancreatic insufficiency. The patient receives secretion through an (IV) intravenous route during the test, and endoscopic ultrasound collects the digestive fluid and checks it for enzymes.

  • Imaging tests like CT (computerized tomography) and abdominal ultrasound help detect pancreatic problems that cause EPI.

How Is Exocrine Pancreatic Insufficiency Managed?

EPI is a life-long condition associated with chronic diseases of the pancreas. The treatment aims at providing the body with necessary nutrients, which help maintain good health. The various treatment options include:

  • Pancreatic Enzyme Replacement Therapy (PERT): PERT is a medicine that acts as a replacement for missing pancreatic enzymes. It has to be taken along with food, helping the body break down nutrients in the food. The FDA (Food and drug administration) approved pancreatic enzymes that are available on prescription include:

  1. Pancreaze.

  2. Pertzye.

  3. Creon.

  4. Ultresa.

  5. Zenpep.

  6. Viokase.

  • Dietary Changes: Foods high in fat and calories are advised, as fat helps the body absorb nutrients from the food. A dietitian can help to plan the diet accordingly.

  • Vitamins: Doctors prescribe supplements containing vitamins A, D, E, and K. As these are fat-soluble vitamins, people with EPI have difficulty absorbing them through food. Replenishing the nutrients keeps the body healthy and maintains required nutrient levels.

  • Treatment of Chronic Conditions: Chronic conditions like cystic fibrosis, chronic pancreatitis, and Shwachman-Diamond syndrome have to be treated accordingly by the healthcare team.

  • Surgery: Surgery is preferred to open ducts blocked by gallstones. Decompression is a technique that is followed to widen a narrowed pancreatic duct, allowing enzyme-rich pancreatic juice to flow into the intestine.

How to Prevent Exocrine Pancreatic Insufficiency?

Doctors recommend people avoid smoking and drinking, as it can trigger chronic pancreatitis leading to EPI. Chronic conditions that are mostly inherited cannot reduce EPI risk; however, checking symptoms can help.


Exocrine pancreatic insufficiency is a condition in which there is an inadequate release of pancreatic enzymes into the intestine, causing unpleasant symptoms. Though there is no cure for EPI, PERT can help the body with essential nutrients and reduce unfavorable symptoms. The doctor's recommendations have to be followed while taking PERT. Planning meals with a dietitian's advice can maintain a healthy balance of nutrients, fats, and minerals in the body.

Frequently Asked Questions


How Can a Person With Exocrine Pancreatic Insufficiency Plan a Diet?

Taking proper care of what is put in the body is extremely important if someone suffers from exocrine pancreatic insufficiency. This is simply because the pancreas in this condition cannot produce enough enzymes that break down the proteins, fats, and carbohydrates present in the food. Smaller meals should be taken throughout the day with a very low-fat diet. People should take lean proteins like chicken or turkey breasts and egg whites, as well as no more than 20 grams of fat each day. Processed and packaged food and alcohol should be avoided completely. Consuming vitamin supplements is a must, along with drinking plenty of water.


What Is the Cause of Exocrine Pancreatic Insufficiency?

Exocrine pancreatic insufficiency (EPI) generally occurs when the pancreas fails to create enough of the enzymes that help in digestion, which is responsible for poor absorption of nutrients, sudden weight loss, and a complete shortage of vitamins. Chronic pancreatitis is the most typical cause of EPI. Exocrine and endocrine pancreatic parenchyma are irreversibly destroyed by chronic pancreatitis, a persistent inflammatory condition, due to atrophy and/or replacement with fibrotic tissue. Pancreatic tumors, pancreas removal, and cystic fibrosis are further causes.


Is Exocrine Pancreatic Insufficiency a Life-Threatening Condition?

The digestion, absorption, and metabolism of carbs, lipids, and proteins all depend on the pancreas. Exocrine pancreatic insufficiency (EPI), a dangerous condition that causes malnutrition, complications, and a poor quality of life, results from damage to the cells that produce pancreatic enzymes. EPI can be treated, and those who suffer from it can live fulfilling lives. EPI, however, can result in significant complications and even death if left untreated. Moreover, other underlying diseases in some EPI patients could reduce life expectancy.


Can an Individual Recover From Exocrine Pancreatic Insufficiency?

There is no permanent cure for exocrine pancreatic insufficiency, but exocrine pancreatic insufficiency(EPI) can be successfully treated with pancreatic enzyme replacement therapy. EPI, however, can result in fatal complications and significant problems if left untreated. The natural enzyme production of the pancreas is replaced with pancreatic enzyme replacement treatment (PERT). One should take the capsules containing the enzymes with food. By dissolving the proteins, lipids, and carbs in the food, these aid in digestion. As an individual age, one may need to be evaluated for specific medical concerns, modify the diet, and use different medications according to the doctor’s advice.


What Foods Should People With Exocrine Pancreatic Insufficiency Avoid?

When a person is suffering from exocrine pancreatic insufficiency, it becomes impossible for the pancreas to create enzymes that help in digestion, so highly processed foods that are difficult for the body to digest are recommended to be avoided for a person suffering from this condition. Any food found in microwaveable meals, meat products, and breakfast cereals is also recommended to be avoided. Fried, cheesy, and creamy foods should be avoided too.


What Is Life Expectancy for People With Pancreatic Insufficiency?

The underlying etiology affects the prognosis of patients with exocrine pancreatic insufficiency. If they stop drinking, people with a cause like alcohol consumption can have a good outlook. Exocrine pancreatic insufficiency may be reversible in these persons, or at the very least, the condition will probably not worsen. However, those who have cystic fibrosis or autoimmune pancreatitis may continue to advance toward practically total pancreatic insufficiency with a more guarded prognosis.


What Are the Symptoms of Exocrine Pancreatic Insufficiency?

When a person is suffering from exocrine pancreatic insufficiency, the main three things they will face are gas, bloating, and abdominal pain or discomfort. Apart from these people with exocrine pancreatic insufficiency may notice greasy, oily, large, loose, and odoriferous stools; they might float in the toilet bowl due to their oily nature and are challenging to flush and unexpected weight loss, diarrhea is also very common.


Can Exocrine Pancreatic Insufficiency Be Diagnosed With a Blood Test?

Yes, exocrine pancreatic insufficiency can be determined by blood tests if the test shows elevated levels of amylase and lipase in the blood. Other tests such as stool tests and pancreatic function tests. The blood will also be tested in the lab for folate, iron, and vitamin B12. Insufficient levels may indicate that EPI is preventing the body from absorbing certain nutrients. The laboratory may also search for trypsinogen, a substance that the pancreas produces to aid with digestion. An excessive level indicates a problem.


Can People With Exocrine Pancreatic Insufficiency Have Oatmeal?

Yes, one can have oatmeal for breakfast with low-fat milk, which is a good source of vitamins A and D and can help maintain the immune system of the body. Additionally, oatmeal is a prebiotic food, feeding the beneficial microorganisms in the gut. Maintaining a healthy gut flora, also known as the gut microbiome, will strengthen the body's immune system, improve mood and digestion, and shield one against disease.


Is Peanut Butter Good for People With Exocrine Pancreatic Insufficiency?

Yes, nuts and nut butter are rich in nutrients and high-calorie foods and can be added to a healthy epi diet if the person is trying to gain weight. Fiber, vitamins, and minerals like potassium are all in peanut butter, making it a healthy fat. Healthy fats found in peanut butter can lubricate the digestive system and facilitate the passage of food through the intestines. Bloating, gas, and abdominal discomfort are examples of digestive distress symptoms that peanut butter may help to alleviate.


How Can Exocrine Pancreatic Insufficiency Be Treated?

Pancreatic enzyme replacement therapy (PERT) is included in the treatment plan that the doctors generally prescribe because this medication is a substitute for the digestive enzymes that are generally missing in this condition. Doctors frequently prescribe PERT to treat exocrine pancreatic insufficiency (EPI). PERT can lessen the symptoms and aid in ensuring that one consumes enough nutrition. PERT aids in digestion by being consumed with meals or as a snack. EPI, a chronic illness marked by an impairing capacity to digest some nutrients, particularly fat, is incurable, nevertheless. Better condition control is made possible by PERT which contains digestive enzymes.


Will There Be Weight Gain With Exocrine Pancreatic Insufficiency?

Even when one takes a normal amount of food, exocrine pancreatic insufficiency might cause weight loss since the body isn't breaking down food into the smaller forms the digestive system can use. However, very few people gain a lot of weight while suffering from this condition, even after finding a diet they can tolerate. Even though this condition causes weight loss, the capacity of the body to absorb nutrients and weight gain is enhanced by pancreatic enzyme replacement therapy (PERT).


Are Pancreatitis and Pancreatic Insufficiency Different?

Exocrine pancreatic insufficiency (EPI), a significant contributor to malnutrition and maldigestion, can be the direct result of exocrine pancreatic condition or develop secondarily to it, in which the pancreas cannot make enough digestive enzymes for the effective digestion of food and absorption.  Pancreatitis, which can be acute or chronic, is the medical term for inflammation of the pancreas. The majority of occurrences of chronic pancreatitis are linked to long-term, heavy alcohol consumption. Due to its prevalence, chronic pancreatitis is a prevalent cause of EPI.

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Last reviewed at:
04 Dec 2023  -  5 min read




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