Exocrine Pancreatic Insufficiency: What You Need To Know

Date: May-17-2016 Exocrine pancreatic insufficiency is a medical condition in which the pancreas does not produce enough of the molecules needed to digest foods.

This condition leads to poor absorption of nutrients, weight loss, and a lack of vitamins.

Two of the main causes of exocrine pancreatic insufficiency (EPI) are cystic fibrosis and chronic pancreatitis. Because the symptoms are similar to other common diseases of the stomach and intestine, exocrine pancreatic insufficiency is often underdiagnosed.

EPI can be successfully treated with prescription enzymes and healthy lifestyle practices.

Contents of this article:

What is exocrine pancreatic insufficiency?

Causes of exocrine pancreatic insufficiency

Signs and symptoms

Tests and diagnosis

Treatment and prevention

Summary

Fast facts on exocrine pancreatic insufficiency

Here are some key points about EPI. More detail and supporting information is in the main article.

The pancreas is one of the organs that make up the gastrointestinal (GI) system.

The main function of our GI system is to digest and absorb food.

The pancreas produces amylase, protease, and lipase, three molecules known as enzymes that are necessary for the normal digestion of food.

Pancreatic enzyme replacement therapy (PERT) medications are made from the pancreas of pigs.

It is possible for a person to live without a pancreas.

What is exocrine pancreatic insufficiency?

Digesting food is a complicated process. It starts in the mouth with chewing and the release of saliva. Once the food is swallowed, acids in the stomach break it down.

The pancreas is an important organ that helps with the body break down food that has been eaten.

After about 15 minutes, the broken-down food moves to the small intestine. Here, the pancreas provides the necessary enzymes to change the food into smaller molecules. These can then be absorbed into the bloodstream and sent on to nourish the body.

The pancreas, along with the salivary and sweat glands, is one of the body's main exocrine glands. Exocrine glands release substances onto another organ or body surface by way of an opening called a duct.

Endocrine glands, such as the thyroid and pituitary, differ in that they release their hormones directly into the bloodstream. The pancreas functions both as an exocrine and endocrine gland.  When the pancreas works properly, it enables effective digestion and absorption of important nutrients.

In EPI, the pancreas doesn't produce enough of the enzymes needed to digest food. Without this breakdown, the body can't absorb the nutrients and vitamins needed for the body to look and feel healthy. This leads to diarrhea, a lack of vitamins, and weight loss.

If EPI is not properly treated, it can result in a lack of growth in infants and children, bone problems, a shortened life expectancy, and leave the body unable to fight infections.

Causes of exocrine pancreatic insufficiency

There are many causes of EPI. Anything that damages the pancreas and either stops or blocks the release of its enzymes can result in EPI. The two most common causes are cystic fibrosis and chronic pancreatitis.

Cystic fibrosis, a life-threatening genetic disorder of childhood, produces thick, sticky mucus that affects both the lungs and the digestive system. The mucus builds up and plugs the opening of the pancreas, preventing the natural release of its enzymes during digestion.

In chronic pancreatitis, the pancreas is inflamed and replaces normal healthy pancreatic tissue with scar tissue. The buildup of this scar tissue prevents the digestive enzymes from coming out the duct.

Research has confirmed a link between smoking and the development of chronic pancreatitis.

Other medical conditions and diseases that can cause EPI are:

Pancreatic cancer

Surgical removal of the pancreas

Obstructions of the pancreatic duct

Celiac disease

Crohn's disease

Autoimmune pancreatitis

Diabetes

Zollinger-Ellison Syndrome

Dumping syndrome

Gastric bypass and other GI surgeries

Signs and symptoms of exocrine pancreatic insufficiency

EPI can take a while to diagnose because its shares symptoms in common with other disorders that affect the stomach and intestines. These conditions include irritable bowel syndrome, peptic ulcer disease, gallbladder diseases, and inflammatory bowel problems.

One of the most common symptoms of EPI is diarrhea, a condition where a person passes liquid stool from the body very frequently.

The most frequent symptoms of EPI include diarrhea and weight loss.

The diarrhea is referred to as "steatorrhea" which is watery, pale, bulky, frothy, extremely foul smelling, and greasy stools.

These stools contain oily droplets, and because they are made up of so much undigested fat, they stick to the toilet bowl or float on top of the water, making them hard to flush.

Additional symptoms of EPI may also include:

Weight loss

Tiredness

Gas

Cramps

Bloating

Pain in the center of the stomach radiating to the back

Loss of muscle

Signs of a lack of vitamins, such as brittle nails, hair loss, and skin problems

Tests and diagnosis of exocrine pancreatic insufficiency

EPI is often diagnosed based on the symptoms a patient presents to a doctor, particularly when fatty stools and weight loss are mentioned. What makes EPI hard to recognize is that diarrhea does not occur until 90 percent of the pancreas' enzyme production is lost.

Treatment should be started right away, even before any diagnostic testing is done.

Tests to confirm the diagnosis include stool collection for laboratory analysis and various blood tests to check for fats and a lack of vitamins deficiencies. A CAT (CT) scan will also likely be done to look for underlying causes of EPI.

Treatment and prevention of exocrine pancreatic insufficiency

Pancreatic enzyme replacement therapy (PERT) is the standard treatment for EPI. PERT are prescription-only medications. They are derived from a pig's pancreas and contain all three pancreatic enzymes.

People can reduce their risk of developing EPI by quitting smoking.

This therapy takes over the role of the pancreas. The amount of medication given differs from person to person, and is based on the patient's weight, and how much fat they eat. These medications must be taken with all meals and snacks.

PERT is safe and has very few side effects. The U.S. Food and Drug Administration (FDA) have approved the following six PERT medications:

Creon

Pancreaze

Viokace

Pertzye

Ultresa

Zenpep

In addition to taking the replacement enzymes, individuals with EPI need to stop habits that can worsen both the health of the pancreas and overall quality of life.

Healthy lifestyle practices are important to maintain, and include:  

Quitting smoking

Eating a well-balanced diet with a normal amount of fat

Eating smaller, more frequent meals

Avoiding alcohol

Taking vitamin supplements (primarily the fat-soluble vitamins A, D, E, and K), as directed by a medical provider

Summary

EPI is an underdiagnosed digestive disease where the pancreas does not produce the necessary amount of enzymes to digest food.

This condition is underdiagnosed because its main symptoms such as diarrhea and weight loss are similar to other digestive illnesses.

Treatment is very effective and can help an individual eat and digest their food normally, allowing them to feel better, absorb nutrients, and enjoy a better quality of life.

Written by Kathleen Davis FNP

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.