Exocrine Pancreatic Insufficiency (EPI) Coping

While exocrine pancreatic insufficiency (EPI) is a lifelong condition, home remedies and prescription medications can help treat uncomfortable symptoms such as bloating and abdominal pain. There are also different coping strategies to help improve your overall quality of life—emotionally, physically, and socially.

While coping strategies can work differently for each individual, the following are some general tips on how to navigate life with EPI.

What Is Exocrine Pancreatic Insufficiency?

Exocrine pancreatic insufficiency (EPI) is a rare but serious condition that occurs when the pancreas fails to produce important digestive enzymes to absorb nutrients from food. These enzymes include amylase (to break down carbohydrates), protease (to break down proteins), and lipase (to break down fats). Without these enzymes, the body cannot properly digest food and absorb nutrients, particularly fat.

If you’ve had EPI for a long time, you might be living with the stress of having several bowel movements in a day. You might also be dealing with the symptoms of EPI-related conditions, such as cystic fibrosis, celiac disease, chronic pancreatitis, or diabetes.

Although EPI treatments are important, managing your medication may be stressful too. For example, taking pancreatic enzyme replacement therapy (PERT), which is an EPI medication to replace your body's missing digestive enzymes after each meal, may reduce the pleasures of eating.

Emotional

Depression and anxiety are common with EPI. People with chronic health conditions, such as chronic pancreatitis, are more likely to develop depression. If you’re feeling sadness or anxiety that doesn’t seem to go away, it is important to talk to your doctor or a psychologist. Treatments include professional counseling, such as psychotherapy (or "talk therapy"), and antidepressant medication.

In addition, understanding EPI and its treatment may help lessen the anxiety associated with having this condition. Be open with a gastroenterologist (a doctor who specializes in the digestive system) about any uncomfortable symptoms you may be experiencing, even if you find them embarrassing. You may also consider speaking to a dietitian, who can help you create a diet plan so you can eat and live more comfortably.

Physical

Exercise

Aerobic exercise (physical activity that raises the heart rate, such as walking, jogging, cycling, and swimming) can lead to overall improvements in pancreatic function. In recent studies, patients who suffer from EPI along with having type 1 and type 2 diabetes showed improvements in β-cell (cells in the pancreas that produce insulin) function through moderate exercise (200 minutes per week).

In addition to exercise, drinking plenty of fluids is crucial to managing EPI, as good hydration helps the pancreas to function more properly. Drink plain water and limit sugary drinks, fruit juices, and caffeinated beverages, which can counteract the hydrating effects of water.

Depending on the severity of your EPI symptoms, be sure to discuss with your healthcare provider ideas for creating a suitable exercise and diet plan to best manage the disease.

Diet

Diet plays a large role in the management of EPI, and you should take extra care with what and how you eat. In general, you should avoid certain foods that may trigger common symptoms of EPI, which include bloating, abdominal pain, flatulence, and diarrhea. To do this, consider working with a dietitian so you can know exactly how to get proper nutrition in your meals and snacks without making your symptoms worse.

Your dietitian may recommend eating smaller meals throughout the day (to avoid bloating), avoiding too much fiber (to prevent fats from being digested), avoiding processed foods with unhealthy hydrogenated fats, and eating more lean fats (to provide your body with the fuel it needs while keeping your meals low in fat).

Social

Support groups may provide an opportunity to talk to people who have similar conditions. The following organizations have programs that can help:

• National Pancreas Foundation (NPF): If you can’t find a nearby in-person group, search for online support groups instead. To get started, visit the communities page.
• CREON On Course: This support program can help you explore financial savings, the type of multivitamins to take, and educational resources that can help you better understand how to manage EPI.
• Exocrine Pancreatic Insufficiency Coalition (EPIC): EPIC is a coalition of like-minded organizations that advocates on behalf of patients who are living with enzyme deficiencies. They may be able to help you learn about treatment options and access services.

In addition to support groups, it may also help to explain how you feel and share your experiences with family members and friends who can help you navigate the ups and downs of living with EPI. It may allow them to offer the support you need.

Practical

EPI Diary

If you have EPI, you may experience unwanted flares or worsening symptoms over time. Having a plan in place on what to do when you experience any uncomfortable symptoms can reduce any unnecessary panic. To do this, consider creating a diary that you can share with your gastroenterologist or dietitian to help you better recognize and understand your triggers. These may include diet, stress, exercise, vitamin supplements, or prescription medications.

The following are some of the items you might include in your EPI diary:

• When and where you experience EPI flares or worsening symptoms
• How long the EPI flares or symptoms last
• What medications you take for EPI and if they are effective
• What you eat and when you eat it
• Other medications you might be taking for any EPI-related conditions
• Any vitamins or supplements you may be taking and when you take them
• What exercises you do and when
• What stresses you experience in your daily life

Financial Planning

As EPI is a lifelong condition, you may have to be on medication permanently. In the long term, this can be expensive, particularly if you have other underlying health conditions.

You may be entitled to Social Security benefits that can help offset some of the costs of EPI medications. Be sure to speak with your doctor and/or attorney to help you understand and navigate the process.

Summary

While exocrine pancreatic insufficiency (EPI) is a lifelong condition, home remedies and prescription medications can help treat uncomfortable symptoms such as bloating and abdominal pain.

There are also different coping strategies to help improve your overall quality of life—emotionally, physically, socially, and practically. These include communicating with a doctor or psychologist about depression and anxiety and eating smaller portions at various times of the day. They can also include joining EPI support groups or keeping a diary to track the progression of EPI symptoms, especially if they worsen over time.

A Word From Verywell

There are steps you can take to ensure a healthy and happy life with EPI. However, this is not meant to downplay the challenges your disease may present.

In addition, keep in mind that it is normal to experience emotional highs and lows while living with EPI. When this occurs, surround yourself with the appropriate support groups that can help you reduce anxiety, stress, and/or depression. It is also important to remember to eat and sleep well, as they are basic necessities to maintaining good health.