Exocrine Pancreatic Insufficiency (EPI) Symptoms

An Overview of Frequent Symptoms and Potential Complications

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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.

EPI most often occurs in people who have conditions affecting the pancreas, such as chronic pancreatitis and cystic fibrosis. However, people often don't have symptoms until the condition has become advanced.

It is important to inform your healthcare provider of a family history of the disease or if you have underlying gastrointestinal issues that may lead to EPI. EPI can occur in both adults and children.

This article will explain EPI, its symptoms, and potential complications.

Cross Section of a Pancreas

PIXOLOGICSTUDIO/SCIENCE PHOTO LIBRARY / Getty Images

Digestive Enzymes

The pancreas is an organ that plays an important role in digesting food. It also produces the important digestive enzymes, amylase, protease, and lipase, which can speed up digestion and remove toxins from the body.

Frequent Symptoms

In EPI, undigested and unabsorbed food in the digestive tract can lead to frequent gastrointestinal symptoms. These symptoms can range from mild to severe. Symptoms of EPI typically become more severe when 90% of your pancreas’s normal enzyme production is gone. At this point, you’re more likely to have symptoms clearly associated with EPI.

The hallmark symptoms of severe EPI are weight loss and loose, fatty stools called steatorrhea. While symptoms of EPI are nonspecific and can be similar to other digestive problems, it is important to ask your healthcare provider for a thorough medical evaluation if you suspect EPI. Common symptoms of EPI include:

  • Bloating and excessive flatulence: Bloating refers to the distension (protrusion) of the abdomen. Bloating occurs when there is too much gas or extra liquid, causing an uncomfortable feeling of tightness around the abdomen. Flatulence (passing gas) is caused by bacterial fermentation of unabsorbed foods, which releases gases like hydrogen dioxide and methane.
  • Abdominal pain: This can be caused by bloating and a buildup of different gases in the abdomen.
  • Bowel changes: This includes diarrhea and particularly foul-smelling, greasy, oily stool that is difficult to flush (steatorrhea).
  • Weight loss: If you have EPI, weight loss can occur even when you’re eating a normal amount of food. This happens because your body is unable to break down food into smaller pieces to be absorbed as nutrients. If your body is unable to absorb nutrients like fats, you won't be able to gain weight. Malabsorption may also make your stomach feel fuller than usual, causing you to eat less and lose weight unexpectedly.
  • Nutritional deficiencies: Deficiencies in fat-soluble vitamins are commonly seen in people with severe forms of EPI. The inability to absorb nutrients such as fats and proteins are significant nutritional problems tied to severe EPI. You may also lack fat-soluble vitamins A, D, E, and K because they cannot be absorbed by the digestive tract. Instead, these vitamins end up being expelled from the body, along with undigested fats.

EPI and Nutritional Deficiencies

Nutritional deficiencies commonly seen in people with EPI include:

  • Vitamin A, which can lead to skin rashes and night blindness
  • Vitamin D, which can lead to low bone density such as osteopenia and osteoporosis
  • Vitamin E, which can increase the risk of developing macular degeneration and cataracts (clouding of the clear lens of the eye), neurological problems (depression or short-term memory loss), or muscular or joint-related issues (pain, weakness, or fatigue)
  • Vitamin K, which can cause abnormal bleeding or bruising

Complications

If EPI is left untreated and becomes more severe, several complications can arise. Because complications are typically long term, they can have a significant effect on your quality of life. EPI complications may lead to skeletal, renal (kidney-related), and cardiovascular issues. These include:

  • Osteopenia or osteoporosis: Osteopenia is a condition in which a person's bones are weaker than what they used to be. By contrast, osteoporosis is a more severe form of osteopenia, when a person's bones are likely to break. People with severe or prolonged EPI have a vitamin D deficiency that can lead to osteopenia and may progress to osteoporosis. This is because vitamin D aids in the absorption of calcium, which is important for maintaining good bone health.
  • Anemia: This is a condition in which a person's red blood cells are low or are not functioning properly, causing a decrease in oxygen levels in the blood. This is caused by the malabsorption of iron or vitamin B12, which is important for making red blood cells, in people with EPI. Anemia can make a person feel weak and tired.
  • Heart arrhythmia: In severe cases of EPI, blood and fluid loss can leave the heart unable to pump enough blood to the body. This can lead to heart arrhythmias, which are irregular heartbeats.

When to See a Doctor/Go to the Hospital

Early detection of EPI yields a good prognosis for better management of the disease. If you have any of the common symptoms of EPI—bloating and flatulence, abdominal pain, diarrhea, or foul-smelling stool that can be difficult to flush—do not hesitate to seek medical attention.

While other warning signs can be too subtle for you to notice, it is especially important to discuss EPI with your healthcare provider if you have a family history of the disease or if you have underlying gastrointestinal issues that contribute to EPI.

Summary

EPI is a rare malabsorptive condition in which the pancreas doesn't produce digestive enzymes. It is mostly seen in people with conditions affecting the pancreas, such as pancreatitis and cystic fibrosis.

People with EPI often experience a range of symptoms that can resemble other gastrointestinal conditions. Because there is a greater risk of malnutrition and complications if EPI progresses and becomes severe, seek immediate medical attention if you experience persistent or unexplained digestive issues.

A Word From Verywell

EPI can cause pain and discomfort, which can have a serious effect on your quality of life. Since EPI can share symptoms with many other gastrointestinal issues, work with your healthcare provider to make sure you have a correct diagnosis and your pain is being managed. By being proactive in your care, you can ease the physical and emotional burdens that come with EPI.

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8 Sources
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  1. American Gastroenterological Association. Understanding exocrine pancreatic insufficiency. Updated October 21, 2019.

  2. Sankararaman S, Schindler T, Sferra TJ. Management of exocrine pancreatic insufficiency in childrenNutrition in Clinical Practice. 2019;34(S1):S27-S42. doi:10.1002/ncp.10388

  3. Cleveland Clinic. Enzymes. Updated May 12, 2021.

  4. Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clinical and Experimental Gastroenterology. 2019;12:129-139. doi:10.2147/CEG.S168266

  5. Min M, Patel B, Han S, et al. Exocrine pancreatic insufficiency and malnutrition in chronic pancreatitis. Pancreas. 2018;47(8):1015-1018. doi:10.1097/MPA.0000000000001137

  6. Ghodeif AO, Azer SA. Pancreatic insufficiency. In: StatPearls. StatPearls Publishing; 2021.

  7. Lin S-Y, Hsu W-H, Lin C-C, Lin C-L, Tsai C-H, Kao C-H. Effect of acute pancreatitis on the risk of developing osteoporosis: A nationwide cohort study. PLOS ONE. 2017;12(6):e0179358. doi:10.1371/journal.pone.0179358

  8. Shteyer E, Saada A, Shaag A, et al. Exocrine pancreatic insufficiency, dyserythropoeitic anemia, and calvarial hyperostosis are caused by a mutation in the cox4i2 gene. American Journal of Human Genetics. 2009;84(3):412-417. doi:10.1016/j.ajhg.2009.02.006