Exocrine Pancreatic Insufficiency (EPI) Treatments

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Exocrine pancreatic insufficiency (EPI) is a rare but serious malabsorptive condition that occurs when the pancreas fails to produce important digestive enzymes. 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, celiac disease, diabetes, and cystic fibrosis. However, people typically don't have symptoms until the condition has become advanced.

While EPI is a lifelong condition, home remedies and prescriptions can help treat uncomfortable symptoms. Be sure to speak with your doctor about your symptoms and medical history to determine which EPI treatment strategy is best for you.

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Lifestyle and Home Remedies

To improve your symptoms of EPI, talk to your doctor about potential lifestyle changes and accommodations that you can implement. The following are some steps you can take to improve your quality of life with EPI:

  • Maintain a healthy diet: When you have EPI, take extra care with what and how you eat. Work 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 (trans) fats, and eating more lean fats (to provide your body with the fuel it needs while keeping your meals low in fat).
  • Take nutritional supplements: Since fats can't be digested properly if you have EPI, you won’t get the vitamins that your body has to absorb through fat, called fat-soluble vitamins. These include vitamins A, D, E, and K. Discuss with your doctor about taking these vitamins to manage your EPI symptoms.
  • Avoid alcohol: Alcohol can harm your pancreas. If you have trouble avoiding alcohol, talk to your doctor about how to quit safely.
  • Quit smoking: Smoking increases the risk of pancreatic conditions such as pancreatitis, pancreatic cancer, and an increased probability of reduced pancreatic exocrine function. If you smoke, ask your doctor for information on smoking cessation programs.
  • Exercise regularly: Regular movement can promote your overall health. Ask your doctor about the best exercises for you.
  • Relieve stress: While stress can't be completely eliminated, there are many ways to cope. Deep breathing exercises, yoga, or tai chi can be helpful ways to reduce stress and unwanted stress-induced acid reflux.

Adjusting Your Diet When You Have EPI

When adjusting your diet, it is especially important to avoid saturated and trans fats. In general, you shouldn’t eat more than 20 grams of saturated fat each day or more than 10 grams of saturated fat at one meal. Find ways to cut it out of your diet, like eating grilled or baked foods instead of fried foods. Also, consider using cooking spray instead of oil or butter and choosing low-fat or fat-free dairy.

Prescriptions

If your doctor suspects that you have EPI, they may prescribe prescription medications to manage symptoms, including pancreatic enzyme replacement therapy (PERT).

Pancreatic Enzyme Replacement Therapy (PERT)

Since the pancreas doesn't produce enough digestive enzymes, you might benefit from a type of prescription medication known as pancreatic enzyme replacement therapy (PERT). PERT can replace digestive enzymes and help you absorb nutrients from the foods you eat. Recent studies have also shown PERT to improve symptoms of abdominal pain, flatulence, and the consistency of stool production.

Before taking PERT, your doctor will decide on the dose (in capsules) based on the severity of your condition. Then, your doctor may suggest that you take these capsules at the beginning of every meal or snack. Occasionally, patients report some bloating and gas when they first begin taking the enzymes as their digestive system gets accustomed to them, though these side effects are usually mild.

To be effective, PERT must be taken exactly as prescribed every time you eat. However, if you have problems with heartburn while taking PERT, your doctor may add a proton pump inhibitor (PPI) to reduce stomach acid.

Potential Problems with PERT

In about half of EPI cases, people treated with PERT don’t fully return to normal fat digestion. This can happen for a number of reasons, including incorrectly taking your enzyme replacements or doses that are too low. Acid imbalances in the gut or germ overgrowth in the intestines can also prevent the therapy from working. Always consult your doctor if your PERT treatment isn't working as it should.

Summary

If you are diagnosed with EPI, your doctor may recommend prescription medications and dietary and lifestyle modifications, such as cutting back or quitting smoking or drinking alcohol, as these lifestyle choices can promote inflammation.

Long-term treatment goals for patients with EPI will depend on the severity of your pancreas function at the time of diagnosis. To do this, your doctor may want to periodically test your pancreatic function. They will also continue to monitor your weight and nutritional status to ensure you are well-nourished and do not have any nutritional deficiencies.

A Word From Verywell

EPI can be greatly improved with PERT prescriptions. Pancreatic functioning can be improved when drinking and smoking are avoided or eliminated completely. That said, consult with your gastroenterologist about supplementing your low-fat meals with fat-soluble vitamins (A, D, E, K), as many people with EPI are low in these vitamins.

Additionally, while PERT is an effective treatment for replacing digestive enzymes and absorbing nutrients properly in the body, do not hesitate to consult your doctor if your treatment isn't working. Your gastroenterologist may revise your treatment plan by increasing your enzyme dosage, prescribing PPIs, or treating you for germ overgrowth in the intestines, which can help you improve your overall quality of life.

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  1. Singh VK, Haupt ME, Geller DE, Hall JA, Quintana Diez PM. Less common etiologies of exocrine pancreatic insufficiency. World Journal of Gastroenterology. 2017;23(39):7059-7076. doi:10.3748/wjg.v23.i39.7059

  2. Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World Journal of Gastroenterology. 2013;19(42):7258-7266. doi:10.3748/wjg.v19.i42.7258

  3. Perbtani Y, Forsmark CE. Update on the diagnosis and management of exocrine pancreatic insufficiency. F1000Research. 2019;8:F1000 Faculty Rev-1991. doi:10.12688/f1000research.20779.1