Exocrine Pancreatic Insufficiency (EPI)

What Is EPI?

Exocrine Pancreatic Insufficiency, often called EPI, is a condition where the pancreas does not make enough digestive enzymes. These enzymes normally help break down fats, proteins, and carbohydrates in food. Without them, the body cannot properly absorb nutrients, leading to digestive problems and malnutrition over time.

Why Does It Happen?

EPI usually develops because of conditions that damage the pancreas, such as:

• Chronic pancreatitis (long-term inflammation of the pancreas)

• Cystic fibrosis

• Pancreatic cancer

• Surgery involving the pancreas, stomach, or intestine

• Other pancreatic diseases

  
  

When the pancreas cannot produce enough enzymes, food passes through the digestive tract without being fully broken down or absorbed.

Common Symptoms

The symptoms of EPI often appear gradually and may be mistaken for other digestive issues. Signs to watch for include:

• Frequent, loose, or greasy stools (that may float or be hard to flush)

• Bloating and excessive gas

• Abdominal cramping

• Unexplained weight loss

• Fatigue or weakness

• Nutrient deficiencies (such as vitamins A, D, E, K, or B12)

  
  

Because fat is the hardest nutrient to digest, problems with fat absorption are often the first sign of EPI.

How Is It Diagnosed?

Doctors may use several tests to diagnose EPI, including:

• Stool tests to check for undigested fat

• Blood tests to look for vitamin deficiencies

• Imaging studies (CT, MRI, endoscopic ultrasound) to evaluate the pancreas

• Breath tests in some cases to measure digestion

  
  

If you notice persistent digestive symptoms, it’s important to see a doctor for evaluation.

Treatment Options

The main treatment for EPI is pancreatic enzyme replacement therapy (PERT). These are capsules that contain digestive enzymes and are taken with meals to help break down food.

Other important steps include:

• Healthy diet: Balanced, nutrient-rich meals with enough protein and calories

• Vitamin supplementation: To replace fat-soluble vitamins (A, D, E, K) if levels are low

• Avoiding alcohol and smoking: Both can worsen pancreatic damage

• Working with a dietitian: To ensure meals and enzymes are adjusted for your needs

  
  

With proper treatment, most people with EPI are able to control their symptoms and maintain a healthy lifestyle.

Living Well with EPI

EPI can be overwhelming at first, but support and treatment make a big difference. Patients often feel much better once they start enzyme therapy. Keeping a food and symptom diary, communicating regularly with your doctor, and staying consistent with medications can help improve quality of life.

✅ Takeaway: Exocrine Pancreatic Insufficiency is a manageable condition. With the right treatment—especially enzyme replacement therapy—patients can regain digestive health, absorb nutrients properly, and live well.