Exocrine pancreatic insufficiency, also known as EPI, is a condition that results in a deficiency of exogenous pancreatic enzymes, and thus the inability to digest food.
The pancreas releases enzymes, which are proteins that create chemical reactions in the body that break down food and allow it to be absorbed for use as energy. If the pancreas does not produce enough of these enzymes, the digestion and absorption processes are disrupted, according to the American Gastroenterological Association (AGA).
EPI usually occurs in conjunction with diseases or conditions that affect the pancreas, according to the National Pancreas Foundation. These include cystic fibrosis and chronic pancreatitis.
Gastrointestinal symptoms of EPI
Since EPI affects digestion and absorption, it is not surprising that it can lead to a number of uncomfortable gastrointestinal symptoms. Its severity can range from mild to very painful.
According to the AGA, digestive symptoms of EPI include:
Of course, these symptoms can be signs of other health conditions as well, which often makes diagnosing EPI difficult, according to the AGA report. Your doctor will be able to distinguish whether your symptoms are due to EPI or another medical condition.
Non-digestive symptoms of an EPI
According to the AGA, EPI can sometimes lead to malnutrition. This is a condition in which the body is deprived of essential vitamins, minerals and nutrients that keep it healthy and allow it to function properly.
Symptoms of malnutrition, according to Johns Hopkins Medicine, include:
- Pale and dry skin
- changes in skin color
- Bruising easily
- Skin rash
- bleeding gums
- painful joints
- Thinning hair or hair that falls out easily
- Swollen or cracked tongue
When food is not properly absorbed, a number of vitamin deficiencies can develop. Deficiencies in important vitamins and minerals can lead to a number of health problems.
Pancreatic enzymes help digest fats, and without them, vitamins that absorb fats, such as vitamin A, vitamin D, vitamin E, and vitamin K, cannot be absorbed by the body. Vitamin B12 is one of the most commonly absorbed vitamins in the EPI.
Research has shown that a lack of vitamin K can lead to easy bruising.
Vitamin E deficiency can lead to ataxia (impaired muscle control) and peripheral neuropathy.
Vitamin B12 deficiency can cause neurological problems as well as anemia.
Vitamin A deficiency can lead to vision problems such as night blindness, according to the American Academy of Ophthalmology. This occurs when the eyes find it difficult to adjust to the dark. People with night blindness have trouble seeing in the dark, but have no problem if there is enough light. Night blindness is sometimes seen in patients with EPI, according to guidelines published in 2021.
A vitamin D deficiency can lead to soft and weak bones, according to the Cleveland Clinic. Vitamin D, along with calcium, are essential for bone health. Too little of it is one of the many causes of osteoporosis, or loss of bone density.
Research has also found that too little calcium can lead to muscle cramps in people living with EPI.
Prevent EPI symptoms
Once you have an EPI diagnosis, your doctor will work with you to create a treatment plan. According to the AGA, the main treatment for EPI is pancreatic enzyme replacement therapy, or PERT, which will replace the enzymes your pancreas is no longer producing.
It is also important to eat a diet rich in fruits, vegetables, whole grains, and healthy proteins. Follow your doctor’s instructions closely and report any new symptoms that appear so that you both can know the best way to manage your condition.