Exocrine Pancreatic Insufficiency

Outline of the human body, showing some digestive organs with a close-up of the pancreas.

The pancreas is a gland in the abdomen between the stomach and the spine. The pancreas makes hormones and enzymes that help the body control blood sugar, digest food, and store energy from food.

Exocrine pancreatic insufficiency (EPI), is when the pancreas does not make enough proteins (enzymes) to digest food. If EPI is not treated, your body may not get enough nutrition or vitamins from the food you eat. EPI may lead to weak bones (low bone mass), a weak body defense system (immune system), and an increase in your risk of heart problems.

What are the causes?

This condition may be caused by:

Inflammation of the pancreas (pancreatitis).
Cystic fibrosis. This is an inherited disease that mainly affects the lungs and digestive system.
Cancer of the pancreas.
Surgery on the pancreas.
Diabetes.

What increases the risk?

You are more likely to develop this condition if:

Your pancreas does not make a lot of enzymes.
Not enough enzymes reach your small intestine.
Something else stops the enzymes from mixing with food.

Other factors that increase the risk include:

Smoking.
Drinking a lot of alcohol.

What are the signs or symptoms?

Symptoms of this condition include:

Bloating or passing a lot of gas.
Pain or cramps in the abdomen.
Diarrhea. This may be oily and smell bad.
Weight loss.

How is this diagnosed?

This condition may be diagnosed based on:

Your medical and family history.
A physical exam.
Blood tests.
Poop (stool) tests.

How is this treated?

This condition may be treated with:

Pancreatic enzyme replacement therapy, or PERT. This is taking medicine that has enzymes to help you digest food.
Management of the medical condition causing your EPI.
Lifestyle changes. These may include:
- Diet changes. A dietitian may develop a specific eating plan for your condition.
- Quitting smoking.
- Avoiding alcohol.

Follow these instructions at home:

Eating and drinking

Eat frequent healthy meals and snacks as told by your dietitian.
Do not drink alcohol.

General instructions

Take over-the-counter and prescription medicines only as told by your health care provider. This includes vitamin or mineral supplements.
Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your provider.
Keep all follow-up visits. Your provider will check if the treatment is working.

Where to find more information

American Gastroenterological Association (AGA) GI Patient Center: patient.gastro.org

Contact a health care provider if:

Your symptoms get worse, or you get new symptoms.
You continue to lose weight.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.