What Is EPI (Exocrine Pancreatic Insufficiency)?

WHAT IS EPI?

Exocrine Pancreatic Insufficiency (EPI) is a condition in which your body doesn't provide enough pancreatic enzymes to properly break down food. People with EPI are unable to properly digest the nutrients in food such as fats, proteins, and carbohydrates, leading to maldigestion. Once diagnosed, EPI is a manageable condition when treated with pancreatic enzyme replacement therapy (PERT) as part of an EPI management plan.

What is PERT?

Taken as prescribed, PERT replaces the enzymes your body isn’t providing in order to help you digest food. Once diagnosed with EPI, your doctor or gastroenterologist can prescribe the right dose for you.

What Is EPI?

transcript Video Transcript

What Is EPI?

MEL: EPI is really the inability of my pancreas to produce enough enzymes to help me digest food.

RHONDA: I was having these symptoms and I went on the computer and kind of typed it in and did my research and I kind of told them what I had found and then, you know, together he said, “Yep. It sounds like, you know, you nailed it.”

DEBRA: I knew the pancreas had to do with insulin and diabetes, but I really didn’t understand as far as the digesting of food.

RHONDA: What’s happening with EPI is that the foods aren’t being broken down and because you have food in there, that’s undigested, it’s causing these bloating and cramps, and the oil isn’t being broken down, so that’s coming out in your stool. Once we found out it was EPI, I was actually relieved to have a diagnosis.

MEREDITH: For somebody who was recently diagnosed with EPI, I would tell them to pay attention to their symptoms, talk to their doctor openly, and take their medication as prescribed.

To better understand EPI, it helps to know what the pancreas does.

Located in the center of the abdomen, the pancreas has 2 important functions:

• Endocrine function makes insulin, a hormone that helps the body process the sugar we eat
• Exocrine function makes enzymes to help digest food so the body can absorb it

In people with EPI, it’s the exocrine function of the pancreas that is affected. Your body doesn’t produce or supply enough of these pancreatic enzymes needed to break down the food you eat. As a result, EPI affects the way your body digests food, causes unpleasant digestion symptoms, and may prevent you from getting the necessary nutrition from the foods you eat.

What are the 3 main enzymes produced by the pancreas?

The exocrine function of the pancreas produces 3 main types of enzymes:

Lipase

(breaks down fats)

Protease

(breaks down proteins)

Amylase

(breaks down carbohydrates)

EPI is caused by an underlying condition or procedure. However, the frequency, severity, and variety of EPI symptoms may vary from person to person. It may take months or even years for EPI symptoms to appear. The symptoms of EPI may also be similar to other gastrointestinal disorders, which can make EPI a difficult condition to diagnose.

Only your doctor can determine if EPI is the cause of your symptoms. Use our Symptom Checker to identify your symptoms and help start a discussion with your doctor.

Use the Symptom Checker

See how EPI affects digestion.

Digestion starts in your mouth

When you chew food, the enzymes in your saliva begin the process of digestion.

Food travels down to the stomach

Food mixes with stomach acid and enzymes that further break it down.

EPI starts with the pancreas

Next, the pancreas releases enzymes that mix with the food as it enters the small intestine. If you have EPI, there is a deficiency of pancreatic enzymes.

Maldigestion

With EPI, food doesn’t get broken down the way it should, so your body isn’t able to digest and absorb nutrients properly.

EPI symptoms

EPI may result in nutrients not being absorbed properly and uncomfortable gastrointestinal symptoms.

Identify EPI symptoms

Need a doctor experienced in EPI?

Find an EPI doctor

How is EPI diagnosed?

Learn about EPI diagnosis

How is EPI treated?

Learn about PERT

Reference sources:

1. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017;23(12)(suppl):S203-S209. 2. Singh VK, Haupt ME, Geller DE, Hall JA, Quintana Diez PM. Less common etiologies of exocrine pancreatic insufficiency. World J Gastroenterol. 2017;23(39):7059-7076. 3. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73. 4. Pancreatic enzymes. Pancreatic Cancer Action Network website. https://www.pancan.org/facing-pancreatic-cancer/living-with-pancreatic-cancer/diet-and-nutrition/pancreatic-enzymes/. Accessed December 15, 2020. 5. Röder PV, Wu B, Liu Y, Han W. Pancreatic regulation of glucose homeostasis. Exp Mol Med. 2016;48:e219. doi:10.1038/emm.2016.6. 6. Ferrone M, Raimondo M, Scolapio JS. Pancreatic enzyme pharmacotherapy. Pharmacotherapy. 2007;27(6):910-920.

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