What you need to know about exocrine pancreatic insufficiency

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Article by Master, Doctor Mai Vien Phuong - Gastrointestinal endoscopist - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital.

There is usually no way to prevent exocrine pancreatic insufficiency, especially if it is the result of an inherited condition such as cystic fibrosis. To reduce your chances of developing pancreatitis and the associated exocrine pancreatic insufficiency, avoid heavy alcohol intake, eat a balanced diet, and avoid smoking.

1. What is exocrine pancreatic insufficiency?

Exocrine pancreatic insufficiency (EPI) occurs when the pancreas cannot produce or secrete enough digestive enzymes to break down food and absorb nutrients. Fat digestion will be most affected. As your body tries to get rid of partially digested fat, your intestines will feel uncomfortable.
When exocrine pancreatic insufficiency, the patient may experience symptoms such as bloating, abdominal pain and diarrhea. In severe cases the disease can lead to weight loss, fatty diarrhea and malnutrition.
In terms of etiology, anything that disrupts the normal process of digestive enzymes leaving the pancreas can cause exocrine pancreatic insufficiency. For example, pancreatitis that does not improve over time and cystic fibrosis are the most common causes. Other conditions that cause exocrine pancreatic insufficiency may be genetic, other bowel disorders, or a side effect of surgery.
2. Symptoms of exocrine pancreatic insufficiency The symptoms of exocrine pancreatic insufficiency are similar to other conditions that affect the digestive system. They are:
Celiac disease Irritable bowel syndrome Crohn's disease Colitis Pancreatic cancer Symptoms of exocrine pancreatic insufficiency often go unnoticed. Some common symptoms are:
Abdominal pain Loss of weight due to malnutrition Vitamin deficiency such as vision problems, osteoporosis Fatty stools due to decreased absorption of fat in the intestine Diarrhea .

3. How is exocrine pancreatic insufficiency diagnosed? Your doctor will likely use a variety of techniques to diagnose exocrine pancreatic insufficiency and uncover its underlying cause. Specifically:
Medical history and physical examination: Sometimes, doctors diagnose severe exocrine pancreatic insufficiency based on your medical history and the presence of a number of characteristic symptoms including steatorrhea, diarrhea bleeding and weight loss. Imaging tests: Imaging tests such as X-rays, CT scans, or MRIs will assist your doctor in looking for evidence of damage to the pancreas. Laboratory tests: Laboratory tests check the amount of fat in the stool to see if it is being digested. The breath test measures fat digestion indirectly by looking for certain chemicals as you exhale. Check for related conditions: You will be given additional tests to see if a related condition such as pancreatitis or diabetes is the root cause of exocrine pancreatic insufficiency. 4. How to treat exocrine pancreatic insufficiency? If you are diagnosed with exocrine pancreatic insufficiency, treatment will focus on relieving symptoms and helping your body absorb nutrients. Specifically:
Diet and lifestyle changes: Combining a healthy diet and lifestyle changes will help the digestive system work better. Patients should have a healthy, balanced diet containing the right fats. Medications and supplements: You may also need vitamin supplements because exocrine pancreatic insufficiency makes it difficult for the body to absorb certain vitamins. Your doctor may prescribe enzyme supplements to replace those that the pancreas doesn't make. 5. Is exocrine pancreatic insufficiency preventable? There is usually no way to prevent exocrine pancreatic insufficiency, especially if it is the result of an inherited condition such as cystic fibrosis. To reduce your chances of developing pancreatitis and the associated exocrine pancreatic insufficiency, avoid drinking a lot of alcohol, eat a well-balanced diet, and avoid smoking.
Only about half of people with exocrine pancreatic insufficiency return to normal fat digestion. If you have symptoms that suggest exocrine pancreatic insufficiency, discuss it with your doctor. Symptoms can be signs of an underlying medical condition such as pancreatitis or diabetes.
Treating exocrine pancreatic insufficiency is important because it can improve your quality of life, preventing further damage to your pancreas and serious complications from malnutrition. Adhering to a treatment plan and making positive lifestyle changes can improve your quality of life.

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References:
Domínguez-Muñoz, JE. (2011, June). Pancreatic enzyme therapy for pancreatic exocrine insufficiency. ncbi.nlm.nih.gov/pmc/articles/PMC3151413 Lindkvist, B. (2013, November 14). Diagnosis and treatment of pancreatic exocrine insufficiency. ncbi.nlm.nih.gov/pmc/articles/PMC3831207/ Löhr JM, et al. (two thousand and thirteen). Synopsis of recent guidelines on pancreatic exocrine insufficiency. DOI: 10.1177/2050640613476500 Pezzilli, R, et al. (2013, November 28). Exocrine pancreatic insufficiency in adults: A shared position statement of the Italian association for the study of the pancreas.