Exocrine Pancreatic Insufficiency, often called pancreatic insufficiency or EPI, is the inability of your digestive system to break down and properly digest the foods you eat.
Exocrine Pancreatic Insufficiency or EPI is characterized by the pancreas NOT producing enough pancreatic enzymes (protease, amylase, lipase) to promote normal digestion and the need for pancreatic enzyme supplementation.
This condition can be mild or severe.
What Causes Exocrine Pancreatic Insufficiency?
There are more causes for pancreatic insufficiency than most people think. Some of the conditions that cause EPI are:
- chronic pancreatitis
- cystic fibrosis
- obstructions of the pancreatic duct (cancer, tumors)
- Shwachman-Diamond syndrome (SDS)
- Celiac disease
- Crohn’s disease
- Autoimmune pancreatitis: This is often caused by immunoglobulin G4 (IgG4)-related disease and can progress to EPI.
- Zollinger-Ellison syndrome
- GI and pancreatic surgical procedures
What Are The Symptoms of Pancreatic Insufficiency?
When trying to discover whether your symptoms may match those of pancreas insufficiency one has to remember that you may not have the exact same symptoms that Tom, Dick or Harriet experience. In fact …
Only your licensed physician will know (hopefully anyway) for sure whether you have pancreatic insufficiency or parasites (example only).
These are the symptoms most often found to be relevant to exocrine pancreatic insufficiency:
Frequent diarrhea. EPI can cause problems with the digestion process. As a result undigested food can move too quickly through the digestive tract.
Not all people experience this symptom.
There are many causes of diarrhea so just because you have a couple of days of it does not mean you have pancreatic insufficiency.
However, if you do have (been diagnosed) with any of the above conditions that can cause EPI it would be prudent to ask your doctor to test you (especially if you have some of the following symptoms as well).
Weight loss. People with EPI cannot digest fats, proteins, and carbohydrates found in the food they eat, which can result in weight loss.
I’m not talking just a pound or two or even 10 that one may lose on a low fat diet. I’m talking severe weight loss that doesn’t stop even though you are eating two or three healthy meals per day.
If the malabsorption is severe enough you could become skin and bone.
IF your doctor has been oblivious, you need to bring it to his/her attention because severe malabsorption issues could be caused by EPI and you need to get a handle on it.
Gas and bloating. People with EPI cannot properly digest the food they eat, which can result in uncomfortable symptoms like gas and bloating.
Stomach pain. The gas and bloating caused by maldigestion in people with EPI will frequently result in stomach pain.
Foul-smelling, greasy stools (steatorrhea). Steatorrhea is a type of bowel movement that is oily, floats, smells really bad, and is difficult to flush. It may even have attached globs of fat.
People with EPI are not able to absorb all of the fat that they eat, so undigested fat is excreted, resulting in stools that look oily or greasy.
Not all people experience this symptom.
Talk to your doctor if you notice oil droplets floating in the toilet bowl or stools that float or stick to the sides of the bowl and are hard to flush because these may be signs that you have EPI.
Does your poop float, sink or actually swim around the toilet bowl doing the backstroke? Maybe one day it floats, the next it sinks or maybe it even “bobs” up and down?
Are you the type of person who NEVER checks out your poop?
Yes you do! You look don’t you?
I like to play a game I call “Pilot to Bombardier.”
Of course I have to look and view the bomb damage! And it is important to check out what that poo actually looks like.
What color is it?
Is it rock solid or nice and soft?
Oh wow it’s floating and looks like a battle cruiser!
And if you’re like me you have probably wondered what makes my poop float?
If you asked your mom when you were a kid “Hey mom why does my poop float?” She might have come up with a very brainy answer like “It floats son because it’s full of fiber. And fiber floats.” And …
Was she right or wrong?
Scientifically she’s wrong. But who knew right? It probably sounded good to her at the time! But you probably still wondered, even as a kid, why some poop floats and why some sinks, right?
If you are concerned about exocrine pancreatic insufficiency this discussion about poop may help because knowing your poop can actually save your life (in some cases). Yes, I am venturing off the path a bit, talking about stool appearance but bear with me and things will come out fine.
Ask Yourself “Is My Poop Looking Healthy?”
Your poop can actually tell you how healthy you are; at least to some degree. If your stool looks like a nice sized snake (not a skinny little devil suffering from starvation), is easily evacuated and looks like #4, in the following Bristol stool chart (yes the folks at the University of Bristol actually did a poop study and then published the study in the Scandinavian Journal of Gastroenterology), then chances are you probably have a well, oiled, finely tuned intestinal tract.
What are the chances that you’ll now be looking at and rating your poop?
You’ll do it all the time!
If you ever happen to see that your poop looks like a nightcrawler (big long worm) as seen in the next chart top row, far right, rather than a nice sausage-shaped candy bar with peanuts #3 or a smooth healthy snake #4 you may want to make an appointment with your doctor.
Stools that look like an emaciated snake or a long, big worm may signal a colon tumor or polyps.
What Can Be Done To Help My EPI Symptoms?
If you have been diagnosed with EPI your doctor may have prescribed Pancreatic Enzyme therapy. This usually consists of taking CREON or a similar prescription enzyme replacement with every meal.
Many people experience nasty side effects from CREON and other prescription enzymes because they contain alcohol. It’s not the same type of alcohol you’d drink but it’s alcohol and …
Your inflamed, damaged pancreas doesn’t like alcohol.
Some people are allergic to pork. And pork enzymes are used in the replacement enzymes because pigs are close to humans. I’m sure you know a few humans whom you’d swear were pigs anyway …
There are viable, less expensive solutions available that do not seem to cause the problems because they do not contain alcohol and they are far less expensive than prescription enzymes.
I was using Now Foods Super Enzymes in the capsules because they contain more lipase than the tablets. The capsules have 2960 USP units of lipase which makes them close to CREON 3,000.
If your doctor has prescribe a much higher dose you can opt for a different solution from Vital Nutrients which offer 17,750 USP units of lipase per capsule. 2 caps equal The higher doses of CREON. (I’m an Amazon affiliate so if you visit Amazon via my links and purchase a product I’ll receive a small reward which will help pay for my hosting, time and coffee. Thank you!)
BOTH of the above solutions to prescription enzymes also contain pig enzymes so if you have a valid allergy to pork they aren’t going to work for you.
I think we’ve covered most of the important, basic information regarding exocrine pancreatic insufficiency and poop. If you think you have exocrine pancreatic insufficiency you should schedule an appointment with your doctor and get evaluated. Should you be diagnosed with EPI your doctor will likely prescribe pancreatic enzymes (Creon, etc) to help regulate your digestion.
Please tell me I’ve had acute pancreatitis twice may being the last time, after getting out of the hospital I’ve been alcohol free 7 days ago I was back in with what I’m now told too be cronic pancreaits, now not having alcohol for 3 months still didn’t stop my pancreaits attack and no one seems to know the reason why. I’m still here in hospital a lot better now but very fustrated
Hi Alan – You said “Please tell me” but I’m not sure what you are asking me. If you are asking me why you have had acute pancreatitis twice, or have been diagnosed with CP even after quitting drinking – I don’t know. That is up to you and your health care team to determine. I do know this … There is ALWAYS a cause or reason. The pancreas simply does NOT wake up one morning with a bad attude for no good reason. You may have a genetic variant (hereditary, alcoholic) that predisposes you to whatever form of pancreatitis you have (origin). For example you do NOT need to be a full blown, die hard, daily guzzling alcoholic to get alcoholic pancreatitis. All you need is the genetic variant and drink alcohol. There may be an underlying condition (autoimmune disease, gallstones, SOD, drug side effect, virus, trauma, toxin, etc) which has not been discovered that caused the original attack. I wish I could be more help. I’d have a heart-to-heart with the doc and make sure he did what’s necessary to find out what exactly caused the original attack and why he/she has diagnosed CP (usually due to damage seen on scans).
Have had a horrific abdominal “attack” of pain for 4 days. could not eat much but drank fluids lots. I have gallbladder disease, have not had ir removed & control it with diet but eat allowed fats. My MD palpated my abdomen and suspects Pancreatic swelling. She balks at imaging due to fact I have had immense amounts of radiation imaging in the past year due to a serious head injury. I have an endoscopy coming up: what tests should I request?? Thank You Glad your there.
Your doc should know what tests Carol but intially blood work for enzyme elevation (amylase and lipase) HOWEVER they usually do not elevate unless you are acutely ill. Yet sometimes both will elevate slightly if pancreas is slightly inflamed. Endoscopy is good, especially if it’s EUS. ALL of the other tests are radiology (US, CT, EUS, MRCP). Good luck! 🙂
hi, i had 2 episodes of acute pancreatitis. last one was 5 months back. Now i started losing weight. And my stool is greasy. doctor advised me to take creon 30000mg per meal. and this is coz of Exocrine pancreatic insufficiency. and im very much depressed… its highly costly. and i dont have any idea how long i should be in medication.
will this be cured?
will i bcm normal?
i want to know the best food to eat to heal my condition. as you said grape juice. bt grape juice is sour in taste. wont it hurt the pancrease?
what shoul i do… please answer me……
im afraid that i want to eat pills through out my life,
Hi Nishanth – sorry to hear you have joined the pancreatitis hall of pain. I understand your depression but cheer up it could be worse! Exocrine pancreatic insufficiency usually necessitates the use of enzymes for life. Once the pancreas is damaged to the extent you need enzymes the chances for complete healing are remote. A proper diet diet (low fat) and supplements can help heal the pancreas but they do not cure the condition once extensive damage has been done. Grapefruit juice is sour but it helps a lot. IF you are on medication (other than creon) check with your doctor BEFORE drinking grapefruit juice or eating grapefruit to see if it’s ok. I know this isn’t what you wanted to hear but like I said it could be worse.
So since im on creon i now have epi???
Hi Stephanie – not necessarily. You’d have to ask your doc that.
So if my stool always floats, or some of it does within one bowel movement even with a no fat (under 25 g) diet does that mean I have EPI? The last time I had a elastase test it came back normal a few months ago, but even after changing my diet I am still having the same problem, even when it is more formed and a “4” it floats and has white specks in it? I have not been diagnosed with anything, had an MRI, CT, and EUS and nothing was found but it is EPI could imaging see that? I am 27 and doctors keep making all the tests last forever because I have to force them to do them so I can get better as I have 3 little boys 6,3, and 2. I am eating fruits, gluten free oatmeal, vegetables, and some chicken. thank you
Hi Sierra – If your elastase test is normal I doubt you have EPI. Stools often float because they are full of gas. Yep! IF you see globs of fat on the stool and/or they stick to the bowl tell your doctor because you may have absorption issues for some reason which may or may not have to do with your pancreas.