The pancreas is one of the vital organs that make up the digestive system. Exocrine pancreatic insufficiency is a digestive disorder that develops when the pancreas does not make enough of the enzymes needed for digestion. Enzymes are chemicals that are released by the body to bring about certain chemical reactions in the system.
The pancreas produces three key enzymes such as amylase, protease and lipase that are required for the normal digestion of food into smaller molecules. These molecules are absorbed into the bloodstream and offer nutrients to the body. This disorder can result in poor absorption of nutrients, diarrhoea, weight loss and deficiency of vitamins. The symptoms of EPI are quite common to stomach and intestine diseases and often it is underdiagnosed by a healthcare provider.
Health condition that injures the pancreas and that either ceases or blocks the release of its enzymes can result in EPI. The primary causes of exocrine pancreatic insufficiency (EPI) are cystic fibrosis and chronic pancreatitis.
Cystic fibrosis is a life-threatening genetic disorder that occurs during childhood, producing thick, sticky mucus that affects the functioning of the lungs and digestive system. The mucus accumulates and lumps up the opening of the pancreas that averts the release of enzymes during digestion. While in chronic pancreatitis, the pancreas becomes inflamed and scarred. This build-up of scar tissue hinders the digestive enzymes from leaving the duct. Other medical conditions that can cause EPI includes:
Surgical removal of the pancreas
Obstructions of the pancreatic duct
Zollinger-Ellison Syndrome, a tumour of the pancreas
Gastric bypass and other GI surgeries
Exocrine pancreatic deficiency (EPI) is difficult to diagnose as some of the symptoms are common with other disorders of the GI system which include irritable bowel syndrome (IBS), peptic ulcer disease, gallbladder diseases and inflammatory bowel problems.
The most common and frequent symptoms of EPI are diarrhoea and weight loss. The type of diarrhoea in EPI is known as steatorrhea and this type produce stools that are watery, pale, bulky, frothy and extremely foul-smelling.
Other symptoms of EPI might also include:
Loss of weight
Pain in the centre of the stomach that radiates to the back
The healthcare provider diagnoses EPI based on the symptoms experienced by individuals such as fatty stools and weight loss and once they rule out the chance of other common conditions. Steatorrhea does not develop until the pancreas loses 90% of enzyme production and this can sometimes make it difficult to diagnose EPI. Some of the other tests to confirm the diagnosis include stool sample analysis, blood work to check fat deposits and vitamin deficiencies. Furthermore, the doctor may also ask for a CT scan to determine the underlying causes of EPI.
The main treatment mode for EPI is pancreatic enzyme replacement therapy. The enzymes are obtained from the natural, whole pancreas of a pig that contains all three pancreatic enzymes. This therapy takes charge of the pancreas role. The amount of medication given will vary from person to person and it depends on body weight and fat intake in the diet. A person on PERT should take some medications along with the meals and snacks. This treatment option is considered safe and has minimum side effects.
A person suffering from EPI in addition to PERT therapy should modify the lifestyle that helps them to improve the health of the pancreas and overall well-being.
Some of the lifestyle modifications include:
- Quitting smoking
- Eating a wholesome and balanced diet, that is low in fat
- Reducing meal size, but increasing frequency of meals
- Avoiding alcohol
- Taking vitamin supplements such as vitamins A, D, E and K, with the concern of medical experts.
- Adhering to a disciplined lifestyle and treatment may help people with this condition to eat and digest food normally and enhance the overall quality of life