Ask most people on the street what their pancreas does for them, and they probably won’t have a good answer. This small, flat gland hidden deep within your abdominal cavity may be a mystery to many, but it has a vital role to play in your digestion and when something goes wrong with your pancreas, it can have serious impacts on your health. 

What is Pancreatic Insufficiency?

Pancreatic insufficiency, or exocrine pancreatic insufficiency (EPI) more specifically, is a condition where your pancreas no longer produces the digestive enzymes you need to break down fats or digest food. Many different conditions can cause EPI through damaging the tissue of your pancreas in one way or another. A quick list of many of the most common causes of EPI includes:

  • chronic pancreatitis
  • acute pancreatitis
  • autoimmune pancreatitis
  • Zollinger-Ellison syndrome
  • inflammatory bowel diseases
  • celiac disease
  • genetic conditions such as cystic fibrosis
  • pancreatic cancer
  • surgery
  • diabetes mellitus

Pancreatic disease is one of the main causes of EPI. There are several types of pancreatic disease, though, and each can cause different problems for your pancreas. Chronic pancreatitis is a long-term generalized inflammation of your pancreas that eventually destroys the tissues that make digestive enzymes. Acute pancreatitis, by contrast, is less common but can turn into chronic pancreatitis if left untreated. 

Autoimmune pancreatitis is another less common variety of pancreatitis. It is caused when your immune system mistakenly begins attacking the tissue of the pancreas. This condition requires medical treatment such as steroid therapy to help curb the inappropriate immune system response.

The prevalence of autoimmune diseases of this kind are low, but other related conditions such as Crohn’s disease can also cause trouble for your pancreas. This condition results in inflammation of the small intestine from an inappropriate auto-immune response. Though this condition is linked to EPI, it is not known exactly how this relationship works. 

Another relatively rare condition closely related to EPI is celiac disease. People with this condition typically eat a diet low in carbohydrates and free of gluten to manage symptoms. When dietary changes are made and problems still persist, EPI is sometimes the culprit. 

Weight loss surgeries can be a cause of EPI. Alterations of the digestive tract such as removal of part of the stomach or re-routing of the duodenum, the first portion of the small intestine, can lead to disruptions of the normal function of your pancreas. Many kinds of gastric dysfunction can follow a weight loss surgery, including abnormalities in gut reflexes and issues with the biliary and pancreatic ducts. 

Is Pancreatic Insufficiency Serious?

Not being able to digest the nutrients in your food can have serious or even life-threatening effects on your health. In the case of EPI, the inability to metabolize fat and malabsorption of fat-soluble vitamins due to the lack of enzymes can lead to maldigestion of food, vitamin deficiencies, and possibly malnutrition.  

Does Pancreatic Insufficiency Go Away?

There are occasions when EPI can go away on its own, but these are rare. Some causes such as the genetic condition Shwachman-Diamond syndrome can cause people to experience EPI during childhood, only to have pancreatic function improve later in life. The exact reasons for this are not known, but for people with this syndrome, pancreatic lipase levels increase as they age out of adolescence.  

In most cases of EPI, pancreatic function cannot be restored. This is certainly true for causes such as surgery or pancreatic cancer where pancreatic tissue has been damaged, destroyed, or removed. Particularly when pancreatic cancer treatment requires the resection of tissue, the potential for your pancreas to do its job is significantly impacted. 

There are occasions where the underlying condition causing your EPI can be treated, which can alleviate symptoms. Getting acute pancreatitis under control or managing Crohn’s disease or inflammatory bowel diseases through diet, lifestyle, and medication when appropriate can also help to alleviate symptoms of EPI.

In cases where weight loss surgery or other gastric surgery has caused disruption to the function of the pancreas, it is unlikely that normal pancreatic function can be restored. Changing the structure and routing of your stomach and small intestine can have far-reaching consequences for your entire digestive tract. 

How is Exocrine Pancreatic Insufficiency Diagnosed?

Like so many conditions studied in the field of gastroenterology, there are many different diseases and problems that may present with the same common symptoms. In many cases, the bloating, diarrhea, and abdominal pain listed as the most common symptoms of EPI may also be caused by the conditions causing it such as celiac disease. This can make getting a proper diagnosis difficult, and you may need to see a specialist who is trained in gastrointestinal problems. 

One of the first clear signs you have EPI comes from looking at your poop. The presence of fecal fat in bowel movements detected with a fecal elastase-1 test is a relatively clear and reliable way to test whether your body is processing fats properly. 

If there is something wrong with your digestive system, there is likely a blood test for it. EPI is no exception, with the IRT (immunoreactive trypsinogen) test being one of the more commonly used. This test looks for levels of pancreatic acids that may be elevated in cases where pancreatitis is the cause of your EPI. 

Medical imaging is also used to help diagnose pancreatic problems. This can involve everything from X-rays to CT scans and even endoscopic ultrasound. Images will be examined to look at the pancreas itself, your small intestine, bile ducts, gallbladder, and more. 

Treatment of Exocrine Pancreatic Insufficiency

Treatment options for EPI will depend somewhat on the cause of your condition. Treating the root cause of EPI may help to alleviate symptoms, though you will still likely need to seek further treatment to address the effects of EPI directly. 

Pancreatic enzyme replacement therapy (or PERT) is one way to help address the malabsorption and potential malnutrition created by pancreatic insufficiency. This can help replace lost exocrine function and allow your body to process the essential nutrients found in the food you are eating. 

To help manage the side effects of nutrient malabsorption, you will also likely need to begin taking vitamin supplements to replace fat soluble nutrients such as vitamins A, D, E, and K that you are not getting in your diet. This can help prevent additional complications from arising as a result of malnutrition.

Talking to Your Doctor About EPI

Making sure you have a good relationship with your healthcare provider is essential for good health, especially as you age. This means having someone who can understand your particular medical needs, and someone who is able to recommend specialists when necessary. With conditions like EPI, this could be necessary to sort through the symptoms and indications to get a clear diagnosis.  

At Cary Gastroenterology, we specialize in treating conditions affecting the whole gastrointestinal tract. Our doctors and staff have the knowledge and experience to get you the clearest diagnosis possible, and to help you understand your treatment options. The complex relationships between the organs of the GI tract demand specific expertise, and that is where we excel. If you are interested in learning more about the services we provide at Cary Gastroenterology, consider requesting an appointment with us today.