Exocrine pancreatic insufficiency (EPI) and pancreatitis are both serious disorders of the pancreas. Chronic pancreatitis is one of the most common causes of EPI.
Continue reading to learn more about the differences between EPI and pancreatitis, as well as other conditions affecting the pancreas.
The pancreas plays more than one role. It makes the insulin needed to regulate glucose. It also produces a large share of the enzymes you need to digest food and absorb nutrients. When your pancreas isn’t functioning well, you’re likely to have at least some of the following symptoms:
- abdominal tenderness, swelling, or pain
- nausea or vomiting
- excess gas
- diarrhea
- foul-smelling stool
- lightly colored stool
- fever
- weight loss
- malnutrition
These symptoms could be due to EPI, pancreatitis, or several other disorders of the pancreas.
Pancreatitis means your pancreas is inflamed. There are several types of pancreatitis with a variety of causes. The three main types are acute, chronic, and hereditary.
Acute pancreatitis
Acute pancreatitis comes on suddenly. Inflammation of the pancreas causes severe pain in the upper abdomen, which can last a few days. Other symptoms include:
- bloating
- nausea or vomiting
- diarrhea
- fever
Causes of acute pancreatitis include:
- gallstones
- chronic alcohol use
- trauma
- infection
- certain medications
- abnormalities of electrolytes, lipids, or hormones
- hereditary conditions
Treatment depends on the cause.
Chronic pancreatitis
Chronic pancreatitis is a progressive illness. In addition to upper abdominal pain, symptoms may include diarrhea and weight loss. As the disease progresses, it causes irreversible damage to the pancreas. This can lead to diabetes and malnutrition due to EPI.
Causes include:
- chronic alcohol use
- cystic fibrosis
- hereditary disorders of the pancreas
Among people with chronic pancreatitis, about 20 percent go on to develop EPI.
Treatment depends on the cause and may include pancreatic enzyme replacement therapy (PERT), insulin, and pain management.
Hereditary pancreatitis
In many cases, chronic pancreatitis is caused by genetic mutations, including mutations of PRSS1, SPINK1, and CFTR genes. Pancreatitis can also be due to hereditary pancreatitis or intestine abnormalities.
Hereditary pancreatitis is a progressive disease. Treatment may include PERT and pain management.
EPI is a condition in which you’re deficient in pancreatic enzymes to the point where you’re malnourished. One symptom of EPI is steatorrhea, which is excess fat in the stools. Signs of this are stools that are:
- pale in color
- foul-smelling
- difficult to flush
You may also experience oily leakage from the anus. Other symptoms may include:
- abdominal bloating or cramping
- gas
- diarrhea or fecal incontinence
- weight loss
- malnutrition
Causes of EPI include:
- pancreatitis
- cysts or benign tumors of the pancreas
- blockage or narrowing of the pancreatic or biliary duct
- pancreatic cancer
- side effects of pancreatic surgery
- cystic fibrosis
- diabetes
Treatment may include:
- PERT
- a low-fat diet, unless you have cystic fibrosis
- nutritional supplements, especially fat-soluble vitamins A, D, E, and K
- avoiding alcohol and smoking
Cystic fibrosis is a genetic condition that affects the lungs and digestive tract, including the pancreas. It’s usually diagnosed within the first few years of life. Symptoms include:
- frequent respiratory infections
- coughing
- abdominal distension
- gas
- foul stools
- salty-tasting skin
- inability to gain weight
- developmental delays
- malnutrition due to EPI
Treatment includes:
- PERT
- a variety of medications to address respiratory issues
- special breathing exercises and chest physiotherapy
- dietary management and nutritional supplementation
- lung transplant
Pancreatic cancer doesn’t always cause symptoms early on. As it progresses, you may develop jaundice, or yellowing of the skin and eyes, as well as EPI. Treatment may include:
- surgery
- chemotherapy
- radiation
- pain management
- PERT
Diabetes is a condition in which the pancreas either fails to produce enough insulin or the body can’t use it effectively. Insulin is needed to distribute glucose to cells throughout your body. Symptoms of unmanaged diabetes include:
- excess hunger and thirst
- fatigue
- frequent urination
The connection between diabetes and EPI isn’t entirely understood. But diabetes can predispose you to EPI, and having EPI for a long time is associated with diabetes.
Treatment for diabetes depends on the type, symptoms, and complications. It may include dietary management, insulin, and blood sugar monitoring. If you have diabetes and develop EPI, your doctor may prescribe PERT.
Sometimes, EPI occurs following pancreatic surgery due to pancreatic cancer, cysts, or benign tumors.
It’s not necessary to see your doctor if you have minor gas and bloating on occasion. But if you have frequent trouble with digestion, there are a number of conditions that could be causing these symptoms. It’s important to find the cause so you can get on the right therapy.
If you have symptoms of EPI, such as abdominal pain, foul stools, and weight loss, see your doctor right away. You may be malnourished and in need of treatment. Be especially aware of these symptoms if you have:
- acute or chronic pancreatitis
- pancreatic cancer
- pancreatic surgery
- cystic fibrosis
- diabetes
It’s also a good idea to talk with your doctor or pharmacist before adding over-the-counter (OTC) digestive enzymes to your diet.
EPI and pancreatitis have some similar symptoms, such as abdominal discomfort, bloating, and gas. But EPI tends to be a complication of pancreatitis. The characteristic sign of EPI is pale, foul-smelling stools that can be difficult to flush.
EPI and pancreatitis are both serious conditions that require medical attention. If you have frequent or persistent digestive problems, there are effective treatments. See your doctor to get a diagnosis so you can start on therapy and enjoy an improved quality of life.