Definition & Facts for Exocrine Pancreatic Insufficiency

In this section:

• What is EPI?
• How common is EPI?
• Who is more likely to have EPI?
• What are the complications of EPI?

What is EPI?

Exocrine pancreatic insufficiency (EPI) is a condition in which your small intestine can’t digest food completely because of problems with digestive enzymes from your pancreas. EPI often develops slowly, over many years.

The pancreas is a large gland behind your stomach. The pancreas is both

• an endocrine gland that makes hormones
• an exocrine gland that makes digestive juice containing enzymes

The pancreas delivers the digestive juice to the small intestine through a single duct. In the small intestine, the enzymes from the pancreas help digest food, breaking down carbohydrates, fats, and proteins.

You may develop EPI if

• the amount of enzymes your pancreas makes is severely reduced
• not enough enzymes reach your small intestine
• other problems prevent the enzymes from mixing with food or otherwise working well

The pancreas is a large gland that makes digestive juice containing enzymes.

How common is EPI?

EPI is rare. However, problems with enzymes from the pancreas occur more often in people with certain health conditions.

Although study results vary, experts think problems with enzymes from the pancreas may occur in1

• 30% to 90% of people with chronic pancreatitis
• 80% to 90% of people with cystic fibrosis

Less commonly, problems with enzymes in the pancreas may occur in people who have

• pancreatic cancer that has not been removed by surgery
• type 1 diabetes or type 2 diabetes
• inflammatory bowel disease
• untreated celiac disease
• surgery of the pancreas or upper gastrointestinal tract
• Sjogren’s syndrome
• a history of smoking or drinking alcohol

Who is more likely to have EPI?

People who have advanced pancreatic diseases are more likely to develop EPI. For example, EPI is more common in people who have

• chronic and acute pancreatitis
• cystic fibrosis
• pancreatic cancer
• surgery of the pancreas or upper gastrointestinal tract

What are the complications of EPI?

In EPI, the small intestine doesn’t digest food as it should and may not absorb enough nutrients—a condition called malabsorption. EPI and malabsorption can lead to complications such as

• malnutrition
• low levels of fat-soluble vitamins A, D, E, and K in the body
• low bone mass, called osteopenia, and osteoporosis
• problems with growth in children
• weakness of the immune system
• increased risk of cardiovascular events, such as heart attack and stroke

Reference

1] Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG. [Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clinical and Experimental Gastroenterology. 2019;12:129–139. doi:10.2147/CEG.S168266

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