Exocrine Pancreatic Insufficiency

The food which we eat is made of carbohydrates, fats and proteins. The digestion of food involves breaking down of the complex substances into simple substances which can be absorbed easily by our body. Digestion begins in the mouth where the food is chewed and mixed with the saliva. It further moves into the gastrointestinal tract which consists of the stomach, pancreas and small intestine. In the stomach, the food is mixed with acid and proteins are broken down. While in the small intestine, the food gets completely digested with help of enzymes released from pancreas and bile produced by the gall bladder. The digested food is absorbed by the cells of small intestine and is circulated in the body to provide nutrients.

Exocrine Pancreatic Insufficiency

What is Exocrine Pancreatic Insufficiency?

Pancreas is a gland with an endocrine and an exocrine function. Endocrine means it produces and releases hormones into the blood stream. It releases hormones like insulin and glucagon to regulate the blood glucose levels. While exocrine means pancreas cells produce enzymes which are released into the small intestine for digestion of the complex food substances. It releases enzymes such as:

  • Amylase for breakdown of starch into glucose
  • Lipase for breakdown of triglycerides, phospholipids into fatty acid and glycerol
  • Protease for breakdown of proteins into amino acids

These simple products of digestion are absorbed by the small intestine and provided to the body.

Exocrine Pancreatic Insufficiency (EPI) is a medical condition where the pancreas is not able to release sufficient amount of enzymes into the small intestine. Due to certain underlying medical reasons, the exocrine function of pancreas is hampered. This impairs the digestion process of food, mainly the breakdown of the lipids or fats. Since the food is not properly digested, it does not get absorbed and gives rise to a number of symptoms. Both malabsorption and malnutrition affects a person’s overall health and well-being. The good thing is that exocrine pancreatic insufficiency is treatable.

Symptoms of Exocrine Pancreatic Insufficiency

Exocrine pancreatic insufficiency causes following symptoms:

  • Loss of appetite
  • Weight loss and tiredness happens because of fewer amounts of nutrient in the body resulting in loss of weight and cause fatigue.
  • Diarrhea
  • Pain in the stomach which begins in the centre and radiates around can be a symptom of Exocrine pancreatic insufficiency.
  • Steatorrhoea: It means the bad smelling stools which contain undigested fats. People with Exocrine pancreatic insufficiency are not able to digest and absorb all the fat which they eat. Due to which the undigested fat gets excreted in the stool which are watery, pale, greasy and have extremely foul smell. In addition, the oil floats in the toilet bowl or stools stick to the sides of the bowl and are difficult to flush.
  • Bloating: The undigested food is fermented by the bacteria present in the gut region which causes gas and flatulence problems.
  • Edema: Due to less amount of protein albumin, it leads to retention of the fluid in the body which results in swelling or edema.
  • Anaemia: Absorption of VitB12, folate and iron does not take place efficiently which leads to their deficiency in the body.
  • Bleeding Disorders: There is Vitamin K deficiency which affects healing if there are wounds.
  • Joint Pain: There is deficiency of Vitamin D and hypocalcemia which affects growth of bones and causes pain in them.

Causes of Exocrine Pancreatic Insufficiency

The following are some of the causes which lead to insufficient pancreatic enzymes thus giving rise to exocrine pancreatic insufficiency.

Chronic Pancreatitis: It is long term inflammation of the pancreas caused by excessive alcoholism or gallstones. In some cases it can be autoimmune. The cells of pancreas get damaged which results in insufficient secretion of pancreatic enzymes for digestion.

Cystic Fibrosis: It is a genetic disease which results in secretion of thick and sticky mucus which affects the lungs and the digestive system. The mucus builds up to block the opening (duct) of pancreas, due to which the enzymes do not reach the small intestine and this affects digestion.

Shwachman-Diamond Syndrome: The pancreas does not have enough cells to produce enzymes. This results in insufficient enymes for process of digestion.

Pancreatic Cancer: This can lead to exocrine pancreatic insufficiency.

Crohn’s and Celiac Disease also lead to Exocrine pancreatic insufficiency in some people.

Surgical removal of pancreas.

Diagnosis of Exocrine Pancreatic Insufficiency

Doctor will perform physical examination and ask relevant questions. He will also ask for further tests such as:

  • Three-day faecal test where the stools will be collected for three days to check for the amount of fat in them.
  • Blood tests to determine pancreatic enzyme levels and vitamin levels in the body.
  • CT scan or MRI scan
  • Endoscopic ultrasound

It is necessary to diagnose Exocrine pancreatic insufficiency since some of its symptoms are same as those of other gastrointestinal tract problems such as irritable bowel syndrome, ulcerative colitis and small intestinal bacterial overgrowth.

Treatment of Exocrine Pancreatic Insufficiency

After diagnosis, the treatment for Exocrine pancreatic insufficiency should be started immediately. It involves taking Pancreatic Enzyme Replacement Therapy (PERT). The medication for Exocrine pancreatic insufficiency includes the enzymes from porcine pancreas to be taken in tablet form during all meals and snacks. The six US-FDA approved enzymes which are available by prescription include: Creon, Pancreaze, Pertzye, Ultresa, Viokace and Zenpep. These enzymes take up the role of pancreatic enzymes and help in digestion of food. This treatment for Exocrine pancreatic insufficiency is effective and allows person to digest food, absorb nutrients and have a good quality of life.

In addition to the PERT treatment, the person suffering from exocrine pancreatic insufficiency should take care of the following:

  • Instead of taking a big meal, eat six small meals per day
  • Taking vitamin A,D,E and K supplements is necessary
  • One should stop alcohol intake and stop smoking to improve quality of life.


Exocrine pancreatic insufficiency needs to be treated properly or else it will cause growth problems in infants and a poor prognosis due to inability to fight infections. The symptoms of exocrine pancreatic insufficiency can be managed with the right and early treatment such as the pancreatic enzyme replacement therapy. One needs to consult a nutritionist to follow a proper nutrition to remain well-nourished and to prevent loss of weight.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:May 23, 2018

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