Ways to Manage Exocrine Pancreatic Insufficiency

What is Exocrine Pancreatic Insufficiency (EPI)?

Exocrine pancreatic insufficiency (EPI) is a condition where the pancreas does not manufacture or fail to release adequate digestive enzymes. This causes undigested food to be left in your intestines, leading to gut pain, gas, diarrhea, and bloating.

Your symptoms are considered to be severe when 90 percent (1) of the pancreas’ normal enzyme production is gone. At this stage, you are more likely to experience symptoms that are associated with Exocrine pancreatic insufficiency. The standard symptoms of severe Exocrine pancreatic insufficiency include weight loss and loose and fatty stools known as steatorrhea.

There are many conditions that can cause Exocrine pancreatic insufficiency. These include:

The severity of your symptoms, your overall lifestyle, and any coexisting medical condition you have are all factors that your doctor will take into account while deciding on your treatment.

The first recommendation your doctor is going to give is to carry out some healthy dietary and lifestyle changes to relieve your symptoms, regardless of what is the underlying cause of your Exocrine pancreatic insufficiency.

If you are suffering from severe Exocrine pancreatic insufficiency or you have previously undergone a digestive tract surgery, then your doctor is likely to prescribe certain enzymes to replace the ones that your pancreas are supposed to release normally.

There is no cure for Exocrine pancreatic insufficiency, but your doctor will work together with you to find the best possible treatment that will alleviate your symptoms and also treat the underlying health condition that is causing Exocrine pancreatic insufficiency. This should improve the overall quality of your life as well.

Let us look at the ways to manage Exocrine pancreatic insufficiency, beginning with dietary changes.

Ways to Manage Exocrine Pancreatic Insufficiency

Some of them:

Dietary Changes

In the past, doctors used to treat Exocrine pancreatic insufficiency by recommending a low-fat diet, and studies carried out by the University of Gothenburg in Sweden also proved the effectiveness of a low-fat diet in treating Exocrine pancreatic insufficiency. (2) However, low-fat diets are no longer the conventional treatment because of the fact that they worsen the symptom of weight loss when you have Exocrine pancreatic insufficiency. A low-fat diet also makes it more challenging for the body to absorb the vitamins that dissolve in fat.

Now doctors advise Exocrine pancreatic insufficiency patients to eat plenty of healthy fats. Healthy fats can be found abundantly in nuts and seeds, fish, and plant-based oils. You will be told to avoid highly processed and hard to digest foods, particularly those that contain hydrogenated oils or those that have a substantial quantity of animal fat. You will also be advised to eat frequent but smaller meals. Avoiding a large and heavy meal makes it easier for your digestive system to break down the fats and proteins present in your food.

As every person is different, it might take you some time to find the exact diet that works best for alleviating your symptoms. If you need to advise on what to eat and what to avoid, then consulting a dietitian is a good idea as they will help you plan a healthy, affordable, easy to make meals and snacks that will ease your Exocrine pancreatic insufficiency symptoms.

Otherwise, also, your gastroenterologist will work closely with you to ensure that you keep getting the right nourishment from your food in order to prevent the loss of nutrients due to Exocrine pancreatic insufficiency.

Dietary Supplements

When you have Exocrine pancreatic insufficiency, it makes it difficult for the body to use the fat present in your food. This means that you may end up having a shortage of fat-soluble vitamins. In this case, your doctor will recommend that you take supplements of vitamins A, D, E., and K.

However, keep in mind that certain supplements can interfere with prescription or over-the-counter (OTC) medications. Do not take any supplements or OTC medicines without consulting your doctor.

Your gastroenterologist may also recommend that you take some very specific vitamins and minerals and that too in precise amounts.

Lifestyle Changes

Your doctor will also advise you to carry out certain lifestyle changes that will benefit the symptoms of Exocrine pancreatic insufficiency. Here are some lifestyle tips that you should consider to improve your overall quality of life when you have Exocrine pancreatic insufficiency:

Follow a healthy diet: Maintaining a healthy and well-balanced diet as per your doctor’s recommendations is essential in curbing your symptoms and getting the necessary nutrients that your body needs. You can consult a nutritionist if you have trouble getting started.

Avoid alcohol: Alcohol is going to cause further harm to your pancreas. If you find it difficult to stop drinking, then you can consider asking your doctor for help on how to quit alcohol safely.

Quit smoking: Smoking and second-hand smoke harm the body in many ways. Smoking is also linked with pancreatic conditions such as pancreatic cancer and pancreatitis. If you are a heavy smoker, then you should seek help on how to quit smoking.

Regular exercise: Regular physical activity is important in promoting your overall health. Your doctor will advise you on the best exercises for your condition.

Lower your stress: While it is impossible to eliminate stress from our lives completely, there are ways by which we can learn to lower our stress levels. Deep breathing exercises, tai chi, meditation, and yoga are just some ways in which you can cope with stress better.

Apart from making healthy changes to your lifestyle, it also helps you to know more about your condition. Educate yourself about Exocrine pancreatic insufficiency and be prepared for any type of situation. Here are some tips:

  • Educate yourself and learn all you can about Exocrine pancreatic insufficiency.
  • Maintain a food journal to understand which foods trigger your symptoms and which ones help soothe your stomach.
  • Report any new or worsening symptoms to your doctor at the earliest.
  • Opt for wearing or keeping loose-fitting clothes with you for when you have pain or feel bloated.
  • Keep your prescriptions updated and medications filled.

Pancreatic Enzyme Replacement Therapy

When functioning normally, the pancreas release several types of digestive enzymes, including lipase, amylase, and protease, into the small intestine. These digestive enzymes are responsible for proper digestion. When you have Exocrine pancreatic insufficiency, the pancreas is not able to produce a sufficient amount of these enzymes. As a result, your doctor may recommend pancreatic enzyme replacement therapy (PERT).

PERT helps the body break down and absorb protein and fat again, and also helps the body replace the digestive enzymes. (3) Doctors prescribe PERT in order to prevent the onset of severe Exocrine pancreatic insufficiency symptoms such as weight loss and malnutrition. If you have Exocrine pancreatic insufficiency and you have symptoms of fatty stools and weight loss, or if you have had surgery of the gastrointestinal tract, then it is likely that you will be taking pancreatic digestive enzymes along with each meal and snack.

Your doctor customizes your enzyme dosage to your body’s abilities for digesting food and looking at the amount of fat you consume. The treatment of PERT works best if you are able to spread out the dosage of enzymes while you eat a meal or snack. When you have fatty meals, you will need larger doses, and smaller and low-fat meals will require fewer enzymes.

If you also have a certain degree of loss of pancreatic function, but you do not have the classic symptoms of severe Exocrine pancreatic insufficiency, even then your doctor might recommend enzyme replacement therapy.

While taking PERT, some people experience problems with heartburn and your doctor may prescribe a proton pump inhibitor (PPI) to decrease the production of stomach acid. However, not everyone who is on PERT requires PPIs.

As of today, clinical trials and other studies have not found any serious side effects associated with enzyme replacement therapy. (4)

Proton Pump Inhibitors

Proton Pump Inhibitors (PPIs) help balance stomach acid to helps enzyme replacements function correctly. Your doctor may prescribe PPIs if PERT is not working or if PERT is giving you heartburn.

PPIs work by decreasing the amount of acid produced by the glands located in the lining of your stomach.

If you have mild heartburn, you may not need to take a prescription-strength PPI, but you can also opt for taking OTC PPIs such as lansoprazole (brand name Prevacid) and esomeprazole (brand name Nexium).

Either your gastroenterologist will recommend a particular OTC product to be taken in a specific dose, or you can also buy one yourself.

Conclusion

It has been observed that nearly half of the patients who are treated with PERT do not fully return to the normal process of fat digestion. (5) This can be due to many reasons, including not taking the enzyme replacements properly or taking doses that are too low for your condition. Furthermore, acid imbalances in the stomach or overgrowth of bacteria in the intestines can also stop PERT from working correctly.

If your treatment does not work, then your doctor will evaluate your entire treatment plan and also check whether you have been following the plan correctly or not. If you have been following the treatment guidelines diligently, then your doctor is likely to change the treatment regimen. These changes could include prescribing PPIs, increasing the dosage of enzymes, or treating the bacteria overgrowth in your intestines. If your symptoms still don’t improve, then your doctor will evaluate you for other gastrointestinal conditions than Exocrine pancreatic insufficiency.

Work closely with your doctor and take your medications as your doctor recommends. Make the necessary dietary and lifestyle changes to alleviate your symptoms. By learning to successfully your Exocrine pancreatic insufficiency symptoms, you will be able to not only enjoy what you eat but also improve the quality of your life.

References:

  1. DiMagno, E.P., Go, V.L. and Summerskill, W.H.J., 1973. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. New England Journal of Medicine, 288(16), pp.813-815.
  2. Lindkvist, B., 2013. Diagnosis and treatment of pancreatic exocrine insufficiency. World Journal of Gastroenterology: WJG, 19(42), p.7258.
  3. Jutta, K. and Lankisch, P.G., 2001. Pancreatic enzyme replacement therapy. Current gastroenterology reports, 3(2), pp.101-108.
  4. Hammer, H.F., 2010. Pancreatic exocrine insufficiency: diagnostic evaluation and replacement therapy with pancreatic enzymes. Digestive diseases, 28(2), pp.339-343.
  5. Lindkvist, B., 2013. Diagnosis and treatment of pancreatic exocrine insufficiency. World Journal of Gastroenterology: WJG, 19(42), p.7258.

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