Exocrine Pancreatic Insufficiency (EPI)

Exocrine pancreatic insufficiency (EPI) is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas.  EPI is most often found in humans afflicted with cystic fibrosis and Shwachman-Diamond Syndrome. EPI is caused by a progressive loss of the pancreatic cells that make digestive enzymes.  Loss of digestive enzymes leads to maldigestion and malabsorption of nutrients.

In humans, the common causes of EPI are Cystic Fibrosis, which is a hereditary recessive disease of Europeans and Ashkenazi Jews involving a chloride channel called CFTR, and chronic pancreatitis. Shwachman-Diamond Syndrome is the second most common cause of pancreatic insufficiency in humans.

EPI is also fairly common in diabetes – both type 1 and type 2. Studies have shown that about 35% of type 2 diabetics and 50% of type 1 diabetics exhibit symptoms and characteristics of EPI. However, treatment is normally only initiated once the patient complains of problems with steatorrhea, bulky stools, abdominal pain, and/or flatulence. Some clinicians refer to this phenomenon as “diabetic diarrhea”, however this term is rarely explained as a symptom of EPI possibly because it could also be linked to GI motility problems. Limited and preliminary studies have indicated that treatment of EPI with products such as Pancrelipase have an effect on glucose control. Also, there have been only small differences in the fat soluble vitamin status of diabetics treated with products such as Pancrelipase, as steatorrhea can lead to a decrease in the absorption of fat soluble vitamins.

Often this is treated with Pancreatic Enzyme Products (PEPs), such as pancrelipase, that are used to break down fats (lipases), proteins (proteases) and carbohydrates (amylases) into units that can be digested by those with EPI.


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