Pancreatitis, cystic fibrosis and other conditions that affect the pancreas cause exocrine pancreatic insufficiency (EPI). People with EPI don’t have enough pancreatic (digestive) enzymes to break down foods and absorb nutrients. It can lead to malnutrition. Pancreatic enzyme replacement therapy (PERT) can help.
EPI occurs when your pancreas doesn’t make enough digestive enzymes. Sometimes the enzymes don’t work as they should.
Enzymes are proteins that cause chemical reactions in your body. Digestive enzymes break down food, allowing your body to get nutrients. Children with cystic fibrosis and adults with chronic pancreatitis are most likely to have EPI.
The pancreas is part of your digestive system. It makes enzymes that aid digestion and help your body absorb nutrients.
When you have EPI, you don’t have enough digestive enzymes. Foods pass through your intestines in a more complete (undigested) state. As a result, your body doesn’t get the nutrients it needs from foods.
The different types of pancreatic enzymes include:
Chronic pancreatitis is the main cause of EPI in adults. As many as 8 in 10 adults with this disorder develop EPI. Pancreatitis causes inflammation and swelling of the pancreas. Over time, chronic inflammation can damage the pancreatic cells that make digestive enzymes.
Other causes of EPI in adults include:
Cystic fibrosis is the top cause of EPI in infants and children. Children inherit cystic fibrosis from a parent. It causes thick mucus to build up in the lungs, making breathing difficult. Mucus also collects in the pancreas, which keeps digestive enzymes from reaching the small intestine.
Nearly 9 in 10 infants with cystic fibrosis develop EPI within the first year. The rest are at risk for developing EPI during childhood or adulthood.
Another inherited condition, Shwachman-Diamond syndrome (SDS), also causes EPI in children. With SDS, the part of the pancreas that makes enzymes doesn’t work properly.
People with EPI have a particularly difficult time absorbing fats from foods. This leads to uncomfortable digestive problems, such as:
Many digestive problems cause symptoms similar to EPI. Your healthcare provider may suspect EPI if you have a condition that affects your pancreas.
You may get one or more of these pancreas function tests:
People with EPI can’t absorb enough fats, proteins and carbohydrates from foods. This problem is called malabsorption. Your body needs these nutrients for energy and to maintain organ function. Malabsorption of nutrients can lead to malnutrition.
Signs of malnutrition include:
EPI is a lifelong condition. Treatments focus on getting your body the nutrients it needs to maintain good health. Treatments include:
It’s helpful to avoid smoking and alcohol use. These substances make your pancreas work harder and can contribute to pancreatitis, which can lead to EPI. Your healthcare provider can offer support to stop using these substances.
Because cystic fibrosis and SDS are inherited, you can’t prevent them or lower the risk of EPI with the conditions. Keeping a close eye on symptoms can help identify possible EPI so you can treat it right away.
For a longer, healthier life, it’s important to manage the condition that causes EPI. Most people will always need to use PERT to manage EPI symptoms.
About half of kids with SDS start producing digestive enzymes as they get older. They may be able to stop PERT.
You should call your healthcare provider if you experience:
You may want to ask your healthcare provider:
You can’t cure EPI, but pancreatic enzyme replacement therapy can greatly reduce uncomfortable digestive symptoms. Follow your healthcare provider’s recommendations for taking PERT, and be sure to take it with every meal or snack. A dietitian can help you get the fats, nutrients and vitamins you need for good health.
Last reviewed by a Cleveland Clinic medical professional on 06/10/2021.
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