Treatment Options for Exocrine Pancreatic Insufficiency

 What is EPI?

Exocrine pancreatic insufficiency (EPI) develops when your pancreas doesn’t make or release enough digestive enzymes.

This leaves undigested food in your intestines and causes gut pain, bloating, and diarrhea. Severe EPI can cause fatty, loose stools and weight loss from malnutrition.

A variety of conditions can cause EPI including:

Your doctor will likely first recommend dietary and lifestyle changes to alleviate your symptoms, regardless of the underlying cause of your EPI.

If you have severe EPI or have had digestive tract surgery, your doctor will prescribe enzymes to replace the ones your pancreas normally releases.

While there’s no cure for EPI, your doctor will work with you to find treatments that can ease your symptoms, treat any underlying conditions, and, ultimately, improve your quality of life.

Here are some medications that can help in treating and managing EPI:

Prescription medications

The pancreas releases digestive enzymes, such as amylase, lipase, and protease into the small intestine. These enzymes are necessary for proper digestion. Since the pancreas isn’t producing enough of these enzymes, you might benefit from pancreatic enzyme replacement therapy (PERT).

PERT can replace enzymes and help you absorb nutrients from the foods you eat. Your doctor will decide on the dose based on the severity of your condition.

You’ll take capsules at the beginning of every meal or snack and never on an empty stomach. Your doctor or dietitian will explain how and when to take it. To be effective, they must be taken exactly as prescribed every time you eat.

If you have problems with heartburn while taking PERT, your doctor may add a proton pump inhibitor (PPI) to reduce stomach acid.

PPIs work by reducing the amount of acid the glands in the lining of your stomach produce. Not everyone on PERT needs PPIs.

Over-the-counter (OTC) medications

If you tend to get mild heartburn, you might not need a prescription-strength PPI. These medications are available over the counter under names such as esomeprazole (Nexium) and lansoprazole (Prevacid).

Your gastroenterologist may recommend a specific OTC product in a particular dose. You can also ask your pharmacist for recommendations.

There are some pancreatic enzyme replacement supplements available without a prescription. These supplements vary in consistency and potency.

If you have EPI, you should avoid OTC pancreatic enzyme replacement supplements.

If you do decide to try them, be sure to talk to your doctor so that they know exactly what supplement you’re considering. That information can help your healthcare provider determine if the supplement is right for you based on your medical situation.

Your doctor can prescribe PERT, if necessary, and you’ll have the added benefit of medical supervision as you try to improve symptoms.

In the past, EPI was treated with a low fat dietTrusted Source.

Low fat diets are no longer recommended because they can make weight loss worse. A low fat diet also makes it more difficult for your body to absorb the vitamins that dissolve in fat.

Instead, your doctor may advise you to eat healthy fats.

Healthy fats are found in:

  • nuts
  • seeds
  • plant-based oils
  • fish

You should avoid hard-to-digest and highly processed foods, especially those containing hydrogenated oils or large quantities of animal fat.

Eating too much fiber can also tax your digestive system. Eating frequent, smaller meals and avoiding large, heavy meals will make it easier for your gut to break down fats and proteins.

Everyone is different, so it may take some time to find the diet that works best for you. You may wish to consult with a dietitian to learn more about planning healthy, affordable meals and snacks that ease your EPI symptoms.

EPI interferes with your body’s ability to absorb nutrients from food. This can affect your intake of fat-soluble vitamins A, D, E, and K. You may need to take dietary supplements.

If you’re on PERT, however, you may be able to get all the nutrients you need from a proper diet without supplements.

Also, some supplements can interfere with OTC or prescription medications. Your gastroenterologist may recommend very specific vitamins and minerals in precise amounts.

Be sure to talk with your doctor before taking dietary supplements.

Talk to your doctor about potential lifestyle changes to improve your symptoms of EPI. The following are some steps you can take to improve your quality of life with EPI:

  • Maintain a healthy diet. Maintain a well-balanced diet based on your doctor’s recommendations. If you need help getting started, consider working with a dietitian.
  • Avoid alcohol. Alcohol can harm your pancreas. If you have trouble avoiding alcohol, talk to your doctor about how to quit safely.
  • Quit smoking. Smoking is associated with pancreatic conditions such as pancreatitis and pancreatic cancer. If you smoke, ask your doctor for information on smoking cessation programs.
  • Exercise regularly. Regular movement can promote your overall health. Ask your doctor about the best exercises for you.
  • Relieve stress. You can’t completely eliminate stress, but you can learn ways to cope. Try deep breathing exercises, yoga, or tai chi.

Also, it always helps to be prepared. Here are some things you can do to educate yourself about EPI and be ready for any situation:

  • Learn all you can about EPI.
  • Keep a food journal to figure out which foods trigger symptoms or make matters worse.
  • Partner with your doctor by reporting new or worsening symptoms right away.
  • Have loose-fitting clothing on hand for when you feel bloated or have pain.
  • Keep your prescriptions up to date and keep your medication on hand. If you’re on PERT, be sure to take some with you when you leave home.

Almost half of the peopleTrusted Source treated with enzyme replacement therapy don’t fully return to normal fat digestion. This can happen for a number of reasons, including incorrectly taking your enzyme replacements or doses that are too low.

Acid imbalances in the gut or germ overgrowth in the intestines can also prevent the therapy from working.

If your treatment isn’t working, your doctor may need to change your treatment plan.

Changes could include:

  • increasing your enzyme doses
  • prescribing proton pump inhibitors
  • treating you for germ overgrowth in your intestines

If your symptoms still don’t improve, your doctor may evaluate you for a condition other than EPI.

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