Exocrine Pancreatic Insufficiency

Bloating, Crampy Abdominal Pain with Changing Bowel Habits?

Irritable bowel syndrome? Not always.

Exocrine pancreatic insufficiency or EPI is often overlooked by healthcare providers and has many similar symptoms as IBS. Mild cases present only with bloating, while more severe cases can additionally have fatty, greasy foul smelling stools that often float in the toilet along with fat soluble vitamin deficiencies and weight loss. Given that bloating is such a non-specific symptom, EPI, is often not evaluated for.

Why do these symptoms occur?

This condition occurs when the pancreas is not producing enough enzymes to break down fats, starches and proteins.

What causes it?

Chronic pancreatitis, prior pancreatic resection, cystic fibrosis among other more rare conditions. In clinical practice EPI is much more common than suggested. Frequent alcohol use and smoking damages the pancreas and its suspected this may lead to an increase in prevalence of this condition.

Who should be tested?

My personal belief is that all patients with bloating and any inconsistency in their stool habits should be tested for this condition as the test is simple and inexpensive and can give a definitive diagnosis.

How is it treated?

The treatment is simple enzyme replacement therapy which are pills taken with each meal. The enzymes mix with the food in the small intestine, just as the enzymes would if they were released from a functioning pancreas and help break down the nutrients so your body can absorb and assimilate them.

Why is this important?

I love catching this diagnosis because symptom improvement is instantaneous with enzyme replacement and many patients who are mislabeled as irritable bowel syndrome, as symptoms are similar, have an actual easily treatable condition which can immediately improve their life and well-being.