EPI Frequently Asked Questions

EPI is a condition where your pancreas doesn't produce enough digestive enzymes to properly break down food. This leads to malabsorption of nutrients, particularly fats, proteins, and carbohydrates. Without adequate enzymes, food passes through your system partially undigested, causing symptoms like steatorrhea (oily stools), weight loss, and nutritional deficiencies.

The most common causes of EPI include chronic pancreatitis (accounting for 70-80% of cases), cystic fibrosis, pancreatic cancer or surgery, diabetes mellitus, celiac disease, and inflammatory bowel diseases like Crohn's disease. Any condition that damages the pancreas or blocks the pancreatic duct can lead to EPI.

EPI is more common than many realize. It affects 80-90% of people with cystic fibrosis, 30-40% of those with chronic pancreatitis, 20-30% with pancreatic cancer, and 5-10% with diabetes mellitus. Many cases remain undiagnosed because symptoms overlap with other digestive conditions.

EPI cannot be cured, but it can be effectively managed. Pancreatic Enzyme Replacement Therapy (PERT) is the primary treatment, helping your body digest food properly. With proper management, most people with EPI can live normal, healthy lives with good nutrition and minimal symptoms.

No, they are different but related. Pancreatitis is inflammation of the pancreas, while EPI is a functional deficiency where the pancreas doesn't produce enough enzymes. However, chronic pancreatitis is the leading cause of EPI because repeated inflammation damages the enzyme-producing cells.

The hallmark symptoms include: steatorrhea (pale, oily, foul-smelling stools that float), chronic diarrhea, bloating and gas, abdominal discomfort, unintentional weight loss, and signs of malnutrition like fatigue, muscle weakness, and vitamin deficiencies. Symptoms often worsen after eating fatty foods.

EPI is typically diagnosed through a combination of symptom assessment, stool tests (fecal elastase-1 is the most common), and sometimes imaging studies. A fecal elastase level below 200 μg/g suggests EPI, while below 100 μg/g indicates severe EPI. Your doctor may also order blood tests to check for nutritional deficiencies.

EPI stools are distinctive: they tend to be pale, greasy or oily in appearance, foul-smelling, bulky, and often float due to high fat content. You may notice an oily film in the toilet bowl. This is called steatorrhea and results from undigested fat passing through your system.

Yes, unintentional weight loss is one of the most common EPI symptoms. Because your body can't properly absorb nutrients from food, you may lose weight despite eating adequate calories. This malabsorption can also lead to deficiencies in fat-soluble vitamins (A, D, E, K) and other essential nutrients.

While both cause digestive symptoms, key differences exist. EPI typically causes oily/fatty stools that float, weight loss, and nutrient deficiencies – these are NOT typical of IBS. IBS usually doesn't cause malabsorption or weight loss. A fecal elastase test can definitively distinguish between the two conditions.

Pancreatic Enzyme Replacement Therapy (PERT) is the primary treatment for EPI. These prescription medications contain digestive enzymes (lipase, protease, and amylase) derived from porcine (pig) pancreas. They help your body digest fats, proteins, and carbohydrates. Brand names include Creon, Zenpep, Pancreaze, Pertzye, and Viokace.

PERT should be taken with every meal and substantial snack. Swallow capsules whole with water at the beginning of your meal, or split the dose (half at start, half during). Never take enzymes after eating – they need to mix with food. Don't crush or chew capsules as this destroys the enteric coating.

Dosing is individualized based on fat content of meals. A typical starting dose is 500-1000 lipase units per gram of dietary fat, or 25,000-50,000 units per meal. Your doctor will adjust based on your response. Snacks typically require half the meal dose. Always follow your healthcare provider's specific instructions.

If you realize during the meal, take them immediately – they can still help with the food remaining in your stomach. If you've already finished eating, don't double your next dose. Taking enzymes after a meal provides limited benefit. Try using reminders or keeping enzymes visible to prevent forgetting.

PERT is generally well-tolerated. Possible side effects include abdominal discomfort, nausea, diarrhea or constipation, and headache. Very high doses over time can rarely cause fibrosing colonopathy. Most side effects are mild and may indicate a need for dose adjustment. Report persistent issues to your doctor.

Yes, but timing matters. Proton pump inhibitors (PPIs) like omeprazole are often prescribed with PERT because they can improve enzyme effectiveness by reducing stomach acid that may degrade the enzymes. Take the PPI 30-60 minutes before your meal and PERT, as directed by your doctor.

Not necessarily with proper PERT. While older guidance recommended strict low-fat diets, current recommendations emphasize eating normally with adequate enzyme doses. However, moderating fat intake can help control symptoms, especially when starting treatment. Work with a dietitian to find the right balance for you.

Focus on limiting rather than eliminating. Be cautious with: very high-fat foods (fried foods, fatty meats, creamy sauces), large portions of fat at once, alcohol, and highly processed foods. Individual tolerance varies – keep a food diary to identify your personal triggers.

EPI-friendly foods include: lean proteins (chicken, fish, turkey), fruits and vegetables, whole grains, low-fat dairy, healthy fats in moderation (olive oil, avocado), and well-cooked, easily digestible foods. Eating smaller, more frequent meals can also help with digestion.

Often yes. Fat-soluble vitamins (A, D, E, K) are commonly deficient in EPI because they require fat absorption. Your doctor should monitor vitamin levels and may recommend supplements. Water-soluble supplements are usually absorbed normally, but fat-soluble vitamins may need special formulations designed for malabsorption.

It's best to limit or avoid alcohol. Alcohol can worsen pancreatic damage (especially if EPI is caused by pancreatitis), increase symptoms, and interfere with nutrient absorption. If you do drink occasionally, keep it minimal and always take your PERT with any alcoholic drinks that contain calories.

Eating out is possible with planning: research menus ahead, choose grilled/baked options over fried, ask about preparation methods, bring your enzymes and take them discreetly, start with smaller portions, and don't be afraid to make special requests. Many restaurants accommodate dietary needs.

Absolutely! With proper treatment and management, most people with EPI live full, active lives. The key is consistent PERT use, working with your healthcare team, maintaining good nutrition, and learning to manage your condition. Many people report their quality of life significantly improves once EPI is properly diagnosed and treated.

This depends on the underlying cause. If caused by progressive conditions like chronic pancreatitis, enzyme production may continue to decline. However, this doesn't mean symptoms will worsen – PERT doses can be adjusted as needed. Regular monitoring and working with your doctor helps maintain good control.

Yes, living with any chronic condition can impact mental health. The uncertainty, dietary restrictions, and symptoms can cause anxiety or depression. This is normal and treatable. Don't hesitate to discuss mental health concerns with your healthcare provider – many find that proper EPI treatment also improves their emotional wellbeing.

Planning is key: pack extra enzymes in carry-on luggage, bring a doctor's letter explaining your medication, research food options at your destination, carry safe snacks, and know where to find pharmacies if needed. Many people with EPI travel extensively with minimal issues once they have a system in place.

This is a personal choice. Telling close friends and family can provide support and make social eating easier. You don't need to explain details – simply saying you have a digestive condition that requires medication with meals is usually sufficient. Most people are understanding when they know you have a health need.