A hidden problem in the digestive system: Let's simply learn about EPI (Exocrine Pancreatic Insufficiency)

Do you eat well, but feel like your body isn't getting the nutrients it needs? Do you constantly have stomach aches, feel full, or lose weight for no reason? Today we're going to talk about a medical condition that's behind all of these things, but that many people don't know about. This is called EPI, which stands for Exocrine Pancreatic Insufficiency. Although the name may sound complicated, let's keep it simple.

Simply put, what is EPI?

Imagine that in your abdomen, behind your stomach, there is a small organ called the pancreas . It is like a little factory in our body. This factory makes special chemicals, called digestive enzymes, that help us digest the food we eat.

Enzymes are like little workers who break down food. Their job is to break down the nutrients in the food we eat into small enough pieces for our bodies to absorb.

Now, here's what happens to someone with EPI:

Your pancreas, that enzyme factory, isn't working properly. That is, it's not making enough enzymes (those workers) to digest food. Or, the enzymes it does make don't work properly. What happens then? The food we eat isn't digested properly, the valuable nutrients it contains aren't absorbed by the body, and it just leaves the body.

There are three main types of enzymes produced by our pancreas:

• Amylase: This is what digests the carbohydrates we eat (like bread and rice).
• Lipase: This is what digests the fats (oils, butter, etc.) we eat.
• Protease and Elastase: These are used to digest the proteins we eat (such as meat, fish, eggs).

In EPI, the enzyme lipase, which digests fat, is most significantly reduced.

Why does EPI occur? Let's look at the reasons.

The causes of EPI can be different for adults and children.

Causes of EPI in adults

The leading cause of EPI in adults is chronic pancreatitis . Simply put, this is when the pancreas is inflamed and swollen for a long time. Think of it like a wound that keeps festering. Over time, the cells in the pancreas that make enzymes are gradually destroyed. About eight out of ten adults with this condition will develop EPI.

In addition, there are several other reasons.

Causes of EPI in children

The main cause of EPI in young children and infants is a condition called cystic fibrosis . This is a genetic disease that is passed down from parents to children. This disease causes the body to produce too much thick, sticky mucus. This mucus can build up in the lungs, making it difficult to breathe, and it can also block the ducts of the pancreas, blocking the passage of enzymes produced by the pancreas to the intestines.

Another genetic condition called Shwachman-Diamond Syndrome (SDS) is also a cause of EPI in children.

What are the symptoms of EPI?

A person with EPI is primarily unable to digest fat in their diet, which can lead to a variety of uncomfortable and troublesome digestive problems.

How does a doctor diagnose EPI?

Because these symptoms are similar to other stomach problems, only your doctor can tell for sure if you have EPI. If you have another condition that affects the pancreas (such as diabetes), your doctor may suspect EPI.

One or more of the following tests may be done to make a diagnosis:

• Fecal Elastase Test (FE-1): This tests a sample of your stool to see if you have an enzyme called elastase, which helps digest proteins. If it is low, you may have EPI.
• Fecal Fat Test: This measures how much fat is in the stool. Too much fat means that the body is not absorbing it.
• Secretin Pancreatic Function Test: This is a slightly more complicated test. In this test, a hormone called 'secretin' is given into the body through a vein in the arm. This hormone 'signals' the pancreas to produce enzymes. Then, the doctor collects the fluid from the pancreas using a method such as endoscopy and checks for the presence of enzymes.

In addition, tests such as a CT scan or ultrasound scan may be performed to check for any problems with the pancreas.

What are the complications of EPI?

The main risk of EPI is nutritional malabsorption . This means that the body is unable to absorb the valuable substances in food, such as fats, proteins, and carbohydrates. These nutrients are essential for our bodies to provide energy and for organs to function properly.

When you continue to go without nutrition like this, your body becomes weak. We call that malnutrition .

What are the treatments for EPI?

EPI is a lifelong condition. This means that it cannot be completely cured. However, with the right treatment, it can be very well controlled and you can live a normal life. The main goal of treatment is to provide your body with the nutrients it needs.

• Pancreatic Enzyme Replacement Therapy (PERT): This is the main treatment. Simply put, it is a pill (capsule) that gives you the enzymes that your body is not making. You take this pill with every meal and snack . The enzymes in the pill help you digest the food you eat.

• High-calorie, high-fat diet: It is important to get enough calories and fat from food. This is necessary because fat helps the body absorb nutrients. It can be helpful to seek advice from a qualified dietitian for this.

• Vitamins: People with EPI may not be able to absorb enough fat-soluble vitamins, such as vitamins A, D, E, and K. So, if you need these vitamins, your doctor will prescribe them as medication.

Is there a way to prevent this situation?

Genetic diseases that cause EPI (such as Cystic Fibrosis) cannot be prevented. However, the risk of chronic pancreatitis, the most common cause among adults, can be reduced.

Smoking and drinking alcohol are very stressful for the pancreas. These things increase the risk of inflammation of the pancreas (pancreatitis) and developing EPI. Therefore, completely avoiding smoking and alcohol consumption is very important for pancreatic health.

When to see your doctor

If you have one or more of the following symptoms, see your doctor as soon as possible.

It will be very helpful for you to ask these questions when you visit your doctor:

• What causes me to develop EPI?
• What treatment is best for me?
• What changes should I make to my diet?
• Should I take vitamins?
• What complications should I be concerned about?

Living with EPI can be challenging, but remember that with the right treatment and lifestyle changes, you can live a completely healthy life.

EPI, Exocrine Pancreatic Insufficiency, Pancreas, Digestion, Enzymes, Fatty Stool, PERT