Pancreatic Exocrine Insufficiency: Symptoms, Diagnosis, & Treatment

Bloating, stomach cramps, and loose stools are three signs that may be associated with pancreatic exocrine insufficiency (also known as PEI or EPI). Pancreatic insufficiency is observed in up to 80% of people with pancreatitis and celiac disease and can occur alongside other conditions like autoimmune diseases, cystic fibrosis, and more.

Pancreatic exocrine insufficiency may contribute to issues like malnutrition, osteoporosis, and muscle wasting if not addressed. A functional medicine approach to pancreatic exocrine insufficiency may help manage symptoms of PEI and support overall digestive health. Here’s what you need to know.

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What is Pancreatic Exocrine Insufficiency

The pancreas is a small digestive organ located under the stomach that helps to produce digestive enzymes like amylase, lipases, and proteases. These enzymes help break down food into particles small enough to be absorbed.

When the pancreas doesn’t produce enough enzymes, food may not be adequately broken down, and optimal amounts of nutrients might not be absorbed. This condition is called “Pancreatic Exocrine Insufficiency” (PEI) or “Exocrine Pancreatic Insufficiency” (EPI).

Pancreatic Exocrine Insufficiency Signs & Symptoms

PEI / EPI may cause noticeable issues with digestion, including:

• Diarrhea
• Foul-smelling, loose stools
• Greasy, fatty stools that float
• Flatulence
• Bloating
• Stomach discomfort and cramping

Due to the potential malabsorption of nutrients associated with PEI / EPI, people with this condition might also experience other issues, including:

• Weight loss
• Muscle wasting
• Nutrient deficiencies, including those deficiencies of
• Fat soluble vitamins like vitamins A, D, E, and K
• Minerals like magnesium‍
• Total cholesterol
• Total protein

What Causes Pancreatic Exocrine Insufficiency

People with other medical conditions may experience PEI / EPI due to the impact these conditions can have on the pancreas. For example, 90% of people with cystic fibrosis may experience PEI, and up to 80% of people with chronic pancreatitis or who’ve undergone abdominal surgery may also experience pancreatic exocrine insufficiency.

Much of the data we have on pancreatic insufficiency management comes from studying people with chronic pancreatitis. Common factors associated with PEI / EPI include:

• Excessive Alcohol consumption
• Malabsorptive conditions like Celiac disease and IBD
• Diabetes, including Type 1 and Type 2 Diabetes
• Small intestinal bacterial overgrowth is associated with PEI / EPI

Other less common risk factors for the development of PEI include

• Abdominal surgeries, including Gastric bypass surgery, Small bowel surgery, Abdominal lymph node dissection
• Pancreatic duct obstruction
• Bone marrow disorders
• Hemochromatosis and iron-storage disorders which can cause the accumulation of iron and other heavy metals in the pancreas

What are The complications of Pancreatic Exocrine Insufficiency?

Because a major consequence of PEI is inadequate digestion, the significant complications associated with pancreatic exocrine insufficiency may result from the nutrient deficiencies it can induce. These include things like

• Osteopenia and osteoporosis
• Vitamin D deficiency
• Vitamin A deficiency
• Vitamin E deficiency
• Magnesium deficiency
• Phosphorus and protein deficiency

These deficiencies can contribute to poor night vision, impaired immune function, dry skin, muscle tension, muscle wasting, and more.

Functional Medicine Labs to Test for Root Cause of Pancreatic Exocrine Insufficiency

Fecal Elastase

Fecal Elastase-1 values under 200 are considered indicative of pancreatic exocrine insufficiency. This test detects the amount of pancreatic elastase in a stool sample. It can be run independently or as part of a comprehensive stool test like the GI Effects.

Tests to Rule Out Root Causes of PEI

• Celiac disease testing
• SIBO testing
• Liver enzyme testing
• Iron and ferritin to rule out iron storage diseases like hemochromatosis that can impact pancreatic function
• A1C to assess for blood sugar regulation and screen for diabetes
• Fecal or serum calprotectin, Fecal lactoferrin, and serum C-reactive protein (CRP) can help to identify IBD if it is present.

Functional Medicine Approaches for PEI

PERT

A common approach for managing pancreatic exocrine insufficiency is to supplement pancreatic enzymes while working to support overall pancreatic health. This is called PERT, or pancreatic enzyme replacement therapy. Supplemental enzymes may include lipase, protease, and amylase.

Lifestyle and Root Cause Medicine

• People with pancreatic insufficiency may benefit from avoiding smoking and alcohol consumption.
• People with inflammatory bowel disease (IBD) may consider managing their condition with the guidance of a healthcare provider.
• People with celiac disease may benefit from adopting and maintaining a 100% gluten-free diet
• People with SIBO may explore addressing their condition with the help of a healthcare professional.
• People with liver disease should address it using approaches recommended by their doctor
• If you have blood sugar issues, managing them can reduce the amount of stress put on pancreatic tissues.
• Chewing food thoroughly may increase the chances that pancreatic enzymes will successfully break down the proteins, carbohydrates, and fats contained within each meal. People with PEI might find it helpful to chew mindfully at meals before swallowing.

Summary

Pancreatic exocrine insufficiency can be associated with symptoms like stomach pain, bloating, and diarrhea. A functional medicine approach to PEI includes exploring potential root causes and considering supplementation with digestive enzymes (known as PERT or pancreatic enzyme replacement therapy). With proper management and care, you may support your digestive health and improve your symptoms.