What is EPI?
Exocrine Pancreatic Insufficiency (EPI) is a disorder of the pancreas that is commonly under-diagnosed. It is the inability of the exocrine pancreas to produce and secrete the enzymes necessary for digestion. These enzymes include amylase, which is needed for digesting carbohydrates such as fruits and vegetables, starches found in grains, and sugar; lipase, which is required for the digestion of fats; and trypsin, and proteases which are essential for digesting proteins. The loss of these digestive enzymes eventually leads to maldigestion and malabsorption of nutrients in the body.
The most common cause of EPI is chronic pancreatitis. Pancreatitis is an inflammation of the pancreas due to the overproduction of the enzymes lypase and amylase. The overproduction of these enzymes can be caused by several factors, which include medications, metabolic disorders, previous surgeries, heavy alcohol use, poor dietary choice, and gallstones. Because of other health issues and past surgeries, I have personally endured the pain of pancreatitis and say with confidence that this is a condition that you want to prevent encountering. It is important to maintain a healthy diet, be accurately informed on the medications you take and limit your use of alcohol and other substances that are not good for your body. Acute pancreatitis, a sudden inflammation, can range from mild abdominal discomfort to a serious, life threatening illness.
Non-pancreatic related conditions that are linked to EPI include Crohn’s Disease, Shwachman-Diamond Syndrome, Cystic Fibrosis, Celiac Disease, and Zollinger-Ellison Syndrome. All of these conditions affect the pancreas in various ways that lead to a decrease in pancreatic stimulation, thus causing a deficiency of necessary digestive enzymes.
Although this disease is occurs in humans, it is also frequently found in dogs. Exocrine Pancreatic Insufficiency is also referred to as Pancreatic Hypoplasia or Pancreatic Acinar Atrophy.
What are the Symptoms of EPI?
When the pancreas becomes atrophied, meaning it is wasting or decreasing in size, it can no longer produce all of the enzymes necessary for digestion. In turn this causes specific symptoms to develop. These include, but are not limited to, abdominal pain or discomfort, bloating, steatorrhea (an excess of fat in the stool), a change in the consistency of stools, flatulence (gas), and weight loss. Malnutrition is the main causative factor of weight loss in EPI patients and has been related to a high morbidity rate.
How is EPI Diagnosed & Treated?
Symptoms of EPI may not appear until 75% to 80% of the exocrine pancreas acinar cells are damaged. Because of this, it is difficult to diagnose this disease or treat it in its early stages. The most reliable tests for EPI include checking serum levels of lipases (fats), proteases (proteins), and amylases (carbohydrates). Another method of choice by most physicians is a fecal fat quantification and a C-Triglyceride breath test. Triglycerides are the main components of natural fats and oils.
According to a company known as Lab Tests Online, the most efficient way to treat EPI is to treat the underlying condition that is causing the enzyme deficiency. At the very least, by treating the underlying condition, any additional damage to the pancreas will be avoided. Of course, treating only the underlying condition won’t treat the damage that has been caused by EPI. The most widespread form of treatment for exocrine pancreatic insufficiency is Pancreatic Enzyme Therapy and/or Replacement. Therapy involves administering the pancreatic enzymes that are missing orally. A common medication for EPI is a Pancreatic Enzyme Product (PEP) called pancrelipase. This is a drug that contains most of the pancreatic enzymes necessary for the digestion process. Pancreatic Replacement Therapy is a more complicated process and is administered according to the medical history of the patient.
Due to the development of malnutrition in exocrine pancreatic insufficiency patients, additional vitamin supplements can help a patient maintain better nutrition. Because it is difficult for a patient with EPI to break down and absorb fat-soluble vitamins, the particular vitamins A, D, E, and K are often added to a course of treatment. Green drinks available on the market generally include most, if not all, of the necessary nutrients our bodies need. These may be easier to absorb than some pills as they come in a powdered form.
Sources
Iliades, Chris, M.D. Everyday Health: Always Choose Well. 29 Jan. 2012.
< http://www.everydayhealth.com/health-report/exocrine-pancreatic-insufficiency.aspx>.
Lab Tests Online: American Association for Clinical Chemistry. 29 Jan. 2012.
Lohr, J.-M. (2007). Exocrine Pancreatic Insufficiency (Uni-Med Science) . Germany: UNI-MED VERLAG AG; 1 edition.
Baumel, H., Deisxonne, B., & Sarles, H. (2012). Exocrine Pancreatic Cancer. New York, New York: Springer; Softcover Reprint of the Original 1st Ed. 1986 Edition.
