Exocrine pancreatic insufficiency (EPI) develops when the pancreas produce or deliver enough of those enzymes. In this article, we look at the various causes of the condition. 

Exocrine pancreatic insufficiency occurs when the pancreas stops releasing enough enzymes to support normal digestion

The symptoms of EPI become most noticeable when production of lipase drops to 5%-10% of normal. When this happens, patients experience weight loss, diarrhoea, fatty and oily stools and symptoms associated with malnutrition. 

Causes 

EPI occurs when the pancreas stops releasing enough enzymes to support normal digestion. There are a variety of conditions or events can damage the pancreas and lead to EPI.  

Chronic pancreatitis 

Chronic pancreatitis is inflammation of the pancreas that doesn’t go away over time. This form of pancreatitis is the most common cause of EPI in adults. The ongoing inflammation damages the acinar cells. This is why most people with chronic pancreatitis also develop exocrine insufficiency. 

Acute pancreatitis 

EPI is far less common in acute pancreatitis. Untreated acute pancreatitis can develop into the chronic form over time, increasing the chances of developing EPI. 

Autoimmune pancreatitis 

Steroid treatment may help people with autoimmune pancreatitis see improved enzyme production. 

Diabetes 

People with diabetes frequently develop EPI.  This is likely related to the hormonal imbalances that the pancreas experiences during diabetes. 

Surgery 

EPI is a common side effect of digestive tract or pancreas surgery. Up to 80% of patients who’ve had surgery on their pancreas, stomach, or upper small intestine will develop EPI. Stomach, intestinal, and pancreatic surgeries can also lead to EPI by changing the digestive system.  

Genetic conditions 

Cystic fibrosis causes the body to produce a thick mucus layer. This mucus clings to the lungs, digestive system, and other organs. 

Shwachman-Diamond syndrome is a very rare, inherited condition that affects the bones, bone marrow, and pancreas. People with this condition usually experience EPI in early childhood. Pancreatic function may improve in children as they mature. 

Coeliac disease 

Coeliac disease is associated with an inability to digest gluten. In this case, the symptoms may be caused by EPI that’s associated with Coeliac disease. 

Pancreatic cancer 

EPI is a complication of pancreatic cancer. The process of cancer cells replacing pancreatic cells can lead to EPI. A tumour may also block enzymes from entering the digestive tract. EPI is also a complication of surgery to treat pancreatic cancer. 

Inflammatory bowel diseases 

Crohn’s disease and ulcerative colitis are both inflammatory bowel diseases that cause the immune system to attack and inflame the digestive tract.  

Zollinger-Ellison syndrome 

This is a rare disease where tumours in the pancreas or elsewhere in the gut produce large amounts of hormones. This leads to excessive stomach acid, which keeps digestive enzymes from working properly and causes EPI.  

REFERENCES: Available on request.