Written by Christine Giordano, MD | Reviewed by Patricia Pinto-Garcia, MD, MPH
Key takeaways:
Exocrine pancreatic insufficiency is a medical condition that makes it hard to digest food. It can lead to nutrition and vitamin deficiencies, which can affect your health.
Symptoms of exocrine pancreatic insufficiency may be mild like stomach pain, cramping, bloating, and gassiness. Some people experience more severe symptoms like greasy, loose stools, night blindness, osteoporosis, and bleeding or bruising.
Medications called replacement digestive enzymes can treat exocrine pancreatic insufficiency and help to ease symptoms.
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The pancreas is an important organ that makes enzymes that play key roles in your health. You’re probably familiar with insulin, one of the key enzymes made by the pancreas that controls blood sugar.
The pancreas also makes three other enzymes called protease, amylase, and lipase. These digestive enzymes are made in the pancreas and then travel into the intestines. In the intestines, these enzymes break down the food you eat so that your body can absorb key nutrients.
Some people have medical conditions that keep the pancreas from making key enzymes. People with Type 1 diabetes, for example, can’t make insulin. But other people don’t make enough digestive enzymes and develop a condition called exocrine pancreatic insufficiency.
Pancreatic insufficiency may not be as familiar to most people as diabetes. But exocrine pancreatic insufficiency can take a toll on a person’s health. Symptoms of exocrine pancreatic insufficiency vary from person to person, making the condition difficult to spot. Here are five warning signs that may mean you’re having trouble making digestive enzymes.
Greasy or oily bowel movements
Many people with pancreatic insufficiency first realize something’s not right when they develop changes in their stool. People with pancreatic insufficiency develop a condition called steatorrhea, which means there’s too much fat in their bowel movements. These stools look greasy or oily. They’re also looser than normal and smell worse.
The contrast is usually more obvious when the stool is in the toilet because the fat in the stool will separate from the water in the toilet. Stools tend to float to the top of the toilet bowl instead of sinking to the bottom. And they’re more difficult to flush, too. Most people have to flush a few times to get their stool to completely disappear.
Normally, digestive enzymes made by the pancreas break down most of the fat people eat. The intestines then absorb this fat. While some fat does pass through the intestines without being absorbed, this is usually only a small amount. People with pancreatic insufficiency absorb much less fat from their food. That fat ends up passing through the intestines, into the colon and then out of the body via bowel movements.
Bloating and gassiness
Everyone gets bloated from time to time. But people with exocrine pancreatic insufficiency can experience bloating every time they eat. People may feel like their stomachs are overly full or stretched out. They may also experience nausea. Along with bloating, people often experience gassiness.
Bloating and gassiness develop when food sits in the intestines without being digested. Without digestive enzymes, your body can’t break down your food the way it normally does. Instead, that food gets broken down in other ways. Bacteria that live in your gut can break down some of the food you eat. But this creates extra gas in the process. This type of breakdown isn’t effective enough to get your body the nutrients it needs. And it causes unpleasant side effects, such as gas and bloating.outlined
Cramping and discomfort
Pain is another common sign of pancreatic insufficiency. Many people describe the experience as cramping or abdominal discomfort. This is similar to the pain you may feel when you have diarrhea because of food poisoning or a stomach bug (gastroenteritis). But the pain doesn’t go away after a few days. Instead, it becomes more pronounced and persistent as time goes on.
There are many reasons people develop abdominal discomfort with exocrine pancreatic insufficiency. Cramping and discomfort can develop because of increased gas and bloating. They can also happen because the intestines may be pushing harder to move food into the colon since it’s not being broken down completely. Also, when fat isn’t absorbed completely, it can trigger the intestines to move more quickly than normal. This can also lead to cramping and discomfort.
Weight loss
People with exocrine pancreatic insufficiency experience unintentional weight loss. This develops because the body isn’t able to absorb nutrients from food. Without enough calories and nutrients, the body starts to break down stored energy in fat and muscle. This leads to weight loss.
But because the body also isn’t absorbing new nutrients, it can’t rebuild and repair itself as easily. The body has to rely on stored energy for everyday and long-term needs. Over time this leads to malnutrition and other health problems like a weakened immune system, muscle loss and even bone loss. Many people develop osteoporosis and muscle loss over time.
Vision changes
People with exocrine pancreatic insufficiency can develop vitamin deficiencies. In order to absorb vitamin A, D, E, and K, the body has to also absorb fat. Since people with pancreatic insufficiency have trouble absorbing fat, they also can’t fully absorb these key vitamins.
Over time, a drop in these vitamin levels can lead to a wide range of symptoms. Low levels of vitamin A and E can lead to vision changes like night blindness, which causes difficulty driving at night or trouble seeing in low light.
Vision changes are often the most obvious signs of vitamin deficiencies from pancreatic insufficiency. But other symptoms can develop, too, including easy bruising or bleeding from low vitamin K levels and muscle weakness from low vitamin E levels. Low vitamin D levels can speed up osteoporosis and bone loss.
What causes exocrine pancreatic insufficiency?
Pancreatic insufficiency develops because of damage to the pancreas. So you’re only at risk for developing pancreatic insufficiency if you have a condition that affects your pancreas, such as:
Pancreatitis: Pancreatitis is an inflammation of the pancreas. There are three types of pancreatitis: acute, chronic, and autoimmune. People with chronic pancreatitis are more likely to develop pancreatic insufficiency. Up to 90% of people with chronic pancreatitis will develop pancreatic insufficiency. But nearly a third of people with acute pancreatitis develop long-term pancreatic insufficiency. About half of people with autoimmune pancreatitis develop pancreatic insufficiency.
Cystic fibrosis: Cystic fibrosis is a genetic disorder that affects many parts of the body including the pancreas. Most people with cystic fibrosis develop pancreatic insufficiency starting in childhood.
Diabetes: People with diabetes are at risk for developing pancreatic insufficiency. People with Type 1 diabetes are more likely to develop pancreatic insufficiency than people with Type 2 diabetes.
Celiac disease: People with celiac disease can develop pancreatic insufficiency if they continue to eat gluten. The risk of pancreatic insufficiency isn’t exactly clear. In some studies, up to 80% of people with untreated celiac disease developed pancreatic insufficiency. But in other studies, the rates were much lower.
Inflammatory bowel disease: People with inflammatory bowel diseases, like Crohn’s disease or ulcerative colitis, can develop pancreatic insufficiency, but the likelihood is lower than with other medical conditions.
Pancreatic tumors or cancer: Tumors or cancer in or near the pancreas can block the tube between the pancreas and small intestine. This may prevent digestive enzymes from leaving the pancreas. Slightly more than half of people with pancreatic tumors develop pancreatic insufficiency.
Surgery: Surgeries that remove part of the stomach or pancreas, including bariatric surgery, surgery to remove a cancer, or surgery for inflammatory bowel disease, can lead to pancreatic insufficiency.
What is the treatment for pancreatic insufficiency?
The good news is that pancreatic insufficiency can be treated with enzyme replacement therapy. Pancreatic enzyme replacement therapy (PERT) consists of activated digestive enzymes that help people with pancreatic insufficiency digest food properly.
These digestive enzymes come in pills. People take these pills with meals. The enzymes inside the pills are released as the pills get broken down in the stomach and intestines. The enzymes can then break down food so the body can absorb nutrients. Most people experience significant improvement in their symptoms as soon as they start taking enzyme replacement therapy. Some people stop experiencing symptoms completely once they start treatment.
Some people also need to take vitamin supplements to help replace any vitamin deficiencies and keep them from coming back. People with exocrine pancreatic insufficiency should also avoid drinking alcohol as much as possible because alcohol can lead to inflammation and damage to the pancreas.
The bottom line
Pancreatic insufficiency is a digestive problem that can lead to uncomfortable symptoms like cramping, bloating, and greasy stools. Over time, people develop weight loss and vitamin deficiencies that can lead to other medical conditions. People with a history of pancreatitis, cystic fibrosis, pancreatic tumors or cancer, celiac disease, and inflammatory bowel disease are more likely to develop pancreatic insufficiency. Pancreatic insufficiency can be treated with enzyme replacement therapy.
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