Another risk factor is pancreatic surgery: According to a review published in April 2020 in the World Journal of Gastrointestinal Pathophysiology, EPI is a common complication following pancreatic surgery and is often underdiagnosed and undertreated. People who have a history of alcohol abuse are also at higher risk of EPI. Doctors likely don’t think of EPI as often as they should, according to Dr. Gillon. Because the symptoms of EPI can be the same as some other digestive conditions, it can be tricky to diagnose. But getting the correct diagnosis is important. EPI can cause symptoms that can have a negative impact on a person’s quality of life and lead to potentially life-threatening complications such as malnutrition and cardiovascular disease, according to a study published in March 2019 in the journal Clinical and Experimental Gastroenterology. If your doctor suspects you may have EPI, they will likely take blood and stool samples and order tests to see if you have this condition, according to the World Journal of Gastrointestinal Pathophysiology review. The good news is that the condition is treatable with pancreatic enzyme replacement therapy (PERT) or vitamin supplements, so it’s important to stay aware of common EPI symptoms.
Diarrhea
Diarrhea can be a symptom of many ailments, but if you find yourself chronically experiencing this problem along with sudden, unexplained weight loss and an overall change in bowel habits, that should raise your suspicions, says Benjamin Lebwohl, MD, a gastroenterologist and assistant professor of medicine at Columbia University Medical Center in New York City.
Steatorrhea
Something else to watch for is steatorrhea, which is foul-smelling oily stools (which float, stick to the sides of the toilet bowl, and are hard to flush) that can be especially worse after eating fatty foods. This is a specific sign of EPI, and you should notify your doctor if you experience it, says Khalid Khan, MD, a gastroenterologist and medical director of the Islet Cell Transplant Program at the MedStar Georgetown Transplant Institute in Washington, D.C.
Abdominal Pain
Abdominal pain is another symptom of many GI problems. Yet with EPI, you’ll feel that pain more when you eat, especially with fatty meals, Dr. Lebwohl says. You may also feel bloating in the abdominal area. The symptoms of diarrhea and stomach pain are also associated with irritable bowel syndrome (IBS), a more common condition than EPI. In younger people, these symptoms are more likely to be IBS, Dr. Khan says, but in people in their sixties or older who may also have diabetes, EPI is a greater possibility.
Unexplained Weight Loss and Fatigue
If you find yourself losing pounds and you’re not sure why — and you have stomach pain along with fatigue — discuss the possibility of EPI with your doctor, Gillon says. EPI prevents your body from being able to properly digest the food you eat, so people with EPI typically need a nutrient-rich diet as part of their treatment, along with enzyme replacement therapy, according to The National Pancreas Foundation (NPF).
Vitamin Deficiency
If you have EPI, your body doesn’t properly digest food, so you’ll have trouble absorbing certain nutrients, including the key vitamins A, D, E, and K, Gillon says. That’s why some people with EPI experience bone loss (osteoporosis) and other health issues related to a lack of these vitamins, according to a study published in September 2019 in the journal Pancreas. In fact, many people with EPI need supplements to help maintain appropriate levels of these vitamins, says the NPF.
When to Call a Doctor
If you’re experiencing a combination of the common symptoms of EPI, call your doctor. Before your appointment, track your symptoms — when they occur and if they’ve changed over time. Remember that fat in your stools is the classic symptom of EPI, as opposed to other digestive conditions. “It’s important to be mindful of your symptoms and not ignore or minimize them if there’s a significant change,” Lebwohl says. “If a person is at increased risk of EPI, diagnosis and treatment can result in a major improvement in quality of life.” In addition to treatment with PERT and vitamin supplements, your doctor can also help you make healthier lifestyle choices, such as improving your diet, avoiding alcohol, and not smoking.
