Conditions Associated with Exocrine Pancreatic Insufficiency

Learn about the underlying conditions associated with EPI, including chronic pancreatitis and cystic fibrosis.

Exocrine pancreatic insufficiency (EPI) is a condition where the pancreas is unable to produce digestive enzymes. As a result, people with EPI are unable to fully digest food.

The primary symptoms of EPI are often similar to other gastrointestinal disorders. These symptoms may include stomach pain, gas, bloating, constipation, diarrhea, and fatty stools.

People with EPI may also lose weight without trying. Some become malnourished. This occurs because the body is unable to properly absorb nutrients.

Here, we will look at several conditions and disorders associated with EPI.

Chronic pancreatitis

Chronic pancreatitis is defined as “ongoing inflammation of the pancreas that does not improve over time.” The most common cause of chronic pancreatitis is long-term alcohol abuse.

However, it can also be caused by recurring acute pancreatitis, certain autoimmune conditions, genetic conditions such as cystic fibrosis, and certain vitamin deficiencies. People are typically diagnosed with chronic pancreatitis between the ages of 35 and 40.

Chronic pancreatitis can cause other health complications such as the hardening of pancreatic tissue, chronic pain, diabetes, gallstones, metabolic bone disease, pancreatic cancer, and kidney failure.

Cystic fibrosis

Cystic fibrosis is a genetic disorder that presents at birth and progresses over time. When a person has cystic fibrosis, the cells that create mucus and digestive juices do not function normally. As a result, the body produces mucus that is thick and sticky—which results in clogged tubes and passageways throughout the body.

Cystic fibrosis can cause a wide range of symptoms, including a persistent cough that produces mucus, gastrointestinal issues, jaundice, chronic pain, delayed physical growth, clubbed fingers and toes, and fevers.

Cystic fibrosis can also result in many complications such as diabetes, liver disease, heart conditions, urinary incontinence, kidney problems, and malnutrition.

Surgery, diabetes, and other conditions

While chronic pancreatitis is the most common cause of EPI, and EPI is common among people with cystic fibrosis, these are not the only conditions associated with EPI. Many different health conditions affect the pancreas, and some have been associated with EPI. These include:

  • Diabetes. Insulin is a hormone that is produced in the pancreas and needed to regulate blood glucose levels (blood sugar). Diabetes is a condition where the body does not make enough insulin or is unable to use the insulin it does make. EPI is common among people with diabetes.
  • Pancreatic cancer. This refers to cancer that originates in the pancreas. The most common form of pancreatic cancer begins with an uncontrolled growth of the cells that make up the glands that produce digestive enzymes.
  • Surgery. Surgeries on the organs of the digestive system can affect how the pancreas breaks down food and can be related to EPI. One example is bariatric surgery (weight-loss surgery).
  • Irritable bowel syndrome. IBS is a gastrointestinal disorder that causes stomach pain, diarrhea, and constipation. While a specific cause is still unknown, it may be due to irregular movement in the digestive system, extra sensitive nerves, or a miscommunication between the brain and gut.
  • Inflammatory bowel disease (IBD). This includes Crohn’s disease and ulcerative colitis, conditions that cause recurring inflammation in the gastrointestinal tract. IBD is a painful condition that can cause a number of GI problems.
  • Small intestinal bacterial overgrowth (SIBO). This condition occurs when there is too much bacteria in the small intestine. It is often caused by surgery or another disease. Pain, bloating, diarrhea, and unwanted weight loss are common symptoms.

Getting an accurate diagnosis

The symptoms of EPI are common and overlap with many other health conditions and disorders. It’s important to work closely with a healthcare provider to get a proper diagnosis and appropriate treatment. Left untreated, EPI can cause serious complications.

EPI is treated with pancreatic exocrine replacement therapy (PERT), medications taken with food that replace the enzymes that are not being produced by the pancreas. Treatment also involves addressing the underlying conditions that are causing EPI or coexist alongside EPI.

Medically reviewed in January 2022.

Article sources open article sources

The National Pancreas Foundation. "Exocrine Pancreatic Insufficiency (EPI)."
Identify EPI. "What is EPI?"
Cleveland Clinic. "Exocrine Pancreatic Insufficiency (EPI)."
The National Pancreas Foundation. "About Chronic Pancreatitis."
Adam Felman. "What's to know about chronic pancreatitis?" MedicalNewsToday. December 21, 2020.
Anton Klochkov, Pujitha Kudaravalli, Yizhe Lim, and Yan Sun. "Alcoholic Pancreatitis." StatPearls. May 24, 2021.
Onecia Benjamin and Sarah L. Lappin. "Chronic Pancreatitis." StatPearls. June 26, 2021.
Mitchell L. Ramsey, Darwin L. Conwell, and Phil A. Hart. "Complications of Chronic Pancreatitis." Digestive Diseases and Sciences, 2017. Vol. 62, No. 7.
Cedars Sinai. "Chronic Pancreatitis."
Mayo Clinic. "Cystic Fibrosis."
Cystic Fibrosis Trust UK. "Cystic fibrosis complications and symptoms."
Cedar Sinai. "Cystic Fibrosis."
Identify EPI. "What conditions are associated with EPI?"
Diabetes UK. "Exocrine Pancreatic Insufficiency." January 15, 2019.
Bernhard Radlinger, Gabriele Ramoser, and Susanne Kaser. "Exocrine Pancreatic Insufficiency in Type 1 and Type 2 Diabetes." Current Diabetes Reports, 2020. Vol. 20, No. 6.
American Cancer Society. "What is Pancreatic Cancer?"
Miroslav Vujasinovic, Roberto Valente, et al. "Pancreatic Exocrine Insufficiency after Bariatric Surgery." Nutrients, 2017. Vol. 9, No. 11.
John S Leeds, Andrew D Hopper, et al. "Some patients with irritable bowel syndrome may have exocrine pancreatic insufficiency." Clinical Gastroenterology and Hepatology, 2020. Vol. 8, No. 5.
Cleveland Clinic. "Irritable Bowel Syndrome (IBS)."
Centers for Disease Control and Prevention. "What is inflammatory bowel disease (IBD)?"
Jamie Eske. "What to know about SIBO and its treatment." MedicalNewsToday. November 25, 2021.
Kathleen Davis. "What is EPI? Symptoms, how it is diagnosed, and everything else you need to know." MedicalNewsToday. November 28, 2021.

Featured Content


Exocrine Pancreatic Insufficiency: A Glossary of Terms

The words and definitions you need to know to understand exocrine pancreatic insufficiency (EPI) and its treatment.

A Quick Guide to Pancreatic Enzyme Replacement Therapy

Learn about medications that can help improve digestion for people who have exocrine pancreatic insufficiency (EPI).

EPI: A Guide to Eating Healthy Fats

How to recognize the dietary fats your body needs when living with exocrine pancreatic insufficiency (EPI).

EPI Treatment: How to Adjust to a Strict Medication Schedule

Try these simple approaches and helpful tips for getting used to taking medication with every meal and snack.