Exocrine Pancreatic Insufficiency: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Exocrine Pancreatic Insufficiency?
A gastroenterologist, a doctor who treats digestive diseases, usually treats EPI. A dietitian, a food and nutrition expert, often helps too. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is exocrine pancreatic insufficiency?
Exocrine pancreatic insufficiency (EPI) is a condition in which your small intestine can't fully digest food. The cause is a problem with digestive enzymes from your pancreas. Enzymes are proteins that break down food.
The pancreas is a large gland behind your stomach. It makes digestive juice with enzymes. The juice flows to the small intestine. There, the enzymes help break down carbohydrates, fats, and proteins. EPI often develops slowly, over many years.
You may get EPI if your pancreas makes far fewer enzymes. It can also happen if not enough enzymes reach your small intestine. Other problems can keep the enzymes from mixing with food or working well.
Symptoms
Symptoms of EPI may include:
- Bloating
- Cramps, discomfort, or pain in the belly
- Diarrhea with loose, greasy, bad-smelling stools
- Passing extra gas
- Weight loss
In rare cases, EPI may lead to problems seeing at night. It may also cause bone problems, such as low bone mass or osteoporosis (weak, brittle bones).
If the small intestine does not digest food as it should, it may not take in enough nutrients. This is called malabsorption. It can lead to malnutrition (poor nutrition), low levels of vitamins A, D, E, and K, and low bone mass. EPI is also linked with a higher risk of heart attack and stroke.
Causes and who gets it
Common causes of EPI include:
- Chronic and acute pancreatitis (swelling of the pancreas)
- Cystic fibrosis (an inherited disease)
- Pancreatic cancer
- Surgery on the pancreas or upper digestive tract
A review says chronic pancreatitis is the most frequent cause in adults. Cystic fibrosis is the most frequent cause in children.
Less common causes include:
- Type 1 and type 2 diabetes
- Untreated celiac disease
- Inflammatory bowel disease, such as Crohn's disease and ulcerative colitis
- HIV
- Rare inherited disorders, such as Shwachman-Diamond syndrome
- Zollinger-Ellison syndrome
People with advanced pancreatic disease are more likely to get EPI.
How doctors diagnose it
Your doctor will ask about your symptoms and your medical and family history. You will also have a physical exam. This may include checking for weight loss, signs of poor nutrition, and belly swelling or tenderness.
Doctors most often order stool tests and blood tests. Sometimes they order pancreatic function tests.
The stool elastase test is the most commonly used stool test. Low levels of elastase in the stool may be a sign of EPI. Blood tests can check for low levels of vitamins and minerals or other signs of malnutrition.
A pancreatic function test measures how your pancreas responds to secretin, a hormone made by the small intestine. Only some US centers do this test. It may not diagnose EPI accurately.
A bone density test, a scan that measures bone strength, is advised when EPI is found and again over time.
Treatment
Doctors treat EPI with pancreatic enzyme replacement therapy (PERT) and lifestyle changes. PERT means taking pills with pancreatic enzymes. It can improve your symptoms and help you get enough nutrients from what you eat and drink. You take PERT during meals or snacks. Follow your doctor's instructions about how and when to take it.
Lifestyle changes can also help. Your doctor may suggest that you:
- Avoid alcohol
- Quit smoking
- Eat small, frequent meals
- Take vitamin pills if your vitamin levels are low
A review says your diet should be balanced. You do not need a low-fat or high-fiber diet. A dietitian can help you make a meal plan. Talk with your doctor before using supplements. The disease causing EPI may need treatment too.
When to see a doctor
See a doctor if you have ongoing belly pain, bloating, loose or greasy stools, or weight loss.
Call 911 or go to the emergency room if you have severe belly pain or pressure, fainting or loss of consciousness, a sudden change in mental state, or you vomit blood.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can do an evaluation and follow your symptoms and weight. They can also coordinate care with a gastroenterologist and a dietitian.
Common questions
Can enzyme pills help exocrine pancreatic insufficiency?
Yes. Enzyme pills, called PERT, can improve your symptoms. They also help you get enough nutrients from what you eat and drink. You take them during meals or snacks, as your doctor tells you.
What causes exocrine pancreatic insufficiency?
Diseases of the pancreas are the main cause. Examples are chronic pancreatitis, cystic fibrosis, and pancreatic cancer. Surgery on the pancreas can also cause it.
Can exocrine pancreatic insufficiency cause weight loss?
Yes, weight loss is one of the symptoms. The small intestine may not take in enough nutrients. Treatment can help correct this.
Do I need a strict diet with exocrine pancreatic insufficiency?
No, a strict low-fat diet is not needed. A review says the diet should be balanced. Your doctor may suggest small, frequent meals.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases - Exocrine Pancreatic Insufficiency (EPI)
- National Library of Medicine (PubMed Central) - State of the Art in Exocrine Pancreatic Insufficiency
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
