Introduction:
A person having watery diarrhea may think it is simply a tummy flu. But things can be even more serious than just a gastrointestinal tract infection. Exocrine Pancreatic Insufficiency (EPI) means indigestion of food caused by the lack of digestive enzymes that normally are produced by the pancreas. Exocrine Pancreatic Insufficiency causes indigestion leading to watery diarrhea and hence also known as pancreatic maldigestion.
What is Fat Malabsorption?
EPI may also present with fat maldigestion, a condition known as steatorrhea. In steatorrhea, very foul-smelling, pale, and bulky stools float on water in the toilet pan and are due to excess gas and undigested fat seen as oil droplets in the stools. In EPI-induced steatorrhea, there may be an oily material leakage from the anal opening and there may also be mild to moderate levels of fecal incontinence (loss of control of feces). A lot of patients present with this oily leakage and fecal incontinence problems and they do not even know that they may be having a problem with exocrine pancreatic insufficiency-induced steatorrhea.
What Are the Causes of EPI?
The pancreas, integral to the digestive system, produces enzymes crucial for digestion, facilitating the absorption of nutrients by the body. In cases of EPI (Exocrine Pancreatic Insufficiency), digestive enzymes are deficient, leading to undigested food passing through the intestines. Consequently, the body fails to obtain essential nutrients from ingested foods.
Various pancreatic enzymes encompass:
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Amylase: Responsible for carbohydrate breakdown.
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Lipase: Functions in fat digestion.
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Protease and Elastase: Essential for protein breakdown.
What Are the Side Effects of EPI?
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Other problems may be loss of fluid and electrolytes deficiency, mineral and other important nutrient loss. This combined with the loss of fats, leads to severe weakness, loss of body weight, fatigue, and malaise. There ensues dehydration due to fluid and electrolyte deficiency.
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EPI causes night blindness and seizures.
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Also, there may be manifestations of loss of fat-soluble vitamins (A, D, E, K) that start to appear along with other symptoms of malabsorption of nutrients.
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Low levels of calcium and magnesium in the serum may also lead to tetany (intermittent muscular spasms).
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Flatulence and abdominal cramps are another problem due to indigestion.
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Swelling (edema) of the peripheral limbs may result from protein depletion that is lost with other nutrients in the intestinal lumen.
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Mouth ulcers and changes in the color of the tongue, abdominal distention, hair fall, and weakened muscle movements are also common symptoms.
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Anemia (pale skin and nails) due to iron deficiency or vitamin B12 deficiency is also associated with EPI.
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Vitamin K malabsorption causes bleeding disorders in the patients. Blood in urine or stools is a common manifestation.
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Bone disorders (osteopenia and osteomalacia) due to lack of vitamin D and low calcium levels in the body are commonly diagnosed as Metabolic Bone Disease (MBD). Bone aches and easy fractures are very common.
For normal digestion to occur, we need normal secretions of the pancreas consisting of proteins (3 percent) and a lot of water and electrolytes (97 percent). If due to diseases like the long history of infection of the pancreas, there is damage to the parts of the pancreas, it causes loss of function of the pancreas that is associated with the digestion of the lipids and other nutrients in food.
Fats, we know, make a lot of bulk of our food, and the resulting energy from food is largely dependent on the digestion of this fat content properly. The pancreas does all this digestion of the fats in the small intestinal lumen through its well-formed secretions. One gram of fats when metabolized yields 9 Calories of energy which is more than double produced by the metabolism of 1 gram of carbohydrates (which is 4 Calories for 1 gram).
So, it is obvious that the patient will feel a lack of energy and fatigue too, along with diarrhea if he has the EPI. People usually know only one condition associated with pancreatic insufficiency and that is diabetes mellitus. We must inform and guide the patients regarding other diseases too. A well-informed patient will never go for self-medication and will not become prey to the quakes if a person gets any indigestion issues.
Who Is at a Greater Risk of Developing EPI?
If considerable damage to the tissues of the pancreas occurs due to any reason, it may lead to EPI. The concomitant disorders may be hepatitis A, diabetes mellitus, SLE or lupus, previous surgery of the gastrointestinal tract, cystic fibrosis, celiac disease of the gut, Crohn's disease, hyperacidity in the stomach due to any underlying disease, heavy smokers, chronic alcoholics, etc. So, if anyone has one of these diseases, and also gets frequent indigestion, weight loss, lack of energy, and some issues with the brain functioning, please do visit your primary care physician to rule out the chances of EPI.
What Are the Clinical Manifestations of EPI?
Individuals suffering from EPI encounter challenges in absorbing fats, resulting in distressing digestive issues, including:
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Abdominal discomfort, flatulence, and bloating.
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Irregular bowel movements such as constipation or diarrhea.
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Excretion of fatty stools characterized by their pale, oily, and malodorous nature, often floating.
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Unexplained weight loss or failure to thrive is observed particularly in infants and children.
How Is EPI Diagnosed?
EPI diagnosis involves pancreas function tests like fecal elastase and fat tests, and secretin test to assess enzyme release. Imaging tests like computed tomography scans or ultrasounds may also identify pancreas issues.
What Is the Treatment of EPI?
Doctors use pancreatic enzyme replacement therapy (PERT) and dietary adjustments, such as abstaining from alcohol and stopping smoking, to treat exocrine pancreatic insufficiency (EPI). For the illness or condition that led to EPI, the doctor could suggest further therapies.
The small intestine cannot properly digest food if a person has exocrine pancreatic insufficiency (EPI), which can result in malabsorption and malnutrition. The patient could be advised to take pancreatic enzyme replacement therapy (PERT) as well as to eat and consume small, frequent meals by the physician or certified dietitian.
Conclusion
Exocrine pancreatic insufficiency patients typically have vague symptoms when they visit their primary practitioner. With a thorough medical history, clinical examination, and early action for borderline patients, a diagnosis must have a high degree of suspicion.