Treating Exocrine Pancreatic Insufficiency: Medication & More

Exocrine pancreatic insufficiency (EPI) is when the pancreas can't produce enough of the enzymes necessary for healthy digestion. It can involve symptoms such as diarrhea, bloating, gas, and pain. Because it affects the way your digestive system absorbs nutrients, it can also cause malnourishment.

The severity of your symptoms, your lifestyle, and any coexisting health conditions you may have all factor into treatment decisions. For example, EPI is sometimes associated with such conditions as:

• acute or chronic pancreatitis
• cystic fibrosis
• diabetes

Your doctor will take all these things into account when tailoring your EPI treatment plan.

Read on as we look at some EPI treatment options, as well as some of the lifestyle factors that can affect your outlook.

The pancreas releases digestive enzymes such as amylase, lipase, and protease into the small intestine. These enzymes are necessary for proper digestion. Since the pancreas isn't producing enough of these enzymes, you might benefit from pancreatic enzyme replacement therapy (PERT).

PERT can replace enzymes and help you absorb nutrients from the foods you eat. Your doctor will decide on the dose based on the severity of your condition. You take capsules at the beginning of every meal or snack, and never on an empty stomach.

Your doctor or nutritionist will explain how and when to take it. To be effective, they must be taken exactly as prescribed every time you eat.

If you have problems with heartburn while taking PERT, your doctor may add a proton pump inhibitor (PPI) to reduce stomach acid. PPIs work by reducing the amount of acid produced by the glands in the lining of your stomach. Not everyone on PERT needs PPIs.

If you tend to get mild heartburn, you might not need a prescription-strength PPI. These medications are available over the counter under names such as esomeprazole (Nexium) and lansoprazole (Prevacid).

Your gastroenterologist may recommend a specific OTC product in a particular dose. You can also ask your pharmacist for recommendations.

There are some pancreatic enzyme replacement supplements available without a prescription. These supplements vary in consistency and potency. If you have EPI, you should avoid OTC pancreatic enzyme replacement supplements. If you do decide to try them, be sure to let your doctor know exactly what you're taking.

Your doctor can prescribe PERT, if necessary, and you'll have the added benefit of medical supervision as you try to improve symptoms.

If you have an EPI diagnosis, you'll need to work closely with your gastroenterologist to ensure that you're getting proper nourishment from your food. It might also be a good idea to enlist the help of a nutritionist to get on the right path.

Your body needs fat, protein, and carbohydrates to function well. But EPI makes it hard to digest fat. Your doctor may recommend eating a low-fat diet to help manage the condition, though not everyone with EPI will need to. If you're on PERT and it's working well, a normal diet might be just fine for you. But it's still important to follow your nutritional plan.

To work, PERT must be taken consistently and at the right dose.

EPI interferes with your body's ability to absorb nutrients from food. This can affect your intake of fat-soluble vitamins A, D, E, and K. You may need to take dietary supplements.

If you're on PERT, however, you may be able to get all the nutrients you need from a proper diet, without supplements.

Also, some supplements can interfere with OTC or prescription medications. Your gastroenterologist may recommend very specific vitamins and minerals in precise amounts. Be sure to consult with your doctor before taking dietary supplements.

Talk to your doctor about potential lifestyle changes to improve your symptoms of EPI. The following are some steps you can take to improve your quality of life with EPI:

• Maintain a healthy diet. Maintain a well-balanced diet based on your doctor's recommendations. If you need help getting started, consider working with a nutritionist.
• Avoid alcohol. Alcohol can harm your pancreas. If you have trouble avoiding alcohol, talk to your doctor about how to quit safely.
• Quit smoking. Smoking is associated with pancreatic conditions such as pancreatitis and pancreatic cancer. If you smoke, ask your doctor for information on smoking cessation programs.
• Exercise regularly. Regular movement can promote your overall health. Ask your doctor about the best exercises for you.
• Relieve stress. You can't completely eliminate stress, but you can learn ways to cope. Try deep breathing exercises, yoga, or tai chi.

Also, it always helps to be prepared. Here are some things you can do to educate yourself about EPI and be ready for any situation:

• Learn all you can about EPI.
• Keep a food journal to figure out which foods trigger symptoms or make matters worse.
• Partner with your doctor by reporting new or worsening symptoms right away.
• Have loose-fitting clothing on hand for when you feel bloated or have pain.
• Keep your prescriptions up to date and keep your medication on hand. If you're on PERT, be sure to take some with you when you leave home.

You have a number of treatment options if you have exocrine pancreatic insufficiency. Work closely with your doctor, take medications as directed, and make some dietary adjustments. You can learn to successfully manage your EPI, enjoy food, and improve your quality of life.