“It doesn’t even allow me to pray properly. It is one of the worst conditions to have,” says Liton Hossain, a 40-year-old freelance software developer from Dhaka, Bangladesh. He was diagnosed with pancreatic problems after he sought expert medical advice due to recurring stomach ache and oily stools.
A couple of examinations and blood tests later, it was found that Hossain suffered from Exocrine Pancreatic Insufficiency (EPI) which manifests as indigestion due to limited or total inability of the pancreas to secrete digestive juices. He also lost around 15 kgs and showed symptoms of malnourishment. He was put on a pancreatic enzyme supplement to manage his condition and aid him in digestion.
What is exocrine pancreatic insufficiency (EPI)
Pancreas is a multitasking organ that is involved in both enzyme secretion (exocrine) and hormone production (endocrine). EPI is the condition where the pancreatic tissues lose the ability to secrete digestive enzymes like amylase (for carbohydrates), lipase (fats) and protease (proteins).
“People diagnosed with EPI cannot digest these nutrients and absorb it into the system. It is mainly caused due to severe inflammation of the pancreas. In rare cases, genetic factors lead to the pancreas being unable to produce digestive enzymes,” says Prof Dr Govind K Makharia, Professor, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi.
“Basically chronic and repeated inflammation leads to the scarring or gradual destruction of the pancreatic tissues,” says Dr Vishnu Abishek Raju, Consultant, Medical Gastroenterology and Therapeutic Endoscopy, Gleneagles Global Health City, Chennai
What causes exocrine pancreatic insufficiency
Dr Neeraj Dhamija, Gastrointestinal surgeon, Sir Ganga Ram Hospital, New Delhi points out that any condition leading to severe disruption of the pancreas could lead to EPI and severe pancreatitis (pancreatic inflammation) is the main reason. There is no specific age group for this condition.
“Chronic pancreatitis leads to pancreatic atrophy (destruction of pancreas). Alcoholism is a major factor that triggers pancreatic inflammation. People whose pancreas is removed due to pancreatic tumor also have this condition,” he says.
EPI could also be inherited. It increases the risk of cystic fibrosis in the form of lesions in the lungs, digestive tract and pancreas. Dr Makharia says that cystic fibrosis is often detected at a young age and since it affects the lungs, they could also have pneumonia. Dr Dhamija points out that individuals born without pancreas (pancreatic agenesis) also suffer from EPI, though this is a rare condition.
Diagnosing exocrine pancreatic insufficiency
Dr Raju says that EPI could have mild, moderate or extreme variants with corresponding levels of severity.
“Greasy and oily stools because of undigested fat content is a primary symptom of EPI. A stool elastase test result is also conducted to diagnose this condition,” he adds. Elastase is an enzyme secreted during digestion and should be detected in our stool. Its absence indicates enzyme deficiency. Pancreatic function test and examining the content of undigested fat in stool are other methods to diagnose pancreatic health and EPI.
Bon appetite and malnourishment
Weight loss and pancreatic damage are synonymous. Food ingested gets ejected out of the body with zero nutrient absorption. Dr Dhamija recently treated a six month old baby boy diagnosed with EPI and a 21 year old college student with pancreatitis that led to EPI.
“The baby had recurring bouts of diarrhoea whereas the college boy had pancreatitis and rapidly lost about 15 -20 kg. He was found to have EPI and suffering from malabsorption of nutrients,” he added.
Dr Makharia also adds that due to the lack of retention of nutrients people affected with both pancreatitis and EPI suffer from severe weight loss, malnutrition, malabsorption and related health complications.
Popping enzymes with every meal
Hossain was an avid beef eater but had to curtail after his pancreas went rogue on him. Dr Makharia opines that imposing dietary restrictions might not be the best way to tackle it as the body needs nutrition.
“Blanket ban on fatty food is not advisable as an adult requires around 30 gm of fat as part of their balanced daily food. Usually people with EPI are given enzyme supplements orally along with their food,” he adds.
These supplements are called Pancreatic Enzyme Replacement Therapy (PERT) capsules. The dosage is decided according to the lipase units required for the body to digest food. Dr Dhamija points out that standard PERT prescriptions are often formulated on the basis of meat-based diets and those eating vegetarian food might actually require much less dosage.
“A supplement capsule with a dosage of 10,000 lipase units is prescribed for smaller meals as per the general standards and 25,000 unit capsule for a more elaborate meal but for someone having a vegetarian lunch 10,000 units itself is enough,” he says. He also adds that if enzyme supplements are taken in excess, it could lead to diarrhoea and stomach discomfort.
The diabetes link with EPI
Along with enzymes, pancreas also produces hormones like insulin which is halted due to pancreatitis. This hormonal deficiency caused due to pancreatic malfunction is called Endocrine Pancreatic Insufficiency.
“If the pancreas tissues are damaged due to pancreatitis then it could lead to both EPI and diabetes,” Dr Dhamija adds.
Dr Makharia also points out the link between diabetes and EPI. He adds that more research is being done in this field to further establish this link. “EPI is a lifelong condition and cannot be fully cured but could be managed with dietary control along with enzyme supplementation,” he says.
Takeaways
The ability of pancreas to secrete digestive enzymes could be severely compromised due to pancreatitis which leads to Exocrine Pancreatic Insufficiency (EPI). Due to lack of digestive enzymes a person will be unable to digest food and absorb nutrients leading to severe malnutrition, weight loss and related health complications. However it could be managed with lifestyle alterations and enzyme supplementation.
