Exocrine Pancreatic Insufficiency: Causes, Symptoms, and Management

When your pancreas can’t produce enough digestive enzymes, you’re dealing with exocrine pancreatic insufficiency, a condition where the pancreas fails to secrete enzymes needed to break down food. Also known as EPI, it’s not rare—especially in people with chronic pancreatitis, cystic fibrosis, or after pancreatic surgery. Without these enzymes, fats, proteins, and carbs pass through your gut undigested. That’s why people with EPI often lose weight even when eating normally, and why their stools are oily, foul-smelling, and float—this is called steatorrhea, fatty stools caused by poor fat digestion.

Many mistake EPI for simple indigestion or IBS. But it’s different. While IBS affects bowel habits, EPI breaks down your body’s ability to absorb nutrients. You might feel bloated, gassy, or have stomach cramps after meals. Over time, you could develop vitamin deficiencies—especially in fat-soluble vitamins like A, D, E, and K. That’s because your body can’t absorb them without pancreatic enzymes. Pancreatic enzyme replacement therapy, a daily pill that replaces the enzymes your pancreas can’t make is the standard treatment. It’s not a cure, but it works. People who take it regularly often gain weight, feel less bloated, and stop having those greasy, embarrassing bowel movements.

What causes EPI? The most common reasons are long-term alcohol abuse leading to pancreatitis, cystic fibrosis (even in adults), autoimmune pancreatitis, or surgical removal of part of the pancreas. Diabetes can also be linked, especially if it’s been poorly controlled for years. Some people get it after a bout of acute pancreatitis that damages enzyme-producing cells. It’s not something you catch—it’s something that develops from damage or disease. If you’ve been told you have "chronic digestive issues" and nothing seems to help, EPI might be the missing piece.

You won’t find EPI on most general health checklists. Doctors don’t always test for it unless you have clear risk factors or severe symptoms. But if you’ve lost weight without trying, have oily stools that won’t flush, or feel constantly tired despite eating enough, it’s worth asking. A simple stool test can check for fat content and enzyme levels. Blood tests can spot vitamin deficiencies. It’s not glamorous, but it’s fixable.

Below, you’ll find real-world guides on how people manage EPI every day—from choosing the right enzyme pills, to adjusting meals so they don’t trigger symptoms, to avoiding dangerous drug interactions with supplements. You’ll also see how EPI connects to other digestive conditions, what to do when enzyme therapy doesn’t work, and how to spot early signs before it gets worse. This isn’t theory. These are stories from people who’ve been there—and found ways to live better.