EPI is a condition that inhibits your ability to properly digest food, and according to a review, it affects an estimated 14 percent of people with Crohn’s and 22 percent of people with ulcerative colitis. Keep reading to learn more about the link between EPI and IBD and how to manage both conditions.
What Is EPI?
According to The National Pancreas Foundation, EPI occurs when the pancreas — an organ located in the abdomen — doesn’t produce enough exocrine pancreatic enzymes, which results in an inability to properly digest food. This can prevent you from obtaining or absorbing the nutrients you need to function. “Exocrine pancreatic insufficiency is probably underreported, which means it’s likely more common than we think,” says Miguel Regueiro, MD, chair of the Digestive Disease and Surgery Institute at Cleveland Clinic in Ohio. “Classically, we see it in kids with cystic fibrosis, but we also see it in adults who have had damage to the pancreas over time, whether that’s due to alcohol, medication, or a virus.” If you have EPI, you’ll likely experience uncomfortable gastrointestinal (GI) symptoms, such as diarrhea, loss of appetite, and weight loss. IBD materializes most frequently as Crohn’s disease or ulcerative colitis. Both are characterized by chronic inflammation of the digestive tract, but there are some differences: Whereas Crohn’s can affect any part of the GI tract (though most frequently the small intestine), ulcerative colitis is generally limited to the large intestine and rectum, according to the CDC. “IBD can manifest with symptoms such as diarrhea, stomach pain, bleeding, and weight loss, depending on where the inflammation is in the GI tract,” says Dr. Regueiro.
The EPI and IBD Connection
Although experts aren’t entirely sure why people with IBD can develop EPI, it most likely has to do with malfunctioning of the immune system. “Because IBD is an autoimmune-type disease, there are sometimes antibodies that can actually attack the pancreas, resulting in pancreatic damage and enzyme insufficiency,” explains Regueiro. Another theory is that EPI is an extraintestinal manifestation — a problem that occurs outside the gut — of IBD. “Inflammatory bowel disease has a whole host of extraintestinal manifestations, such as arthritis,” explains Regueiro. “It’s very common for somebody with Crohn’s or ulcerative colitis to have inflammation in their joints.” “Similarly,” he says, “inflammation of the pancreas may be an extraintestinal manifestation of IBD, and over time, enough damage to the pancreas can lead to exocrine pancreatic insufficiency.” Having IBD can increase your risk for pancreatic problems such as acute pancreatitis, according to a review published in Alimentary Pharmacology & Therapeutics in June 2022. EPI is probably underrecognized because inflammation in the pancreas can be difficult to diagnose, and blood tests can’t always detect the condition, he notes. Plus, even if you have EPI, you may not experience symptoms. “If your pancreas is mildly inflamed over a long period of time, you may not have a lot of pain or other classic pancreatitis symptoms,” says Regueiro. “But over time, your pancreas stops working as well and stops making the digestive enzymes it needs.”
How to Diagnose — and Manage — Both Conditions
If your IBD is generally well controlled with medication but you start noticing strange bowel movements, tell your doctor, because this could be an indication of EPI. “If your stool is floating and you see a lot of fat in it, that’s a sign of EPI,” says Regueiro. Your doctor will test your stool for excess fat and a deficiency of certain pancreatic enzymes, and if it comes back positive, they will likely put you on a treatment called pancreatic enzyme replacement therapy (PERT). The enzymes are generally well tolerated and can be taken in pill form. They replace the digestive enzymes your pancreas isn’t producing, helping your GI system process the nutrients in food. “The treatment works well for the majority of people,” says Regueiro. “It makes EPI pretty easy to treat.”
