HF 8048

Exocrine Pancreatic Insufficiency and Pancreas Enzymes

This handout explains what exocrine pancreatic insufficiency (EPI) is and what you need to know about it.

85% of your pancreas controls the exocrine pancreas function. Your pancreas makes enzymes which help breakdown fats, proteins, and carbohydrates.

2% of your pancreas controls endocrine pancreas function. Your pancreas makes hormones such as insulin and glucagon. They are sent into your blood to help with the breakdown of glucose.

What is EPI?

With EPI, the pancreas does not make enough of the enzymes you need for digestion and absorption. EPI occurs when 90% of enzymes are reduced. This results in fat that is not properly digested and nutrients and vitamins that are not properly absorbed.

Common Signs & Symptoms of EPI

Signs and symptoms can vary and are like many other gastrointestinal conditions.
Please talk with your doctor if you have:

  • Steatorrhea/fatty stools – Oily, greasy, foul-smelling, stool that floats and is hard to flush.

  • Diarrhea

  • Unexplained weight loss

  • Gas

  • Bloating

  • Abdominal pain

Conditions Linked to EPI

Lab and stool tests can be used to diagnose EPI; however, it is often based on symptoms.
These health conditions are linked with EPI:

  • Pancreatic cancer

  • Chronic pancreatitis

  • Blockage of the biliary or pancreatic duct

  • Diabetes

  • Cystic fibrosis

EPI has also been linked to patients who have had gastric surgery, or part/all of their pancreas removed.

Treatment of EPI

To manage patients with malabsorption and maldigestion we work to treat the main condition/disease, manage diarrhea and fix concerns with nutrition. We suggest:

  • A low-fat diet

  • Pancreatic enzyme supplements (Creon/Zenpep)

What are pancreas enzymes?

Pancreas enzymes are prescription medicines used to treat people who cannot digest food normally.

How do I take pancreas enzymes?

You should take Creon/Zenpep with all meals and snacks. It is best to take them throughout the meal (e.g., one at the beginning, one at the end).

How are the enzymes dosed?

Creon is dosed based on your weight and symptoms. For this reason, you may need some adjustment in the beginning to find the right dose.

You get a dose range so that you can adjust based on the meal/snack that you are eating (e.g., If you eat a higher fat meal, you may need to take the higher range dose). If you continue to lose weight or have loose stools, your dose will need to be changed. Make sure you call your doctor about these symptoms.

How long will I have to take enzymes?

If you need pancreas enzymes due to surgery or damage to your pancreas, you will need to take these for life. It is an expensive medicine that does not have a substitute. If you have a hard time paying for this, please let us know so we can see if we can help.

Creon on Course is a resource to help insured patients get vitamins, education and financial support. You can sign up online at CREONonCourse.com or call:

There is also a medicine assistance program that you may qualify for. Contact them at 608-262-6443 or map@uwhealth.org.