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Is it IBS or EPI (Exocrine Pancreatic Insufficiency)?

Dr. Cynthia Rudert, Celiac Disease and Gluten Intolerance expert answers your questions on celiac. 5 million emergency room visits in the U.S. are for diarrhea and abdominal pain. If you have chronic symptoms, could it be EPI? Dr. Rudert answers questions on this often misdiagnosed disorder:

What are the symptoms of EPI (Exocrine Pancreatic Insufficiency)?

Dr. Rudert answers:

The symptoms of EPI are often seen in other gastrointestinal disorders and EPI is frequently misdiagnosed as irritable bowel syndrome (IBS). The mistake occurs because the symptoms often overlap and may even be identical in both disorders. The symptoms can include loose stools/diarrhea, urgency and abdominal pain. The pain can vary in intensity from mild to severe. Some individuals also report fat in their stools (steatorrhea) although when this is present it means that the gland has lost 90% of it's function. How can I find out if I have EPI?

Dr. Rudert answers:

Most physicians do not suspect EPI so it usually never crosses their radar. That is because EPI was traditionally thought to be a disease of middle age male alcoholics. The North American Pancreatic Study Group however has put this common misconception to rest. One reason it is also overlooked is that most blood work, labs and X rays are usually normal in those with EPI. In my practice I see many patients for second opinion consults and this is a frequently missed problem. If one is looking for a test that is sensitive, specific, cheap and noninvasive it doesn't exist! There are blood and stool tests available; however, the results may be normal in mild or moderate EPI disease. In order to be properly diagnosed I recommend seeing a gastroenterologist that has experience with EPI. The cases I see for second opinion consults that I suspect have this disease often have had symptoms for years and unfortunately, some for decades. With longstanding symptoms patients can become deficient in multiple vitamins including Vitamins A,D,E, and K. What is the treatment for EPI?

Dr. Rudert answers:

The treatment for EPI is prescription enzyme replacement therapy (pancrelipase). The pancreas produces 3 enzymes: amylase to digest starch, lipase to digest fat, and protease to digest protein. One must be sure and take the correct dose because if too low a dose is prescribed one will have no benefit. What causes EPI?

Dr. Rudert answers:

In the cause of EPI there are many etiologies including inherited genetic disorders, autoimmune, infectious, pancreatic surgery, heavy alcohol use, and smoking to name a few. If anyone has had pancreatitis in the past they are also at increased risk. It is estimated that 50% of Type 1 diabetics and 30% of Type II diabetics have this commonly missed disorder (EPI). Recent data regarding this association was eloquently presented at PancreasFest 2014. Is EPI genetic?

Dr. Rudert answers:

Like many illnesses EPI may have a genetic component. To fully answer this question would involve more info than you would want to read! I consider David Whitcomb M.D., PhD. (University of Pittsburgh) to be one of the world's authorities on genetic diseases of the pancreas. The most familiar genetic pancreatic disease that most people have heard about is cystic fibrosis (CF). EPI in CF is severe and requires high dose enzyme therapy. Interestingly, I have seen patients with mild CF varients that had no idea that they could be 50 or 60 years old and have a mild varient of a disorder many people only think about in children.

Can EPI be cured?

Dr. Rudert answers:

EPI can be easily treated with enzymes, however usually is not curable.

If I have EPI do I have to be on a special diet?

Dr. Rudert answers:

With enzyme replacement therapy, when given in adequate doses, those with EPI can resume eating a regular diet. I often see patients that tell me before they were diagnosed they felt better when they ate a low fat diet. That is because if your pancreas is not making enough lipase you can't digest fat so one gets worsening symptom loose stools/diarrhea, urgency, gas, bloating, and abdominal discomfort. Dr. Rudert asks: For extra credit can you answer this question? What is the plural of pancreas? Answer: (pancreata) For physicians wanting to learn more about pancreatic diseases it does not get better than PancreasFest hosted yearly by Dr. David Whitcomb and his assistant Ms. Joy Merusi. It is held at the University of Pittsburgh. Thanks Dave and Joy. It was a lot of fun and I got the T shirt to prove it!

#exocrinepancreaticdeficiency #pancreas #ibs #diarrhea #bloating

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