Complaints & connections · borters.ch
Insufficientia pancreatis exocrina
Without digestive enzymes fat is not broken down — enzymes with meals usually solve this.
Also known as: exocrine pancreatic insufficiency · EPI · digestive enzyme deficiency
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
The pancreas makes the digestive enzymes that break down fat, protein and carbohydrates in the small intestine. In exocrine pancreatic insufficiency it produces too few — food, especially fat, is then no longer properly digested and absorbed. Typical signs are bulky, pale, foul-smelling stools that are hard to flush away (“fatty stools”), bloating and fullness after fatty meals, and weight loss despite normal eating; over time, deficiencies of fat-soluble vitamins (A, D, E, K) can develop. Common causes are chronic pancreatitis, pancreatic surgery or cystic fibrosis. The central lever is enzyme replacement: taking digestive enzymes (pancreatin) with meals so food is used again. The diagnosis is usually confirmed with a stool test (pancreatic elastase).
The central lever: take enzymes (pancreatin) with every fatty meal and snack — dose adjusted medically.
Address chronic pancreatitis, surgery effects or cystic fibrosis.
Eat enough and check/replace fat-soluble vitamins (A/D/E/K).
Alcohol further harms the pancreas — avoiding it protects.
Enzyme capsules replace what the pancreas no longer supplies. They must reach the stomach together with the meal, not before or after — otherwise they never meet the food. The gland itself does not recover from them; the dose follows the fat content of the meal.
Symptoms appear only when more than ninety per cent of the enzyme capacity is missing — which is why the diagnosis often comes late. Faecal elastase below 200 µg/g counts as abnormal, below 100 as marked. Fatty, foul-smelling stool that floats is the typical sign. After starting enzymes the stool improves within days; weight and fat-soluble vitamins take weeks to months.
Bulky, pale, foul, floating and hard to flush — the cardinal sign.
Undigested fat ferments and causes gas and fullness.
Because nutrients aren’t absorbed despite normal appetite.
Develops over time, tied to fat digestion.
What a deficiency makes visible on the body — skin, nails, tongue, eyes and nerves. The signs are unspecific: they show where to look, they prove nothing.
Fat-soluble vitamins (A/D/E/K) can fall — vitamin D is readily measured.
Taken up right at the end of the small bowel and needing a helper from the stomach. If either place is affected a deficiency arises — often only after years, because the liver holds a store.
Taken up in the upper small bowel and needing stomach acid. Acid blockers, an inflamed lining and silent blood losses often come together here.
One of the fat-soluble vitamins, lost with the fat when fat digestion is disturbed. Fatty, floating stools over months are the pointer to it.
Needs vitamin D for uptake, and with disturbed fat digestion it additionally binds to fatty acids in the bowel. So bone density and bowel disease hang together more closely than assumed.
Lost in considerable amounts with lasting diarrhoea. Signs are cracked corners of the mouth, loss of taste, poor wound healing and thinning hair.
Here they are not a supplement but a replacement for something missing. Taken with the meal, not before or after — and the amount follows the fat content of the food, not the clock.
Without fat digestion the fat-soluble vitamins do not arrive. Measured and replaced by finding, often at a higher dose than usual and together with a fatty meal.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.
The signal that calls on the pancreas to release its digestive juices as soon as fat arrives in the small bowel. If the juices are missing, the fat stays undigested — hence the shiny, foul-smelling stool.
Makes the pancreas release bicarbonate, which buffers the stomach acid in the small bowel. Without that buffering, digestive enzymes taken by mouth also work less well — which is why they are often combined with an acid blocker.
The same gland also makes the insulin. If tissue is lost, over time a diabetes of its own kind develops — which is why the sugar belongs in the follow-up.
Without enzymes fat stays undigested — and the vitamins in it go along. Levels are measured, not guessed; supplementation follows the finding.
Older advice relied on low-fat diets. Today fat is rather kept and the enzyme dose adjusted, because otherwise weight and fat-soluble vitamins suffer.
Without enzymes fat is not digested — and the fat-soluble vitamins go with it. Vitamin D is therefore measured and replaced by finding, often at a higher dose than usual.
Here with restraint: a lot of fibre can reduce the effect of the enzyme preparations. The amount is adjusted to tolerance.
Listed values: 20 · 26 · 444 · 465 · 600 · 625 · 650 · 666 · 690 · 727 · 776 · 787 · 832 · 880 · 1500 · 1550 · 1600 · 1800 · 2008 · 2127 · 2170 · 2489 · 2720 Hz