Your Smelly Diarrhoea And Weight Loss Could Be Caused By EPI

January 31, 2024
Your Smelly Diarrhoea And Weight Loss Could Be Caused By EPI

Have you experienced sudden weight loss and an unusually smelly diarrhoea, especially after consuming a high-fat meal? Chances are you might have exocrine pancreatic insufficiency (EPI).


Unfortunately, despite it being easy to treat, EPI is often misdiagnosed or overlooked, and it is a chronic disorder that usually leads to mental health issues. In this post, we will explore everything you need to know about the disorder, from its symptoms to managing and treating it.


What is EPI?

The pancreas has two essential functions: It is a part of the digestive and endocrine system.


When food has been broken down and partially digested in the stomach, it is then pushed into the small intestine. The pancreas produces enzymes and digestive juices to help break down fats. This process is known as the exocrine function.


The pancreas is also responsible for producing hormone insulin, which helps regulate your blood sugar level. This process is known as the endocrine function.


When individuals develop EPI, their pancreas does not produce enough digestive enzymes, resulting in the inability to break down fats, which are then passed through the digestive system, causing smelly diarrhoea.


Adults with chronic pancreatitis and children with cystic fibrosis are most likely to develop EPI.


What causes EPI?

When someone has EPI, that person’s pancreas does not produce a sufficient amount of digestive enzymes to break down fats, resulting in food passing through their intestine in a more undigested state. This causes their body not to get enough nutrients.


There are three types of pancreatic enzymes that are affected by EPI:


  • Elastase and protease, which break down proteins


  • Lipase, which breaks down fats


  • Amylase, which breaks down carbohydrates


Certain conditions and diseases result in EPI:


  • Shwachman-Diamond syndrome, a rare inherited bone marrow failure that causes difficulty in absorbing food, resulting in low levels of white blood cells and skeletal abnormalities.


  • Gastrointestinal or pancreatic surgery


  • Bariatric surgery, also known as weight-loss surgery


  • IBD


  • Cystic fibrosis


  • Diabetes


  • Celiac disease


  • Chronic pancreatitis


In some cases, the causes of EPI are not known. Apart from the conditions and diseases mentioned above, EPI can be caused by pancreas damage as a result of smoking and alcoholism. Either one can contribute to EPI. However, combine both together, and you increase your risk exponentially.


What are the symptoms of EPI?

The primary sign of EPI is oily diarrhoea. However, the unfortunate fact is that doctors do not always dive into the diarrhoea subtype. As a result, many suffer in silence unless they state that their diarrhoea seems different. Often, the diarrhoea worsens after consuming fatty or greasy foods.


Individuals with EPI have increased difficulty breaking down fats, leading to lots of uncomfortable digestive symptoms, such as:


  • Sudden weight loss


  • Foul-smelling, oily, and pale stool that floats


  • Oily diarrhoea


  • Constipation



EPI also causes vitamin deficiencies, especially fat-soluble ones, such as vitamins K, E, D, and A.


  • Vitamin K deficiency leads to an increased risk of developing cardiovascular diseases, osteoporosis, poor bone development, and blood clotting issues.


  • Vitamin E deficiency leads to vision issues, numbness, coordination difficulties, and muscle weakness.


  • Vitamin D deficiency leads to bone density loss, which increases your risk of developing fractures, osteoporosis and fatty liver symptoms.


  • Vitamin A deficiency leads to impaired immunity, hematopoiesis, rashes, and ocular disorders, such as night blindness and xerophthalmia.


If left untreated, these deficiencies can affect your overall quality of life significantly.


How do doctors diagnose EPI?

EPI can easily be misdiagnosed or overlooked due to symptoms shared with many gastrointestinal disorders. If your healthcare provider suspects that you may have EPI during your gastroenterology visit, they may recommend one or more of these diagnostic tests:


  • Secretin pancreatic function test: It tests your pancreas’s response to secretin, a hormone that triggers the production and release of digestive enzymes. During the test, an IV drip will feed your body with secretin. Your healthcare provider will use an endoscopic ultrasound to collect some fluid to test its response.


  • Fecal elastase test: Basically, you will provide a stool sample which will be tested for the level of the elastase enzyme. If you have EPI, your stool will have little to no elastase.


  • 48-hour faecal fat test: Basically, you will follow a 100g fat diet for five days. On the last two days, stool samples will be collected to evaluate how much fat was not broken down. An individual with no EPI will be able to break down approximately 90g of fat. Individuals with EPI will have approximately up to 60g of fat left in the stool.


Apart from these diagnostic test, you may also be required to get an imaging test, such as an abdominal ultrasound or CT scan, to help spot any issues with your pancreas that may be causing EPI.


What are the complications of EPI?

Individuals with EPI are not able to break down carbohydrates, proteins, and fats. As a result, their body suffers from malabsorption and are not able to get sufficient nutrients to maintain organ function and energy, leading to malnutrition.


Signs of malnutrition include:


  • Muscle loss


  • Issues maintaining concentration and retaining memories


  • Easily irritated


  • Feeling cold all the time


  • Dizziness or fatigue


  • Edema


  • Depression


  • Hair loss, brittle nails, and dry skin


Can EPI be managed, treated, or prevented?

EPI is a lifelong condition. Most of the treatments available focus on getting the body the essential nutrients needed for the maintenance of health. Such treatments include:


  • Taking vitamin supplements: As mentioned earlier, EPI causes the inability to absorb fat-soluble vitamins. As such, individuals with EPI must take vitamin supplements to ensure that the body receives an adequate amount of them since they are not able to break them down from food.


  • High-fat, high-calorie diet: It is vital to get sufficient fat and calories with your meals. Because their bodies are not already finding it difficult to break down fats, it is crucial that you consume a higher fat and calorie intake so that your body is still able to absorb a healthy level. Your healthcare provider may recommend you work with a dietitian to ensure that you maintain a well-balanced diet.


  • Pancreatic enzyme replacement therapy (PERT): It is a prescribed medication that acts as a substitute for the lack of digestive enzymes. Basically, you consume PERT during your meals to help your body break down and absorb essential nutrients.


In most cases, you can avoid developing EPI, especially if you have the habit of smoking, drinking alcohol, or doing both at the same time. Often, treating other existing health conditions is more effective than treating the symptoms.


For example, if the individual has celiac disease, adhering to a gluten-free diet can help to reverse EPI. Additionally, individuals with diabetes, especially the type-1 ones, are prone to developing EPI. Hence, managing their diabetes often leads to better control of EPI.



When treated timely, most individuals experience a significant change within a week. EPI is a long-term condition, but that does not mean you cannot live a healthier life. If you are looking to improve your gut health, then do not hesitate to visit GUTCARE, a digestive care specialist. With a wide range of treatments, our doctors are able to help you achieve a better overall quality of life.


Click here to make an appointment with us today!



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