1. Home
  2. Health Information
  3. Digestive Diseases
  4. Exocrine Pancreatic Insufficiency (EPI)

Exocrine Pancreatic Insufficiency (EPI)

View or Print All Sections

Definition & Facts

Exocrine pancreatic insufficiency (EPI) occurs when your small intestine can’t digest food completely because of problems with enzymes produced by the pancreas. Complications of EPI can include malnutrition, low bone mass, and problems with growth in children.

Woman eating a small snack at her desk.

Symptoms & Causes

Symptoms of exocrine pancreatic insufficiency (EPI) may include bloating, cramps or pain in the abdomen, and diarrhea. EPI may be caused by diseases and conditions such as pancreatitis, cystic fibrosis, pancreatic cancer, and surgery of the pancreas or upper gastrointestinal tract.


To diagnose exocrine pancreatic insufficiency (EPI), your doctor will ask about your medical and family history, perform a physical exam, and order tests. Tests may include a stool elastase test, blood tests, and a pancreatic function test.


Doctors treat exocrine pancreatic insufficiency (EPI) with pancreatic enzyme replacement therapy (PERT) and lifestyle changes, such as avoiding alcohol and quitting smoking. Your doctor may recommend additional treatments for the disease or condition that caused EPI.

Eating, Diet, & Nutrition

If you have exocrine pancreatic insufficiency (EPI), your small intestine can’t digest food normally, which can lead to malabsorption and malnutrition. Your doctor or registered dietitian may recommend you eat small, frequent meals and take pancreatic enzyme replacement therapy (PERT) when you eat.

Clinical Trials

The NIDDK conducts and supports clinical trials in many diseases and conditions, including digestive diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

Your Digestive System & How It Works

The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.

Related Research

Last Reviewed January 2023

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Christopher E. Forsmark, M.D., University of Florida College of Medicine; Suresh T. Chari, M.D., University of Texas MD Anderson Cancer Center