Exocrine Pancreatic Insufficiency EPI Might Be The Cause Of Your Chronic Stomach Pain

22 Aug 2019
Exocrine Pancreatic Insufficiency EPI stomach pain smelly gas and bloating

Digestive conditions affect 60 to 70 million Americans and people with gastrointestinal (GI) issues often ignore their discomfort. According to EPI Uncovered, an American Gastroenterological Association (AGA) survey sponsored by AbbVie, individuals experiencing chronic GI symptoms wait an average of nearly four years to see a health-care professional and may not know if they have a condition such as exocrine pancreatic insufficiency (EPI).

Among the suspected causes of chronic digestive distress is EPI, which occurs when the pancreas does not produce enough enzymes to properly digest food into nutrients. EPI can be difficult to diagnose, because its symptoms are similar to those associated with more common GI conditions. Many gastroenterologist are not well versed when it comes to EPI. Many times people are misdiagnosed with bad gas or some other GI issue that never seems to get better even with medication.

“Harvard University researchers revealed that a chemical found in cannabis has demonstrated “significant therapy potential” in treatment of pancreatic disease. It’s called FBL-03G, is a derivative of a cannabis “flavonoid” — the name for a naturally-occurring compound found in plants, vegetables and fruits which, among other purposes, provides their vibrant color.”

Who gets EPI?
EPI is associated with certain diseases and conditions that affect the pancreas. Some of these diseases you are born with, like cystic fibrosis, while others may occur later in life, as is the case with chronic pancreatitis.

EPI may be associated with chronic pancreatitis and cystic fibrosis. If you have one of these conditions and symptoms of EPI, we recommend that you talk to your doctor.

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Chronic Pancreatitis
Chronic pancreatitis (CP) is the most common cause of EPI in adults. Over the course of years the inflammation can lead to irreversible damage to the pancreas, including the cells that secrete pancreatic digestive enzymes and the cells that produce insulin leading to diabetes.

Cystic fibrosis
Cystic fibrosis (CF) is an inherited genetic condition that leads to chronic disease that mainly affects the lungs and digestive and reproductive systems. In patients with CF, a thick, sticky mucus is produced in certain organs throughout the body, most commonly in the lungs and digestive system, including the pancreas. Many people living with CF are unable to properly digest food because they may also have EPI.

Diagnosing EPI
If you have exocrine pancreatic insufficiency (EPI), your body cannot properly digest fats, proteins, and carbohydrates in the food you eat. In addition to preventing adequate digestion, EPI produces uncomfortable gastrointestinal (GI) symptoms.

Only your doctor can tell if your GI symptoms are due to EPI or another digestive condition. That is why it is so important to talk to your doctor about your medical history and all of your medications including all vitamins and supplements you take. And make sure to open up and share all of your symptoms at your next visit.

Living with EPI
Getting nutrition from food
The food you eat contains 3 main nutrients—fat, protein, and carbohydrates. Your body uses these nutrients to help give you energy to function.

FAT is found in foods like nuts and cheese.

PROTEIN comes from foods like meat, poultry and fish.

CARBOHYDRATES can be found in bread and pasta. Carbohydrates are broken down into sugars.

If you have EPI, your pancreas cannot properly break down foods, resulting in poor digestion of nutrients—especially fats. Eating healthy is important for all of us. But it’s especially important that people with EPI eat a nutrient-rich diet—along with taking pancreatic enzyme replacement therapy with every meal and snack—since EPI interferes with nutrient absorption.

If you have been diagnosed with EPI, you should work with your doctor or nutritionist to make sure that all your dietary needs are being met.

Pancreatic enzyme replacement therapies
Your doctor may start you on a prescription treatment called pancreatic enzyme replacement therapy, or PERT. PERTs are the main treatment for EPI—they replace the digestive enzymes that your pancreas isn’t producing anymore. When taken with food, PERTs help break down the nutrients in food.

Vitamins and supplements
If you have exocrine pancreatic insufficiency (EPI), your body may not absorb the nutrients from the food you eat. Your doctor may prescribe vitamin and mineral supplements to help you maintain proper levels of the fat-soluble vitamins A, D, E, and K.

Eating healthy with EPI and cystic fibrosis (CF)
A high-calorie diet with adequate amounts of fat is especially important to help patients with CF grow, develop, and thrive. Patients with CF should work with their dietitian or nutritionist to make sure their proper nutrition needs are met.

What are the symptoms of EPI?
Exocrine pancreatic insufficiency (EPI), sometimes called pancreatic insufficiency for short, is the inability to break down and digest food properly.

Symptoms of EPI can vary, but if you have one or more of these symptoms, you should talk to your doctor. Talking to your doctor is important since only your doctor can tell if your symptoms are due to EPI or another gastrointestinal condition.

EPI can cause problems with undigested food moving too quickly through the digestive tract.

Gas and bloating
People with EPI cannot properly digest the food they eat, which can result in uncomfortable symptoms like gas and bloating.

Stomach pain
Fat maldigestion due to EPI can lead to gas, bloating, and stomach pain.

Foul-smelling, greasy stools (steatorrhea)
Steatorrhea is a type of bowel movement that is oily, floats, smells really bad, and is difficult to flush. People with EPI are not able to absorb all of the fat that they eat, so undigested fat is excreted, resulting in stools that look oily or greasy. Not all people experience this symptom.

Talk to your doctor if you notice oil droplets floating in the toilet bowl or stools that float or stick to the sides of the bowl and are hard to flush; it may be a sign of EPI.

Weight loss
EPI affects protein and carbohydrate digestion, but the greatest impact comes from fat maldigestion, which is the primary cause of weight loss in people with EPI. If there is a lot of weight loss your doctor will want to do more test to rule cancer out.

Pancreatic cancer makes up just 3 percent of all cancers in America. But with a one-year survival rate of just 20 percent (and five-year survival rate of less than 8), it’s predicted to be the second leading cause of cancer-related death by 2020.

Headlines about the illness, as a result, tend to be discouraging. But this month scientists from Harvard University’s Dana-Farber Cancer Institute have released some much-needed good news. In their study, published in the journal Frontiers of Oncology on July 23, the researchers revealed that a chemical found in cannabis has demonstrated “significant therapy potential” in treatment of pancreatic cancer.

The specific drug, called FBL-03G, is a derivative of a cannabis “flavonoid” — the name for a naturally-occurring compound found in plants, vegetables and fruits which, among other purposes, provides their vibrant color. Flavonoids from cannabis were discovered by a London researcher named Marilyn Barrett in 1986, and were later found to have anti-inflammatory benefits.

But while scientists long suspected that cannabis flavonoids may have therapeutic potential, the fact that they make up just 0.14 percent of the plant meant that researchers would need entire fields of it to be grown in order to extract large enough quantities. That changed recently when scientists found a way to genetically engineer cannabis flavonoids — making it possible to investigate their benefits.

Enter the researchers at Dana-Farber, who decided to take the therapeutic potential of one of these flavonoids, FBL-03G, and test it on one of the deadliest cancers through a lab experiment. The results, according to Wilfred Ngwa, PhD, an assistant professor at Harvard and one of the study’s researcher, were “major.”

“The most significant conclusion is that tumor-targeted delivery of flavonoids, derived from cannabis, enabled both local and metastatic tumor cell kill, significantly increasing survival from pancreatic cancer,” Ngwa tells Yahoo Lifestyle. “This has major significance, given that pancreatic cancer is particularly refractory to current therapies.”

Ngwa says that the study is the first to demonstrate the potential new treatment for pancreatic cancer. But on top of successfully killing those cells, the scientist found FBL-03G capable of attacking other cancer cells — which was startling even to them. “We were quite surprised that the drug could inhibit the growth of cancer cells in other parts of the body, representing metastasis, that were not targeted by the treatment,” says Ngwa. “This suggests that the immune system is involved as well, and we are currently investigating this mechanism.”

The significance of that, says Ngwa, is that, because pancreatic cancer is often diagnosed in later stages, once it has spread, and the flavonoids seem to be capable of killing other cancer cells, it may mean the life expectancy of those with the condition could increase.

“If successfully translated clinically, this will have major impact in treatment of pancreatic cancer,” says Ngwa.

The next step for the Harvard researchers is to complete ongoing pre-clinical studies, which Ngwa hopes will be completed by the end of 2020. That could set the stage for testing the new treatment in humans, opening up a new window of hope for a group long in need of it.

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