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Pancreatic Insufficiency

Pancreatic insufficiency, also known as exocrine pancreatic insufficiency (EPI), occurs when the pancreas fails to produce sufficient digestive enzymes, leading to poor nutrient absorption, weight loss and discomfort. Dr. Scott in Houston provides treatments and support to restore digestive health.

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Scott Liu

About the Expert

Dr. Scott Liu, MD, is a board-certified gastroenterologist with over six years of experience and a background in military medicine. He earned his medical degree from the University of Maryland, Baltimore, completed his Internal Medicine residency at Naval Medical Center Portsmouth, and finished his Gastroenterology fellowship through the National Capital Consortium. Dr. Liu provides comprehensive care for a broad range of digestive conditions, including abdominal pain, acid reflux, liver disease, chronic diarrhea, and colon cancer screening. He is a member of the American College of Gastroenterology and is known for his disciplined, patient-focused approach and clear communication.

What Is Pancreatic Insufficiency?

Pancreatic insufficiency occurs when the pancreas does not produce enough digestive enzymes to break down food properly. This condition often results from chronic pancreatitis, cystic fibrosis, or pancreatic surgery. Common symptoms include weight loss, greasy or foul-smelling stools (steatorrhea), bloating, and vitamin deficiencies. Without proper enzyme levels, the body cannot absorb essential nutrients. Diagnosis is typically confirmed with stool tests and imaging. Treatment includes prescription pancreatic enzyme replacement therapy (PERT), dietary modifications, and supplementation of fat-soluble vitamins.

Common Causes and Risk Factors

  • Chronic pancreatitis - ongoing inflammation that damages enzyme-producing cells
  • Cystic fibrosis - genetic disorder leading to reduced exocrine function
  • Surgery or tumors - operations or growths that impair pancreatic enzyme output
  • Diabetes - high blood sugar can injure pancreatic tissue
  • Aging - natural decline in enzyme production over time

Signs and Symptoms

  • Unexplained weight loss or poor weight gain
  • Bloating, gas, or abdominal cramps after meals
  • Greasy, foul-smelling stools (steatorrhea)
  • Vitamin A, D, E or K deficiencies
  • Fatigue, weakness, or general malaise

How Dr. Scott Diagnoses Pancreatic Insufficiency and Epigastric Pain?

Dr. Scott uses a step-by-step approach:

Medical History and Physical Exam

He reviews your digestive symptoms, alcohol use, family history of cystic fibrosis or pancreatitis, and examines your abdomen-focusing on epigastric tenderness.

Nutritional Assessment

Dr. Scott evaluates weight changes, dietary patterns, and checks for signs of malabsorption like muscle wasting or vitamin deficiencies.

Fecal Elastase Test

This non-invasive stool test measures pancreatic enzyme output; low levels confirm exocrine pancreatic insufficiency (EPI).

Imaging Studies

  • Abdominal ultrasound to look for signs of chronic pancreatitis or ductal dilation.
  • MRI/MRCP for detailed views of pancreatic structure and ductal anatomy.

Pancreatic Function Testing (If Needed)

Secretin-stimulated tests or direct function tests may be used in complex cases to quantify enzyme secretion.

Dr. Scott
Treatment

Our Team offers a full range of care for exocrine pancreatic insufficiency.

1. Lifestyle and Diet Modifications

  • Eat small, frequent meals to ease digestion
  • Choose lean proteins, whole grains, and low-fat foods
  • Chew thoroughly and eat at a relaxed pace
  • Stay well-hydrated throughout the day
  • Work with our in-house dietitian for a tailored nutrition plan

2. Medications

  • Pancreatic enzyme replacement therapy (PERT) to aid digestion
  • Proton pump inhibitors (PPIs) to optimize enzyme effectiveness
  • Vitamin supplements (A, D, E, K, B12) to correct deficiencies

3. Minimally Invasive or Advanced Procedures

  • Endoscopic ultrasound (EUS) for detailed pancreatic imaging
  • Endoscopic retrograde cholangiopancreatography (ERCP) to open blocked ducts
  • Stent placement when duct drainage needs enhancement
Scott Liu

About the Expert

Dr. Scott Liu, MD, is a board-certified gastroenterologist with over six years of experience and a background in military medicine. He earned his medical degree from the University of Maryland, Baltimore, completed his Internal Medicine residency at Naval Medical Center Portsmouth, and finished his Gastroenterology fellowship through the National Capital Consortium. Dr. Liu provides comprehensive care for a broad range of digestive conditions, including abdominal pain, acid reflux, liver disease, chronic diarrhea, and colon cancer screening. He is a member of the American College of Gastroenterology and is known for his disciplined, patient-focused approach and clear communication.

Frequently Asked Questions

What causes exocrine pancreatic insufficiency?

Pancreatic inflammation (chronic pancreatitis), cystic fibrosis, pancreatic surgery or tumors, long-term diabetes, and age-related decline in enzyme production can all lead to EPI.

How is EPI diagnosed?

Dr. Scott uses a fecal elastase test to measure enzyme levels and may add ultrasound or MRI imaging and pancreatic function tests to confirm the diagnosis.

How quickly do pancreatic enzyme supplements work?

Most patients notice improvement in digestion, less bloating, and better nutrient absorption within a few days of starting PERT.

Can diet changes alone manage EPI?

While eating small, frequent meals with lean proteins and whole grains helps, nearly all patients need enzyme replacement and vitamin supplementation for full symptom relief.

Is pancreatic insufficiency a permanent condition?

Yes, EPI generally requires lifelong management. With proper treatment, however, you can maintain a healthy weight and quality of life.

Does insurance cover pancreatic enzyme therapy?

Most insurance plans cover PERT and necessary tests. Our team at GastroDoxs assists with prior authorizations to minimize your out-of-pocket costs.

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