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Clinician’s Corner: Getting to know your pancreas

Most patients are familiar with the function of the pancreas to produce insulin.  It also produces glucagon to help regulate blood sugars.  Another extremely important function of the pancreas is to make enzymes for digestion of the food we eat. Just as the pancreas can “wear out” and stop producing insulin it can also slow up production of these important digestive enzymes. This condition is referred to as EPI (Exocrine Pancreatic Insufficiency)

In people with EPI, it is the enzyme production of the pancreas that is affected. EPI occurs when mealtime enzyme output is ≤10% of normal.  The undigested food moving through the intestines that causes the unpleasant symptoms of EPI.

EPI is a condition that can be managed with prescription medication called PERT (pancreatic enzyme replacement therapy). PERTs replace the enzymes the pancreas is no longer making. The capsules/tablets are taken with every meal to help break down food into nutrients that can be absorbed. They contain the enzymes lipase which breaks down fats, protease which breaks down proteins, and amylase which breaks down carbohydrates.


  • Frequent diarrhea (usually characterized by frequent, soft bowel movements that appear pale)
  • Unexplained weight loss
  • Steatorrhea (due to excess fat content, stools are loose, floating, oily, foul smelling, and hard to flush)
  • Flatulence bloating and abdominal pain
  • Diabetes (Type-2) is frequently associated with EPI. Conditions associated with EPI


Along with the pancreatic enzyme replacement therapy (which we will “digest” next week) the following should be recommended:

  • A nutritionally well-balanced diet
  • Vitamin and mineral supplements, including fat-soluble vitamins A, D, E, and K
  • Lifestyle modifications such as abstaining from alcohol and smoking cessation
  • Your Thompson Pharmacist should review your med list, to see if some of the medications you take could be causing diarrhea. Most drugs report diarrhea as a side effect, but especially watch out for:
    • Selective Serotonin Reuptake Inhibitors (Citalopram, fluoxetine, sertraline and others)
    • Other antidepressants such as bupropion and trazodone
    • Lithium
    • Metformin- frequently prescribed for our Type-2 diabetics, who are also at risk for EPI
    • Proton pump inhibitors (omeprazole, esomeprazole) along with H2RA’s like ranitidine and famotidine (very rare)
    • Bisphosphonates (alendronate, ibandronate, risedronate)
    • Colchicine
    • NSAIDS- (ibuprofen, naproxen and others)
    • ACE inhibitors
    • Chemotherapeutic drugs


Your Thompson Pharmacist can be a great resource for getting help when your pancreas “wears out”, whether causing EPI or Type-2 diabetes.  We’re here to help.  Go ahead and ASK… at Thompson Pharmacy…it’s all for YOU!