EPI is the result of damage to the pancreas, which can be due to a number of issues, including cystic fibrosis, pancreatic cancer, and chronic pancreatitis — inflammation of the pancreas due to causes such as alcohol abuse — according to the National Gastroenterological Association. Regardless of the underlying cause, a healthy diet and the right EPI treatment is essential to managing this chronic condition.
How Is EPI Treated?
EPI is usually treated with a nutrient-rich diet; vitamin and mineral supplements; and pancreatic enzyme replacement therapy (PERT). “The team approach model is the best for this condition, as treatment may not be as straightforward as ‘Take this pill and you’ll feel better,’” says Shiv Desai, MD, a gastroenterologist at Austin Gastroenterology in Texas. “A provider who is comfortable with managing EPI should lead the care team.” In most cases, this is a gastroenterologist, a doctor who specializes in problems of the gastrointestinal (GI) tract, including the pancreas. Here are the people you’ll likely want on your team.
Your primary care physician (PCP) Since EPI is only one aspect of your health, it’s important to have your PCP involved, Dr. Desai says. This can help ensure your overall physical health and address other health conditions you may have. Keep your PCP informed of any updates to your EPI, including changes to your PERT dosage.Your gastroenterologist “A gastroenterologist is essential for the diagnosis and management of EPI,” says Desai. “For the long term, a person with EPI needs a provider who can monitor weight and ensure adequate nutrition.” In addition to PERT, a GI doc will probably prescribe you vitamin supplements, such as vitamin A, B12, D, E, and K. Tell your gastroenterologist if you experience any changes in your EPI symptoms or feel your treatment isn’t effective enough.A GI nurse practitioner, nurse, and/or medical assistant Many GI practices also include nurse practitioners, nurses, and medical assistants experienced in treating people with EPI. These professionals can be valuable resources to help answer any questions you have about your EPI. You can also call or sometimes email them through a patient portal between appointments.A nutritionist A crucial part of managing EPI is getting the right nutrients. “A nutritionist can help ensure you have no nutritional deficiencies, and they provide education on dietary intake,” Desai says. A nutritionist can help you focus on getting a range of healthy foods and enough fats in your diet. Your nutrition plan should be personalized based on other health conditions you’re managing, too, such as cystic fibrosis.A social worker “This is sometimes the most important person on the team,” Desai says. “Social services can be extremely helpful, because the cost for enzyme replacement can be very high, which is a big issue for some people with EPI and may even cause substantial barriers to adherence.” A medical social worker can assist you with the costs of PERT by referring you to resources, such as assistance programs from medication manufacturers. They can also refer you to a mental health professional, such as a therapist, if living with EPI is affecting you emotionally.A pharmacist For PERT to be effective, the timing is important: It’s taken during your meal in divided doses. Your pharmacist can help answer any questions you have about taking PERT correctly or about the supplements you’re prescribed.
In some cases, you may be able to find all of these professionals in one place. Some institutions have a care team comprised of a physician, an advanced practitioner — for example, healthcare providers who are not physicians but perform many of the same duties, such as a nurse practitioner — a nurse, a medical assistant, a social worker, and a pharmacist, says Desai. In other cases, you may find them through a larger network of medical offices. Remember, too, that the most important person on your EPI treatment team is you. In addition to assembling the right professionals, you might want to check out organizations such as the Pancreatic Cancer Action Network, Aimed Alliance, and Mission: Cure, which provide resources, support, and education.
