EPI and Celiac

Exocrine Pancreatic Insufficiency (EPI) and celiac disease may be common cohorts. Today we will discuss the pancreas functions, what EPI is, and what the research says about celiac and EPI.

What is the pancreas and what does it do?

The pancreas has two functions. One in the endocrine (hormone) system to regulate blood sugars. The other function relates to digestion. The digestive function is our focus for today.

The pancreas releases enzymes into the duodenum for digestion. The pancreas works in conjunction with the bile released from the gall bladder to break down foods after leaving the stomach. When foods hit the duodenum, the villi send a signal the pancreas to release enzymes for digestion.

The duodenum is the first part of the small intestine. It is the part of the small intestine most often biopsied when diagnosing celiac disease.

Damaged villi cannot signal to the pancreas that partially digested food has arrived. The pancreas is not receiving signals to release the digestive enzymes. This failure to fully digest food can cause weight loss, bloating, and diarrhea.

What is Exocrine Pancreatic Insufficiency?

According to WebMd, Exocrine Pancreatic Insufficiency (EPI) is where the pancreas doesn’t make enough enzymes to digest your food. Some symptoms are foul smelling stool, diarrhea, or gas among others.

Diagnostic tests for EPI involve blood tests to test for nutrient deficiencies. Often times, a stool test evaluates excessive fecal fat. EPI is suspected when there is too much fat in the stool.

The cure for EPI is replacement digestive enzymes or PERT. These drugs are available by prescription only. PERT is Pancreatic Enzyme Replacement Therapy.

EPI and Celiac

Finally, right?

In looking at the science, I found two recent articles that look at celiac and EPI. An article published in 2016 talks about how EPI may not be related to structural defects in the pancreas and a gluten free diet may reverse any EPI type symptoms.

Another article published in 2018 though, says that those with celiac on a gluten free diet with persistent malabsorption or weight loss, should be offered a trial of PERT. The scientists also say that EPI could affect between 0 and 77% of those with “classical” celiac symptoms. “Classical” celiac symptoms are digestive with signs of malabsorption. Serious EPI is uncommon affecting 0 to 18% of those with “classical” celiac. Serious EPI is enough to cause steatorrhea or fat malabsorption.


In summary, it looks like there might be a connection between EPI and celiac disease. If one is still experiencing foul stools and malabsorption, a trial of PERT drugs might help.

Many PERT companies are providing co-pay coupons for their drugs, so it might be a cost-effective option to research.

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