6 Signs This Underdiagnosed Condition Is Causing Your Gut Issues

Lea Ann Chen, MD, assistant professor of medicine and director of the Inflammatory Bowel Disease Translational Research at the Rutgers Robert Wood Johnson Medical School, tells SELF there are “many reasons” why EPI is underdiagnosed. “EPI symptoms are nonspecific and overlap with other more common GI diagnoses,” she explains. “Also, the tests to evaluate for EPI are very specific, so it is unlikely to be diagnosed incidentally.”

That means your doctor would specifically need to suspect that you have EPI and order the appropriate tests to verify it versus accidentally stumbling upon a diagnosis while testing you for other conditions—and they likely would not do that specific testing unless you had one of the above conditions associated with a higher risk of EPI or red flag symptoms, like unexplained weight loss or nutrient deficiencies (which we’ll explain more in-depth below). “For patients whose EPI is mild or is not caused by chronic pancreatitis, the condition can be missed,” Dr. Chen says.

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What are the most common exocrine pancreatic insufficiency symptoms?

Because the signs and symptoms of EPI can overlap with those of other GI conditions, you can imagine they’re not exactly fun to deal with. “If EPI is untreated, the symptoms can be extremely uncomfortable,” Mohamed Othman, MD, professor of medicine – gastroenterology at Baylor College of Medicine, tells SELF. However, there are a few tip-offs that you may be dealing with EPI symptoms compared to those of another health condition2.

You have unexplained diarrhea after you eat.

Diarrhea is a common issue that is usually caused by something you ate, a stomach bug, or a more serious condition like inflammatory bowel disease, according to the National Institute of Diabetes and Digestive and Kidney Diseases. 

However, diarrhea is also an issue in people with untreated or under-treated EPI, Dr. Othman says, and there are a few reasons for this. One is that the food you’re eating doesn’t get properly absorbed in your gastrointestinal tract. This allows the bacteria that naturally hang out in your gut to ferment that undigested food, he says. At the same time, water collects around it which can make your stool more liquidy.

There’s also this to consider: That undigested food can include fat, Amy Tyberg, MD, a professor of gastroenterology at Rutgers Robert Wood Johnson Medical School, tells SELF. “The fat subsequently stays in the GI tract and acts as a laxative as it travels through the intestines,” she says. Cue the constant diarrhea.

Your poop looks “fatty.”

EPI can also lead to fatty poops, which are literally bowel movements that have a higher fat content than usual. Medically known as steatorrhea4, these poops are often paler than usual, oily, and smellier than you might be used to, per the Cleveland Clinic. “It’s a result of the lack of absorption of fat in the intestines,” Philip Hart, MD, a gastroenterologist at The Ohio State University Wexner Medical Center, tells SELF.

So, if your body has difficulty absorbing fat in your diet due to EPI, it simply comes out in your stool. Heads up: You might also see fat or oil droplets in your poop or an oily residue floating on top of the toilet water after you go, Dr. Othman says.

You’re losing weight without trying.

When your body can’t break down nutrients in the food you eat, you can’t properly absorb them—and that can cause you to lose weight without trying, Dr. Othman says. Diarrhea caused by EPI can also lead to weight loss if it’s constant.

Your stomach hurts.

This tends to be a more indirect symptom. EPI can cause excessive gas and bloating due to digestion issues, so your stomach may not feel great as a result. Your body’s difficulty absorbing fat can be a major reason for this symptom, Dr. Hart says.