Exocrine pancreatic insufficiency (EPI) causes clay-colored, greasy stools that smell foul. A stool test to check for low levels of the elastase enzyme can help diagnose the condition.
The pancreas usually makes digestive juices that provide enzymes to the small intestine and support the full breakdown of food. EPI is a rare condition that develops when the pancreas cannot make enough enzymes or get them to the gut, or other health issues block the action of the enzymes on food.
EPI can cause stools that look and smell a certain way. Medical professionals can test stool to help diagnose the condition.
Read on to learn more about stools with EPI and what the stool test involves.
People with EPI have a symptom known as steatorrhea. This means that they produce stools with the
These stools may also float in the toilet and be difficult to flush.
Steatorrhea takes this form because people with EPI pass more fat in their stool than those with regular digestive function.
As fats pass through the gut, the small intestine needs bile acids and digestive enzymes to break them down fully. If the pancreas does not produce or secrete enough enzymes in the small intestine, the fats pass into the stool without the gut breaking them down enough.
Symptoms typically develop slowly
- abdominal pain, cramps, or discomfort
- bloating
- diarrhea
- flatulence, or passing a lot of gas
- unexplained weight loss
- vision problems at night or a loss of bone mass in rare cases
Learn more about the digestive symptoms of EPI.
The stool elastase test for EPI checks for levels of an enzyme known as elastase.
People with digestive symptoms of EPI, including the characteristic stools, may benefit from this test. Those with conditions that can cause EPI, such as chronic pancreatitis or cystic fibrosis, may undergo stool elastase tests as routine checkups on pancreatic enzyme levels.
The person having the test will need to provide a stool sample. A healthcare professional will give them a container with instructions on how to collect the sample.
Methods for collecting a stool sample can differ, but, in general, people will need to ensure the following to collect a stool sample:
- The individual needs to write their name, the date, and the time on the container’s label.
- The stool cannot mix with urine, toilet water, or toilet paper. It should also be as solid as possible, and the person should avoid collecting a watery stool.
- The person testing needs to shut the container very tightly.
- They should follow the instructions for returning the sample as quickly as possible, which may involve freezing or refrigerating it.
A person should wash their hands thoroughly after collecting the sample.
A doctor will provide special instructions to those collecting a sample from a diaper.
People taking enzyme supplements may need to stop their dose around 5 days before the test. It is important to let a doctor know about any supplements a person is taking beforehand.
Lower-than-normal levels of fecal elastase suggest that a person has EPI, and a doctor will categorize these as “moderate” or “severe.”
However, having typical elastase levels in a stool elastase test does not necessarily mean that a person’s pancreas produces enough enzymes. Further testing may be necessary to highlight the causes of their symptoms.
According to a
Several other tests can check for EPI. These
Doctors may test the blood for deficiencies in fat-soluble vitamins, including vitamins A, D, E, and K.
They may check pancreatic function using an intravenous (IV) infusion of the intestinal hormone secretin. During this procedure, they insert a tube into the small intestine through the nose to collect fluid samples.
A doctor may also examine the intestine using endoscopy. This involves using an endoscope instrument, which has a tiny camera attached to a flexible tube.
A person’s doctor can advise on what diagnostic tests they recommend and answer any questions the person may have.
The
People with EPI will also need to support these changes with the following lifestyle adjustments:
- avoiding alcohol
- quitting or avoiding smoking
- eating smaller meals more often throughout the day
A dietitian can help people with EPI adjust their food intake.
A person may also need to manage the complications of EPI, such as vitamin deficiencies or a loss in bone density. Taking dietary supplements to replenish the low levels of fat-soluble vitamins may help.
However, people should speak with a clinician before taking any supplements to manage a health problem.
Learn more about the role of diet in managing EPI.
Exocrine pancreatic insufficiency (EPI) can cause foul-smelling, greasy, pale stools. This is because the small intestine passes more fats into the stool, which doctors refer to as steatorrhea.
The fecal elastase test can help doctors identify low levels of an enzyme in people with EPI.
Once they have identified low elastase levels, a medical professional will likely check for deficiencies of fat-soluble vitamins or the response of the pancreas to a small intestine enzyme known as secretin. They can then prescribe pancreatic enzyme replacement therapy to help an individual restore their deficiency.
Dietary management and nutritional supplementation may also be necessary to manage symptoms and reduce complications after an EPI diagnosis.