IBS vs EPI: Are they Related?

a young man holding his stomach because of ibs or epi

Irritable bowel syndrome (IBS) and exocrine pancreatic insufficiency (EPI) are different conditions. However, the symptoms are very similar, which can make diagnosis difficult. In addition, diagnosing EPI is difficult, and many patients don’t know they have IBS because it is a difficult conversation to begin. Here’s a look at IBS, EPI, and their potential relationship.

What is IBS?

Irritable bowel syndrome is a chronic gastrointestinal disorder. It can cause abdominal cramping and pain, bloating, constipation, diarrhea, and alternating constipation and diarrhea. Although experts have a few theories for IBS causes, it needs more research. In some patients, it may have much to do with the smooth muscles of the bowels failing to relax and contract normally, forcing abnormal bowel movements. Another theory relates IBS to the nervous system. The nerve endings in the GI tract may be more sensitive in some people so when the muscles move to pass food, it becomes much more intense than in a normal gut.

Treating IBS can be difficult, but it is manageable. New prescription medications are available for symptomatic treatment. They are designed specifically for symptoms of patients with IBS. Careful dietary habits such as avoiding foods that tend to be triggers for IBS and reducing stress may be extremely beneficial.

What is EPI?

Exocrine pancreatic insufficiency occurs when the pancreas fails to create enough of the enzymes needed to process food. As a result, food doesn't break down fully, and you are not able to absorb the nutrients you would normally. EPI usually occurs because of pancreatic damage or inflammation. This can be the result of chronic pancreatitis, gastrointestinal surgery, cystic fibrosis, or Shwachman-Diamond syndrome.

Symptoms of EPI include stomach discomfort, foul bowel movements, gas, bloating, and diarrhea. Malnutrition may be an issue because you may feel full despite eating little. Unintended weight loss is very common—not only from not eating well due to stomach pain and the feelings of fullness, but because your body isn’t absorbing fats, vitamins, and nutrients.

Treating EPI requires a carefully formulated diet along with certain medications. You may need to take vitamin supplements. The main pharmaceutical treatment is a pancreatic enzyme replacement therapy—artificial enzymes to make up for what your pancreas is failing to create.

What’s the Relationship?

Aside from the more obvious symptomatic similarities, IBS and EPI are both quite difficult to diagnose. Additionally, EPI can actually lead to IBS. These facts are important to understand the relationship, though it is still up for debate in the medical field. Pancreatic issues are difficult to find, especially in early stages.

If you are misdiagnosed for EPI, taking the extra enzymes can cause issues. Conversely, if you’re only diagnosed with IBS, you still aren’t getting the enzymes you need. It can be difficult to sort out treatment when you don’t know if EPI caused IBS, or you don’t have the proper diagnosis. If you suspect one of these things is a problem, ask your doctor to help you find a specialist for these disorders.