Underlying Conditions and Procedures of EPI

EPI can occur in people with certain diseases and conditions that affect the pancreas. These diseases may be present when you’re born or develop over time.2,3

Underlying conditions or procedures which cause or may cause EPI include4-9:

Cystic fibrosis (CF)

CF is an inherited genetic disorder that mainly affects the lungs, digestive, and reproductive systems. People with CF produce thick, sticky mucus. When the pancreas is clogged with mucus, it can’t properly release the digestive enzymes needed to properly break down food.

Chronic pancreatitis (CP)

CP is a disease in which there is inflammation of the pancreas that lasts a long time. This is the most common cause of EPI in adults. CP may cause irreversible damage to the pancreas, including the cells that make digestive enzymes.


An operation to remove all or part of the pancreas, a pancreatectomy could disrupt pancreatic digestive enzyme production or delivery leading to EPI.

Pancreatic cancer

Obstruction of the pancreatic duct by tumors, destruction of the pancreas by tumor growth, and loss of pancreatic tissue from surgery—all potential results of pancreatic cancer—can lead to EPI.

Other underlying conditions or procedures in which EPI has been reported8-14

Acute pancreatitis (AP)

A condition where the pancreas becomes inflamed, AP can lead to temporary or permanent EPI.

Crohn’s disease

By making your immune system attack your own pancreas, by damaging your pancreatic duct, and by scarring or inflaming your pancreas, Crohn’s disease can affect the ability of your pancreas to produce the enzymes you need to digest food. This can lead to EPI.

Celiac disease

Though it is generally temporary and will likely improve with a gluten-free diet, untreated celiac disease can lead to EPI.

Type I diabetes

The inability to produce insulin, a hormone produced by the pancreas that helps control blood sugar, type I diabetes may also be an underlying condition that causes EPI.

Gastrointestinal surgery

Potentially affecting how pancreatic digestive enzymes are delivered to break down food, certain surgeries to the stomach or intestines can lead to EPI.

If you have one of these medical conditions, or have or have had one of these procedures—as well as one, some, or all of the symptoms of EPI—make sure you let your doctor know.

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Uses and Important Safety Information


CREON is a prescription medicine used to treat people who cannot digest food normally because their pancreas does not make enough enzymes due to cystic fibrosis, swelling of the pancreas that lasts a long time (chronic pancreatitis), removal of some or all of the pancreas (pancreatectomy), or other conditions.

Important Safety Information

  • CREON may increase your chance of having a rare bowel disorder called fibrosing colonopathy. The risk of having this condition may be reduced by following the dosing instructions that your doctor gave you.
  • Do not crush or chew CREON capsules or its contents, and do not hold the capsule or capsule contents in your mouth. Crushing, chewing, or holding the CREON capsules in your mouth may cause irritation in your mouth. Talk to your doctor or consult the CREON Medication Guide for how to take CREON if you have trouble swallowing capsules. Always take CREON with a meal or snack and enough liquid to swallow CREON completely. Take CREON exactly as your doctor tells you.
  • Tell your doctor right away if you have unusual or severe: stomach (abdominal) pain, bloating, trouble passing stool, nausea, vomiting, diarrhea, worsening of painful, swollen joints (gout), or allergic reactions including trouble with breathing, skin rashes, or swollen lips.
  • The most common side effects include: increased (hyperglycemia) or decreased (hypoglycemia) blood sugars, pain in your stomach area (abdominal area), frequent or abnormal bowel movements, gas, vomiting, dizziness, or sore throat and cough.
  • CREON and other pancreatic enzyme products are made from the pancreas of pigs, the same pigs people eat as pork. These pigs may carry viruses. Although it has never been reported, it may be possible for a person to get a viral infection from taking pancreatic enzyme products that come from pigs.

Refer to the CREON Medication Guide and Full Prescribing Information every time you refill your prescription because information may change. Tell your healthcare provider if you have any symptom or side effect that bothers you or that does not go away.

You are encouraged to report negative adverse effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

If you cannot afford your medication, contact www.pparx.org.

Reference: 1. CREON [package insert]. North Chicago, IL: AbbVie Inc.

  1. References:
  2. CREON [package insert]. North Chicago, IL: AbbVie Inc.
  3. Dominguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122.
  4. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(suppl 1):S5-S20.
  5. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl 6):vi1-vi28.
  6. Kempeneers MA, Ali UA, Issa Y, et al; for Dutch Pancreatitis Study Group. Natural course and treatment of pancreatic exocrine insufficiency in a nationwide cohort of chronic pancreatitis. Pancreas. 2020;49(2):242-248.
  7. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017;23(suppl 12):S203-S209.
  8. Matsumoto J, Traverso LW. Exocrine function following the Whipple operation as assessed by stool elastase. J Gastrointest Surg. 2006;10(9):1225-1229.
  9. Yuasa Y, Murakami Y, Nakamura H, et al. Histological loss of pancreatic exocrine cells correlates with pancreatic exocrine function after pancreatic surgery. Pancreas. 2012;41(6):‌928-‌933.
  10. Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World J Gastroenterol. 2013;19(42):7258-7266.
  11. Hollemans RA, Hallensleben NDL, Mager DJ, et al; for Dutch Pancreatitis Study Group. Pancreatic exocrine insufficiency following acute pancreatitis: systematic review and study level meta-analysis. Pancreatology. 2018;18(3):253-262. doi:10.1016/j.pan.2018.02.009
  12. Huang W, de la Iglesia-García D, Baston-Rey I, et al. Exocrine pancreatic insufficiency following acute pancreatitis: systematic review and meta-analysis. Dig Dis Sci. 2019;64(7):1985-2005. doi:10.1007/s10620-019-05568-9
  13. Singh VK, Haupt ME, Geller DE, Hall JA, Quintana Diez PM. Less common etiologies of exocrine pancreatic insufficiency. World J Gastroenterol. 2017;23(39):7059-7076.
  14. Pezzilli R, Andriulli A, Bassi C, et al; Exocrine Pancreatic Insufficiency collaborative Group. Exocrine pancreatic insufficiency in adults: a shared position statement of the Italian Association for the Study of the Pancreas. World J Gastroenterol. 2013;19(44):7930-7946.
  15. Chaudhary A, Domínguez-Muñoz JE, Layer P, Lerch MM. Pancreatic exocrine insufficiency as a complication of gastrointestinal surgery and the impact of pancreatic enzyme replacement therapy. Dig Dis. 2020;38(1):53-68. doi:10.1159/000501675

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