EPI – What is Normal and When to Visit a Doctor?

Dr. Roshini Raj, a board-certified gastroenterologist and television personality, talks about exocrine pancreatic insufficiency (EPI), the symptoms, and how to tell if the stomach troubles are more than the common conditions of irritable bowel syndrome, Crohn’s Disease, or ulcerative colitis.

Dr. Roshini Raj is a board certified gastroenterologist and internist with a medical degree from New York University School of Medicine and an undergraduate degree from Harvard College. She is an attending physician at NYU Medical Center/Tisch Hospital and an Associate Professor of Medicine at the NYU School of Medicine. Dr. Raj has a special interest in women’s health and cancer screening and has published several research articles on colon cancer screening.

Dr. Raj is the Good Day NY Medical Correspondent (Fox5), a Today contributor and the Medical Editor of Health Magazine. She also contributes regularly to Dr.Oz, CNN, FNC, Inside Editionand several other national shows/networks. In August 2010, she released her first book, What the Yuck?! The Freaky & Fabulous Truth About Your Body. Dr. Raj has discussed a wide variety of health topics on a range of network and cable shows, including NBC’s Today Show; ABC’s The View, Good Morning America and World News Tonight; CNN’s American Morning, Nancy Grace, and Larry King Live; The Discovery Health Channel; The Tyra Banks Show; The Dr.Oz Show and The Doctors, among others.

Dr. Raj has been quoted in several publications, including The New York Times, The Wall Street Journal, Cosmopolitan, Men’s Health, Women’s Health and Fitness on the state of healthcare and health news of the day. Dr. Raj resides in New York City with her husband and two children.


Neal Howard: Hello and welcome to the program. Thanks for joining us here on Health Professional Radio, I’m your host Neal Howard. There’s no denying whatsoever mind-body connection, the classic expression ‘Trust your gut.’ That’s one that we use a lot but we don’t always take it literally but what do you do when your gut persistently causes discomfort? That’s when you need to follow your gut instinct and get to the doctor. Well our guest today is gastroenterologist Dr. Raj and she’s here to explain what’s normal, what’s a signal of something more serious and when to get checked out. Welcome to the program Dr. Raj, how are  you?

Dr. Roshini Raj: Thank you. I’m glad to be here.

Neal: Now you’re a gastroenterologist, a bit of background about yourself briefly for our listeners.

Dr Raj: Absolutely. So I’m a gastroenterologist practicing here in New York City. I’m also Medical Editor for Health Magazine and I talk a lot in the media about health topics and gut health in particular.

Neal: And a lot of outlets, a lot of folks may know, Good Morning America, World News Tonight,  The Today Show and many others, correct?

Dr Raj: That’s right, yes. I appear frequently on a variety of different national TV shows, always loving to educate the public about living their healthiest best life.

Neal: Now I mentioned that you know the mind-body gut connection is a no-brainer. Why is it important to literally go with your gut and listen to what your body might be telling you?

Dr Raj: Yeah. Well you know I think anyone who’s experienced butterflies in their stomach has experienced that mind-gut connection. The fact that we often can feel our stress or anxiety or even excitement in our gut literally but when we’re talking about trusting your gut, what I mean is really listening to your body and the signals it’s giving you that something might be off. And when it comes to your digestion, it’s very important to pay attention to any kind of unusual symptoms or persistent symptoms because they could be a sign of a more serious underlying condition. So you know we all fall from time to time, we’ll have an occasional stomach upset,  maybe we ate something that was off or too rich or we traveled somewhere and had some changes in our bowel movements for a day or two, that’s you know relatively normal but if things are persistent, if they’re going on for longer or if they are recurrent and if they’re affecting your day-to-day life, this is a reason why you really do want to talk to a doctor because these symptoms could be a sign of something more serious and also are confusing because things like diarrhea, abdominal pain – that could be a sign of many different GI conditions. Something like Crohn’s or irritable bowel syndrome but it also could be a sign of EPI which is a condition that not a lot of people are aware of.

Neal: What is EPI?

Dr Raj: So EPI stands for Exocrine Pancreatic Insufficiency and this is a condition where your pancreas is not producing enough enzymes to digest your food and break down the nutrients and this can then lead to symptoms like diarrhea, bloating, abdominal pain, unexplained weight loss, because you’re not digesting fat you might actually see fat droplets floating in the toilet water or at the bowel movements themselves might float – these are some of the symptoms that include that you might be suffering from EPI.

Neal: Other than the persistence of a symptom, when should a person say “Hey, I’m going to the doctor now because this just isn’t right?”

Dr Raj: Yeah, I think well like the length of symptoms is important also if you’re finding yourself changing your lifestyle. So sometimes people they won’t travel because they’re afraid they’re going to have to run look for a bathroom or they won’t go out on a date or they won’t go to that meeting. If it’s really affecting your day-to-day life, you want to seek medical attention if you find that you are reaching for over-the-counter medicines very often and kind of self-medicating without actually getting the right diagnosis, that’s another reason. Another time that you should be speaking to it a doctor and specifically eventually getting to a gastroenterologist for something like this is a good idea because we have the most experience in diagnosing some of these more rare conditions.

Neal: We on television all of these over-the-counter remedies for this stomach related issue, that stomach related issue – how often in your experience do some of these over-the-counter remedies exacerbate a problem simply because we think that it’s something that is normal or maybe over the counter can fix it when it’s actually something that nothing is going to take care of except more in-depth testing and treatment from a gastroenterologist?

Dr Raj: Yeah. I think it’s very common for people to first try over-the-counter remedies and that’s okay for a very short period of time but as you said, if you do that for a long period of time it really can adversely affect you and the condition because it’s a longer period of time that you’re not getting the right diagnosis, not getting the right treatment, your condition could worsen, it could become more serious so you really wanted to go to the doctor sooner rather than later and stop trying to kind of figure it out on your own. And in terms of gastrointestinal symptoms, it can be very confusing and that’s not something you should try to face or figure out on your own.

Neal: Who’s at risk of EPI? Is this is something that can affect anyone at any age? Are males more susceptible than females? When should we start considering EPI as the problem?

Dr Raj: Yeah. Well it can affect anyone at any age but it has been associated with certain conditions. Things like chronic pancreatitis which is an inflammation of your pancreas, cystic fibrosis, if you’ve had a procedure like a pancreatic surgery – these are some of the conditions that are associated with it but it could really affect anyone.

Neal: Okay. So it’s not something that is a result of another treatment for an underlying or an additional symptom. It could just pop out of nowhere no matter what age you are, no matter what sex right?

Dr Raj: That’s right. That’s correct.

Neal: When you’re dealing with some of these problems, say you have a teenager that’s having bowel movements three four times a day, is that something that’s abnormal for a teenager during their growing years and once you reach your 30s and 40s, should it be once a day twice a day or is there some ideal number for at least bowel movements?

Dr Raj: Well I stay away from generally ideal numbers because I think it’s a very individual thing and what I tell my patients is “What has been the pattern for you and have you noticed a change in that pattern?” For some people, going three times a day might be normal for them and that’s  fine because it’s been going on for years but if you used to go once a day and now all the sudden, you’re going three times a day or if those three times a day are uncomfortable or urgent or the stools are really loose or that kind of thing – that would be a sign that it’s actually a cause for concern. So I think if there’s any question in your mind at all, really don’t hesitate to discuss all of these things with your doctor. How frequently you’re going, what does the stool look like, things that you might think are embarrassing or shouldn’t be discussed, absolutely should be discussed because as we said, your gut and trusting your gut – these are clues to underlying conditions sometimes so you really want to listen to them and discuss them.

Neal: What can we go and learn some more?

Dr Raj: So you can go to a website identifyepi.com and there’s a great symptom checker there and there’s also lists of questions you can bring with you to the doctor. A lot of wonderful resources to learn more about this condition and GI symptoms.

Neal: Dr. Raj thank you so much for joining us on Health Professional Radio today.

Dr Raj: Thank you, it’s my pleasure.

Neal: Great. You’ve been listening to Health Professional Radio, I’m your host Neal Howard.

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