[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-508224-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-508224-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","guideline-management-of-pancreatic-exocrine-insufficiency-pei-for-adults","Guideline - Management of pancreatic exocrine insufficiency (PEI) for adults","","Guideline outlining the management of pancreatic exocrine insufficiency (PEI) in adults, focusing on diagnosis and long-term pancreatic enzyme replacement therapy (PERT). It explains the digestive enzyme deficit, appropriate testing using faecal elastase, and dietary considerations to avoid worsening malnutrition. The document details PERT dosing principles, administration with meals, dose adjustment when symptoms persist, monitoring malabsorption patterns, and evaluating alternative causes when inadequate response occurs. It also covers supportive options such as enzyme administration for patients who cannot swallow and tube-fed alternatives, plus use of acid suppressants.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/guideline-management-of-pancreatic-exocrine-insufficiency-pei-for-adults/508224/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/guideline-management-of-pancreatic-exocrine-insufficiency-pei-for-adults/508224.png","ImageObject",300,407,{"name":42,"@type":43},"Mabel","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-09","2026-10-05",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is pancreatic exocrine insufficiency (PEI) and how is it treated in adults?","Question",{"text":63,"@type":64},"PEI occurs when the pancreas does not produce or transport enough digestive enzymes to digest food and drink for adequate absorption. It is treated with pancreatic enzyme replacement therapy (PERT).","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How is PEI tested and what does normal faecal elastase indicate?",{"text":68,"@type":64},"PEI can be tested with a faecal elastase test. Normal faecal elastase is greater than 500 µg/g faeces.",{"name":70,"@type":61,"acceptedAnswer":71},"When should PERT dosing be increased or alternative causes considered?",{"text":72,"@type":64},"If symptoms are not alleviated after three to four days of taking PERT as recommended, a dose increase is advised. If a patient reaches 10,000 lipase units/kg/day and still has symptoms, other causes should be considered before further dose increases, such as bile acid malabsorption, small intestinal bacterial overgrowth, or coeliac disease.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},508224,1791311544,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":140,"language":141,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":12,"update_tm":145,"read_time":146,"preview_page_count":4},7971474920318,"https://ap-avatar.wpscdn.com/avatar/74000ee537e6b0ca360?x-image-process=image/resize,m_fixed,w_180,h_180&k=1788430171632181674","Guideline  \nManagement of pancreatic exocrine insufficiency (PEI) for adults  \nOverview  \n• Pancreatic exocrine insufficiency (PEI) occurs when the pancreas does not produce or transport sufficient digestive enzymes to suitably digest food and drink in the intestine to allow adequate absorption.  \n• This is treated with pancreatic enzyme replacement therapy (PERT) .  \n• Most patients who require PERT require it for life.  \n• PERT contains lipase, amylase and proteases.  \n• All available PERT is pork based. Permission is given for Jewish and Muslim patients to take PERT as there are no alternatives.  \n• PEI can be tested for with faecal elastase test.  \n• Normal faecal elastase is >500􀁐g/g faeces.  \n• A patient taking PERT does not affect the results of faecal elastase unless the polyclonal test is used.  \n• Low fat diets may exacerbate malnutrition and should be avoided in the vast majority of patients.  \n• PEI is treated by administration of PERT, which treats amylase, protease and lipase deficiencies, therefore treating carbohydrate, protein and fat malabsorption.  \n• Initiation of PERT in patients with severe symptoms may unmask diabetes.  \n• PERT needs to be taken with all food or drink which contains more than very little fat, starch or protein.  \n• PERT should be swallowed whole during the meal, snack or drink.  \n• A usual starting dose is two capsules (of Creon 25,000 or Nutrizym 22) with a meal and one with a snack or milky drink.  \n• If the patient is taking their PERT as recommended and symptoms are not alleviated after three to four days of taking them, they are recommended a dose increase.  \n• Adjustment of PERT dose is dependent on symptoms of malabsorption being present.  \n• It is important to look at the distribution of enzymes taken with each meal rather than just the overall amount taken in the day.  \n• Refer to the ‘PERT for pancreatic insufficiency’ PIL (document ID 12696) on Merlin or the CUH website.  \n• Swallowing whole capsules is encouraged, if a patient cannot swallow then, they can be opened and taken on a spoonful of fruit puree, jam, tomato sauce or any soft, cold and preferably acidic food.  \n• To optimise activation of PERT by increasing the pH of the duodenum, it is recommended to consider gastric acid suppressant medication such as a proton pump inhibitor or H2 receptor antagonist.  \n• For tube fed patients, where oral PERT administration is not suitable, Pancrex V powder® can be given via the feeding tube.  \n• Pancrex V powder® has 25,000 lipase units per 1g.  \n• If the patient has reached a dose of 10,000 lipase units/kg/day and is still experiencing symptoms, then other causes should be considered before increasing the dose further, such as bile acid malabsorption, small intestinal bacterial overgrowth or coeliac disease.  \n• When interpreting symptoms consider other medications being taken such as laxatives, opioids, antibiotics and chemotherapy which can affect the bowels.  \n• It is usually more important to prioritise enabling people to digest the nutrition they are consuming before encouraging them to consume more.  \nContents  \n1 Scope ............................................................................................................................ 2  \n2 Purpose ......................................................................................................................... 2  \n3 Definitions...................................................................................................................... 3  \n4 Introduction.................................................................................................................... 3  \n5 Symptoms of pancreatic exocrine insufficiency ............................................................. 5  \n6 Testing for pancreatic exocrine insufficiency ................................................................. 5  \n7 Treating pancreatic exocrine insufficiency ........................................................","cbCaidHQNToE5s8j","https://ap.wps.com/l/cbCaidHQNToE5s8j","pdf",383601,29,"English","# Scope\n# Purpose\n# Definitions\n# Introduction\n# Symptoms of pancreatic exocrine insufficiency\n# Testing for pancreatic exocrine insufficiency\n# Treating pancreatic exocrine insufficiency\n# Beginning a patient on PERT\n# Monitoring a patient on PERT and adjusting doses\n# Oral nutritional supplements\n# Prescribing\n# Monitoring compliance with and the effectiveness of this document\n# References\n# Associated documents","[{\"question\":\"What is pancreatic exocrine insufficiency (PEI) and how is it treated in adults?\",\"answer\":\"PEI occurs when the pancreas does not produce or transport enough digestive enzymes to digest food and drink for adequate absorption. It is treated with pancreatic enzyme replacement therapy (PERT).\"},{\"question\":\"How is PEI tested and what does normal faecal elastase indicate?\",\"answer\":\"PEI can be tested with a faecal elastase test. Normal faecal elastase is greater than 500 µg/g faeces.\"},{\"question\":\"When should PERT dosing be increased or alternative causes considered?\",\"answer\":\"If symptoms are not alleviated after three to four days of taking PERT as recommended, a dose increase is advised. If a patient reaches 10,000 lipase units/kg/day and still has symptoms, other causes should be considered before further dose increases, such as bile acid malabsorption, small intestinal bacterial overgrowth, or coeliac disease.\"}]","Guideline - Management of pancreatic exocrine insufficiency (PEI) for adults | PDF",1791213113,73]