Pancreatic Enzyme Insufficiency (PEI) and Pancreatic Enzyme Replacement Therapy (PERT) - Overview and Learning Outcomes

Oct 5, 2026

Uploaded by Jake

Educational overview of pancreatic enzyme insufficiency (PEI) and pancreatic enzyme replacement therapy (PERT), led by an oncology dietitian. Covers the pancreas’ digestive and endocrine roles, digestive enzymes by food group, and the process of digestion. Defines PEI, explains causes, incidence in operable and inoperable pancreatic cancer, key signs and symptoms, and diagnostic considerations. Details how PERT supports digestion, who benefits, practical tips and considerations, differential diagnosis, and includes a case study and summary.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages37

Reading Time1 h 33 min

AccessFree to download

Overview and learning outcomes

Role of the pancreas and role in digestion

Pancreatic enzyme insufficiency (PEI)

Pancreatic enzyme replacement therapy (PERT)

Differential diagnosis

Case study

Summary

Pancreatic enzyme insufficiency (PEI) and pancreatic enzyme replacement therapy (PERT) Lauren Roberts HPB/UGI Lead Oncology Dietitian The Clatterbridge Cancer Centre (Wirral & Liverpool) Overview and learning outcomes 􀁘 Role of the pancreas and role in digestion 􀁘 Pancreatic enzyme insufficiency (PEI) Causes Signs and symptoms Diagnosing PEI Impact of PEI 􀁘 Pancreatic enzyme replacement therapy (PERT) Groups that benefit from PERT Impact of PERT Pancreatic replacement therapy Use tips and considerations with PERT PERT and enteral feeding Differential diagnosis 􀁘 Case study 􀁘 Summary Poll one What are the key roles of the pancreas? Answer all that apply… A) Detoxifying B) Absorbing nutrients C) Release of gastric juices containing enzymes to help break down food into small particles for absorption by the body D) Releases insulin and glucagon to help maintain blood sugar levels Digestive process Digestive enzymes Keller and Layer ( 2005) Imrie , C.W et al. ,(2010) | Food group | Saliva | Gastric | Pancreatic | Jejunal /Ileal | | --- | --- | --- | --- | --- | | Carbohydrate | Salivary amylase | Gastric amylase | Amylase | Sucrase, Maltase, Lactase, Isomaltase | | Fat | Salivary lipase | Gastric lipase | Lipase , Steapsin | Intestinal lipase | | Protein | | Pepsin, Rennin, Gelatinase | Trypsin, Elastase, Chymotrypsin, Carboxypeptidase | Brush Border Peptidases | Digestion and the role of the pancreas Endocrine function (maintenance of blood glucose levels) Throughout the pancreas Secretes from the islets of langerhans • Beta cells –insulin • Alpha cells –glucagon • Delta Cells –Somatostatin • Pancreatic polypeptide Exocrine function (secretion of digestive enzymes) Acinar cells –digestive enzymes Ductal cells –bicarbonate Optimal pH 6.5 for effective functioning Digestive enzymes Carbohydrates Amylase Disaccharidesand glucose Fats Lipase Fatty acids Protein Protease Peptides and amino acids Pancreatic exocrine insuffiency/ PEI Definition: ‘PEI is defined as a reduction of pancreatic exocrine activity in the intestine at a level that prevents normal digestion.’ Phillips et al. , (2021) Incidence of PEI Inoperable pancreatic cancer –50-100% Operable pancreatic cancer- • 12% following central pancreatectomy • 20% following distal pancreatectomy • 20-45% pre-op for head of pancreas • 70-98% following pancreatico-duodenectomy Bartel et al.,(2015) Philips et al. ,(2015) Sabateret et al. ,(2016) Causes of pancreatic exocrine insufficiency | Primary causes (lack of healthy tissue) | Secondary causes (lack of pancreatic stimulation) | | --- | --- | | Obstruction of pancreatic duct by tumour | Changes in intestinal pH following gastric/duodenal resection | | Damage to the exocrine pancreas | Asynchrony in the delivery of pancreatic juice following a bypass of the bile duct, pancreas, stomach or duodenum | | Loss of pancreatic tissue (surgery) | Abnormal CCK & secretin release | | Pancreatitis | | | Cystic fibrosis | | Keller and Layer,(2005)

FAQs

What is the definition of pancreatic enzyme insufficiency (PEI)?

PEI is defined as a reduction of pancreatic exocrine activity in the intestine at a level that prevents normal digestion.

What are the primary and secondary causes of PEI?

Primary causes include obstruction of the pancreatic duct, damage to the exocrine pancreas, loss of pancreatic tissue from surgery, pancreatitis, and cystic fibrosis. Secondary causes include lack of pancreatic stimulation such as changes in intestinal pH after gastric/duodenal resection, asynchrony after bypass, and abnormal CCK and secretin release.

How does PERT help, and who benefits from it?

PERT provides pancreatic enzymes to support effective digestion. It benefits groups with PEI, including those with pancreatic cancer and other causes of pancreatic exocrine insufficiency.

Oct 5, 2026

Uploaded by Jake