Pancreatic enzyme replacement therapy (PERT) - for the treatment of pancreatic exocrine insufficiency (PEI) - Research Review Educational Series

Oct 5, 2026

Uploaded by Rhys

Pancreatic enzyme replacement therapy (PERT) is reviewed as an educational overview for healthcare professionals managing pancreatic exocrine insufficiency (PEI), an under-diagnosed and under-treated condition with multiple etiologies that can lead to serious complications. The review explains PEI background, diagnostic signals such as reduced duodenal lipase and steatorrhoea, and links treatment optimisation to individualized dosing adjusted to disease severity and patient response. Evidence supports PERT benefits for symptoms, nutrition markers, and survival, aligned with local and international guidance.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

About Research Review

Pancreatic enzyme replacement therapy (PERT)

Diagnosing PEI

Background

Mechanisms causing PEI

Likelihood by patient population

Abbreviations used in this review

A RESEARCH REVIEW™ EDUCATIONAL SERIES Pancreatic enzyme replacement therapy (PERT) for the treatment of pancreatic exocrine insufficiency (PEI) Making Education Easy 2023 About the experts Kylie Russell BSc, PGDip, MHSc, NZRD Kylie is an Advanced Clinical Dietitian working in public and private practice in Auckland. She is specialised in nutrition for hepato-biliary, pancreatic and upper gastrointestinal surgery, bariatric surgery and chronic gastrointestinal disease including inflammatory bowel disease. She is also a guest lecturer at Massey University and the University of Auckland. Professor John Windsor BSc, MB ChB (Auckland), MD, FRACS, FACS, FRCSEd, FRSNZ John is a General and Hepatobiliary surgeon at Auckland City and Mercy Hospitals, specialising in pancreatic, biliary, gastric andoesophageal surgery. His primary clinical and research interests are pancreatic diseases. He holds a personal chair in Surgery at the University of Auckland and is Yeoh Ghim Sen Professor at the National University of Singapore. He is also Director of the Centre for Surgical and Translational Research, and Chairperson of the national HBP Tumour Stream. He is an elected Fellow of the American Surgical Association, the James IV Association of Surgeons and the Royal Society of New Zealand. ABOUT RESEARCH REVIEW Research Review is an independent medical publisher producing electronic publications in a wide variety of specialist areas for health care professionals. Educational Series are a summary of the most important international and local literature which impacts on treatment of a specific medical condition. These Reviews provide information on a disease, current treatment and local /international guidelines. They are intended as an educational tool. Please send us any feedback or comments to [admin@researchreview.co.nz](admin@researchreview.co.nz) | This publication is an educational resource for healthcare professionals focusing on the treatment of pancreatic exocrine insufficiency (PEI) with pancreatic enzyme replacement therapy (PERT) . This is an under-diagnosed and under-treated condition with multiple aetiologies that can cause serious complications. To optimise treatment, it is essential that the dose of PERT is individualised according to the patient’s disease severity and adjusted according to their response. Multiple studies have shown that PERT is associated with improvements in symptoms, nutritional parameters and survival in patients with PEI. This review is supported by an educational grant from Viatris. | | | --- | --- | | Background
The pancreas produces enzymes (e.g. lipase, amylase, trypsin and chymotrypsin) and bicarbonate, both of which are important for macronutrient digestion.1 These secretions enter the second portion of the duodenum via the pancreatic duct following mediation by hormonal and neuronal mechanisms.2 Inadequate pancreatic secretion can result in maldigestion and malabsorption referred to as pancreatic enzyme insufficiency (PEI) .1–4 PEI is primarily caused by a wide range of pancreatic-related conditions such as chronic pancreatitis, cystic fibrosis, pancreatic obstruction, pancreatic tumours, pancreatic resection, and diabetes (type 1, 2 and pancreatogenic diabetes) .2,3 Other conditions where PEI may arise include gastric resection and bariatric surgery, coeliac disease, IBD, short bowel syndrome and in older adults due to an aging pancreas (Table 1) .2,3,5 The prevalence of PEI is unknown due to its multiple causes, however, it is widely considered an under-diagnosed condition.3,6
Regardless of the underlying disorder, there are four possible mechanisms causing PEI:6,7
1. Damage to the pancreatic parenchyma making it unable to synthesise sufficient enzymes
2. Asynchrony between digestive enzyme secretion and meal delivery
3. Obstruction of the pancreatic duct
4. Decreased endogenous stimulation | | |
DEFINITE (100%) | Total pancreatectomy, severe chron

FAQs

What is pancreatic exocrine insufficiency (PEI)?

PEI is maldigestion and malabsorption caused by inadequate pancreatic enzyme and bicarbonate secretion, leading to problems such as reduced digestion and nutrient absorption.

What mechanisms can cause PEI?

The review outlines four mechanisms: pancreatic parenchymal damage, asynchrony between enzyme secretion and meal delivery, pancreatic duct obstruction, and decreased endogenous stimulation.

How is PERT intended to be optimised for patients with PEI?

PERT dosing should be individualized based on disease severity and adjusted according to the patient’s response to achieve optimal treatment outcomes.

Oct 5, 2026

Uploaded by Rhys