[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-508315-105":59,"doc-detail-508315-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","pancreatic-exocrine-insufficiency-and-enteral-feeding-practical-guide-with-case-studies","Pancreatic Exocrine Insufficiency and Enteral Feeding - Practical Guide with Case Studies","","Pancreatic disease patients may develop severe malnutrition due to pancreatic exocrine insufficiency (PEI) and related malabsorption, yet administering pancreatic enzyme replacement therapies (PERT) becomes difficult when enteral nutrition (EN) is required. This review examines PERT use in complex patients on EN, using case studies to compare administration methods across the United States and the United Kingdom. It outlines assessment of malabsorption signs, including subtle indicators, and discusses practical implementation when PEI is suspected on current EN regimens.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/pancreatic-exocrine-insufficiency-and-enteral-feeding-practical-guide-with-case-studies/508315/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/pancreatic-exocrine-insufficiency-and-enteral-feeding-practical-guide-with-case-studies/508315.png","ImageObject",300,407,{"name":92,"@type":93},"Stanford","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-09","2026-10-05",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why do patients with pancreatic disease often develop malnutrition and malabsorption?","Question",{"text":112,"@type":113},"They may develop significant malnutrition due to gastrointestinal complications limiting oral intake, and due to malabsorption from pancreatic exocrine insufficiency (PEI). Medication side effects can further complicate meeting nutritional requirements.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What makes administering PERT difficult in patients receiving enteral nutrition?",{"text":117,"@type":113},"PERT products are predominantly designed for oral administration, which can be challenging when patients require EN. International differences in EN and PERT products also affect practical delivery methods.",{"name":119,"@type":110,"acceptedAnswer":120},"How can malabsorption signs be masked in patients on low-fat enteral feedings?",{"text":121,"@type":113},"More subtle malnutrition indicators may emerge, such as difficulty with wound healing, worsening functional status, ongoing weight loss, or recurrent hypoglycemia despite adequate caloric intake. Traditional stool signs may be reduced or confused by medications like opiates, antibiotics, or prokinetics.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},508315,1791508999,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},2336477552062,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES \\#181  \nCarol Rees Parrish, M.S. , R. D. , Series Editor  \nPancreatic Exocrine Insufficiency and Enteral Feeding:  \nA Practical Guide with Case Studies  \nPatients with pancreatic disease can develop severe malnutrition. Many factors contribute to the malnutrition seen in this patient population, one of the most problematic being pancreatic exocrine insufficiency (PEI) with resultant malabsorption. Pancreatic enzyme replacement therapies (PERT) are predominantly designed for oral administration, but this can be challenging in patients requiring enteral nutrition (EN). This review explores the use of PERT in complex patients who are on EN. Case studies will be utilized to demonstrate different methods available in order to provide practical guidance on administration, both in the United States (U.S.) and the United Kingdom (U.K.).  \nINTRODUCTION  \nPatients with pancreatic disease, pancreatic  \nresection, and cystic fibrosis often develop significant malnutrition as a result of the numerous gastrointestinal (GI) complications preventing adequate oral intake. Malabsorption, as well as side effects of medications such as antibiotics and opiates, adds an additional challenge to meeting nutritional requirements. Inpatients requiring EN, standard elemental formulas may not be tolerated or absorbed. Semi-elemental (or peptide-based) formulas are often utilized, providing less long-chain triglycerides and more  \nmedium-chain triglycerides, thereby decreasing the dependence of pancreatic lipase for absorption. However, some patients will continue tomalasborb, even with semi-elemental products, worsening the malnutrition present.  \nTraditional signs and symptoms of malabsorption include the presence of pale stools (often described as yellow or clay colored), floating or oily stools, stools with an unusually foul and offensive odor, abdominal bloating, cramping or gas, urgency and/or frequent stools.1 The use of gut slowing medications, such as opiates, or the use  \nMary E. Phillips BSc (Hons) RD DipADP Advanced Specialist Dietitian (Hepato-pancreatico-biliary Surgery), Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, UK Amy Berry MS, RD, CNSC Nutrition Support Specialist (GI Surgery at the Emily Couric Cancer Center), University of Virginia Medical Center, Charlottesville VA Lucy S. Gettle, RDN CNSC Clinical Dietitian Specialist (Adult Cystic Fibrosis), University of Virginia Medical Center, Charlottesville VA  \n62 PRACTICAL GASTROENTEROLOGY • NOVEMBER 2018  \nPancreatic Exocrine Insufficiency and Enteral Feeding  \nNUTRITION ISSUES IN GASTROENTEROLOGY, SERIES \\#181  \nof low fat enteral feedings may result in reduction of obvious clinical signs and mask ongoing malabsorption. In these patients, constipated or infrequent stools (vs. diarrhea) may be reported, as well as abnormal color, unusually large volumestools, abnormal cramping and/or gas etc. The addition of antibiotics or prokinetics, can further confuse the clinical picture. Hence, sometimes it is the presence of more subtle signs of malnutrition such as difficulty with wound healing, worsening functional status, ongoing weight loss, or recurrent hypoglycemia/reduction in insulin requirement despite adequate caloric intake, that should trigger the consideration to consider an empiric trial of PERT. 2,3  \nEN and PERT products vary internationally. The aim of this paper is to provide a guide in the management of this complex patient group, combining the experience of dietitians specializing in patients with PEI, both in the U.S. and the U.K. We will also provide practical guidance in implementing the various modalities that can be utilized when it is determined that a patient is malabsorbing on their current EN regimen, as direction provided in the literature is sparse.4-10  \nCASE \\#1  \nA 62 year old female with pancreatic cancer and poorly controlled diabetes (HbA1c = 8.3%) completed a neo-adjuvant course ","cbCailr7cNcgTuK9","https://ap.wps.com/l/cbCailr7cNcgTuK9","pdf",1511720,"English","# Introduction\n## Nutritional issues in PEI and EN\n# Case Studies\n## Case #1","[{\"question\":\"Why do patients with pancreatic disease often develop malnutrition and malabsorption?\",\"answer\":\"They may develop significant malnutrition due to gastrointestinal complications limiting oral intake, and due to malabsorption from pancreatic exocrine insufficiency (PEI). Medication side effects can further complicate meeting nutritional requirements.\"},{\"question\":\"What makes administering PERT difficult in patients receiving enteral nutrition?\",\"answer\":\"PERT products are predominantly designed for oral administration, which can be challenging when patients require EN. International differences in EN and PERT products also affect practical delivery methods.\"},{\"question\":\"How can malabsorption signs be masked in patients on low-fat enteral feedings?\",\"answer\":\"More subtle malnutrition indicators may emerge, such as difficulty with wound healing, worsening functional status, ongoing weight loss, or recurrent hypoglycemia despite adequate caloric intake. Traditional stool signs may be reduced or confused by medications like opiates, antibiotics, or prokinetics.\"}]","Pancreatic Exocrine Insufficiency and Enteral Feeding - Practical Guide with Case Studies | PDF",1791217086,25]