Fast Five Quiz: Exocrine Pancreatic Insufficiency Management

Romesh Khardori, MD, PhD


March 08, 2021

Figure 1. The pancreas, which acts as both an endocrine gland and a digestive organ.

PERT should be taken with meals or immediately afterwards, as gastric emptying of nutrients should occur together with pancreatic enzymes reaching the duodenum.

Administering acid-suppressing medications is an important component of therapy, as suppressing acid increases the efficacy of PERT. Either histamine-2 (H2) receptor blockers or proton pump inhibitors (PPIs) can be given. Studies have shown improved lipid digestion and absorption with administration of acid-suppressing medications in combination with nonenteric-coated PEP formulations. However, to ensure the efficacy of PERT, it is important that patients avoid food, drink, and medication that may increase steatorrhea; this includes minimizing calcium- and magnesium-containing antacids, as well as reducing fiber intake and avoiding alcohol.

Just as antacids are not interchangeable, PEPs are not interchangeable; for example, Viokace is the only PEP without an enteric coating and must be taken with a PPI.

PEPs are extracts of porcine pancreas that contain all three pancreatic enzymes (amylase, protease, and lipase) in varying proportions, but lipase plays the most significant role in therapy.

Learn more about PEPs.


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