Fast Five Quiz: Exocrine Pancreatic Insufficiency Management

Romesh Khardori, MD, PhD


March 08, 2021

The initial goal of therapy is 10% enzyme activity, considering that steatorrhea does not usually occur until 90% of pancreatic lipase activity is lost.

Currently, the most common monitoring strategy is clinical response. The 72-hour fecal fat analysis is considered the gold standard for laboratory evaluation of EPI. However, because stool collection is clinically inconvenient, and breath tests are not fully validated or readily available, following patients clinically is the common approach in determining the efficacy of PERT. However, it is important to note that symptoms do not always reflect the patient’s nutritional status.

Initial oral lipase dose is 500 units/kg/meal. Patients should not exceed 10,000 units/kg/meal. Dosing is adjusted based on the amount of lipase in the supplements: The goal of the initial dose is to provide 40-60 units/minute of lipase activity within the duodenal lumen. To achieve this goal in adults, approximately 25,000-40,000 units of lipase is needed to digest a typical meal, or about 5000-25,000 units of lipase per snack.

Learn more about PERT.


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