Exocrine Pancreatic Insufficiency Guidelines

Updated: May 23, 2023
  • Author: Samer Al-Kaade, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Guidelines Summary

Guidelines concerning the diagnosis, etiology, and management of pancreatic exocrine insufficiency (PEI) were voted on by pancreatic specialists at the 2019 Annual Meeting of the Pancreatic Society of Great Britain and Ireland and published in 2021. Some, but not all, of the recommendations are listed below [46] :

  • The FE-1 test is recommended as a suitable first-line PEI exam, despite the fact that the gold-standard diagnostic test for PEI is considered to be the coefficient of fat absorption
  • If a diagnosis of PEI is unclear, it can be supported by employing positive markers of malnutrition, including clinical history, anthropometric measurements, or serum micronutrient levels (such as magnesium, vitamin E, and retinol-binding protein/vitamin A); when diagnosing PEI, however, do not consider these markers in isolation
  • It is recommended that PERT commence at a dose of at least 50,000 units lipase with meals and 25,000 units lipase with snacks; if this is ineffective, dose adjustment by the patient should be encouraged
  • Patients should spread pancreatic enzyme consumption throughout a meal
  • Patients should avoid diets that are very high in fiber, but restriction of dietary fat is not routinely recommended
  • No significant complications are associated with PERT
  • PERT’s efficacy is impacted by acid and temperature; if PERT is ineffective, a proton pump inhibitor can boost its usefulness, but if, after addition of the inhibitor, one of the PERT agents is still not effective, it is recommended that a trial be conducted of an alternative PERT preparation
  • With limited evidence suggesting an association between long-term use of very–high-dose PERT and fibrosing colonopathy in children with cystic fibrosis, doses in this population should be restricted to 10,000 units lipase/kg/day