Management of pancreatic exocrine insufficiency

Australasian Pancreatic Club Pancreatic Enzyme Replacement Therapy Guidelines Working Party, 2015

Patients with pancreatic exocrine insufficiency (PEI) need oral pancreatic enzyme supplements to enable adequate digestion and absorption of fat, protein and starch. In adults, a suitable initial regimen for pancreatic enzyme supplementation is:

pancreatic enzymes 50 000 units orally, with each main meal pancreatic enzymes pancreatic enzymes pancreatic enzymes

PLUS

pancreatic enzymes 25 000 units orally, with every snack. pancreatic enzymes pancreatic enzymes pancreatic enzymes

Adjust the dose according to symptoms and nutritional markers, with advice from an accredited practising dietitian or specialist. Reduce the dose once symptoms are controlled and the patient is nutritionally replete; use the lowest effective dose and number of capsules for maintenance therapy. Enzyme supplements should be taken at the start of a meal or snack, with the dose split into 2 for larger meals.

For patients requiring high doses of pancreatic enzyme supplements, add a proton pump inhibitor to reduce inactivation of the enzymes by gastric acid. Use:

1esomeprazole 20 mg orally, daily esomeprazole esomeprazole esomeprazole

OR

1lansoprazole 30 mg orally, daily lansoprazole lansoprazole lansoprazole

OR

1omeprazole 20 mg orally, daily omeprazole omeprazole omeprazole

OR

1pantoprazole 40 mg orally, daily pantoprazole pantoprazole pantoprazole

OR

1rabeprazole 20 mg orally, daily. rabeprazole rabeprazole rabeprazole

Supplement fat-soluble vitamins if blood concentrations are low; see Fat-soluble vitamin deficiencies.

Management of patients with PEI caused by cystic fibrosis requires specialised adviceToouli, 2010.