What you should know about treating exocrine pancreatic insufficiency (or EPI)

Fortunately, the digestive enzymes we make in the pancreas can be replaced—so treatment is often called PERT, which stands for Pancreatic Enzyme Replacement Therapy. The enzymes come in capsules and are taken with a meal, so that they work just like your enzymes would, mixing with the food you eat. They get activated by the environment in the small intestine, digesting the food and allowing it to be absorbed.   

When to Take PERT

Capsules should be taken with all meals and snacks–starting with the first mouthful. 

Even with a glass of milk or alternatives to milk. This is important, because you could have symptoms and problems of malabsorption if you don't take the enzymes every time you eat. 

• Capsules should be swallowed with a cold drink. The enzymes are damaged at high temperatures, so hot drinks will make them less effective. 

• The enzymes should be swallowed as a capsule if possible. They should not be crushed or chewed. The capsules may have to be opened and mixed with applesauce or something similar for infants and young children.

• If you are having a large meal with more than 2 courses, or one lasting more than half an hour, you may need to take half of your enzymes at the beginning and the other half in the middle of your meal.

• Doctors may also prescribe an acid blocker to get the enzymes to work better. 

• You may be started on a dose of enzymes that needs to be adjusted. Let your doctor and/or dietician know if you are having bulky, greasy stools, are bloated or constipated, or having abdominal pain. There is a fine balance between the food you eat and the enzymes you need to take.  

Do NOT take enzyme supplements:

• On an empty stomach.
• If you eat just a small amount of fruit, vegetables, dried fruit, fat-free sweets (jelly babies, wine gums, mints), a cracker 
• With drinks like coffee (without milk), tea, sodas, thin juices.