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What you should know about starting on Pancreatic Enzyme Replacement Therapy (PERT)

With my first few doses of PERT, I ate relatively small, careful and low-FODMAP meals so I could better assess whether PERT was working. And wow, was it working.

With the first few small (and low-FODMAP, to reduce variables that I was testing) meals, I had an immediate improvement. I didn’t realize until I took PERT how sick I felt every time I ate anything, even when I didn’t have obvious post-meal symptoms of gas, stabbing abdominal pain, or next-day bathroom habits. With PERT, I felt…nothing? Which is apparently how I used to feel after I would eat. There was no sick feeling, no bloating within an hour, and no discomfort for hours. There was no gas after I ate or overnight. In…

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 Blog: My Experience with Pancreatic Enzymes (PERT)

Here is my experience with pancreatic enzymes. My first (diagnosed) acute pancreatitis attack happened in 1998 and I was diagnosed with chronic pancreatitis in 2013 following severe weight loss and multiple years living with digestive issues (such as dispersed and oily stools).

 How to deal with Creon, Nutrizym or Pancrex supply issues

PERT are supplied under the product brands: Creon®, Nutrizym® and Pancrex®. These supply issues are intermittent. The current supply issues mean some people will need to be supplied with a different brand of PERT. This advice is designed for everyone who takes PERT.

Articles of Interest

A Do-It-Yourself Protocol for Over-The-Counter Enzymes...

It’s also for people with EPI who are struggling to afford their pancreatic enzyme replacement therapy (PERT) or are limiting the number or size of meals they eat as a result of the cost of PERT.

A New Alternative for Pancreatic Enzyme Replacement

The search for a non-porcine enzyme replacement therapy for patients with pancreatic enzyme insufficiency has been difficult, but never the less, the goal may be in sight.

Are You Taking Pancreatic Enzymes the Right Way?

Pancreatic enzyme replacement therapy (PERT) is a cornerstone of care for individuals with pancreatic exocrine insufficiency (PEI). However, finding the right dose can be challenging, especially with the limited options available...

Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines

There is a need for readily accessible, pragmatic advice for healthcare professionals on the management of pancreatic exocrine insufficiency.

Management of Exocrine Pancreatic Insufficiency in Children

Regardless of the underlying etiology, the clinical manifestations of untreated EPI in children often include loose stools, steatorrhea, abdominal pain, excessive gas, and poor growth.

Pancreatic enzyme replacement therapy (PERT) for pancreatic cancer

All pancreatic enzymes are made from pork products, and there is no alternative. It includes information about pancreatic enzyme replacement therapy (PERT), including Creon®, Pancrease®, Nutrizym® and Pancrex®.

Pancreatic Enzyme Replacement Therapy: A Concise Review

Pancreatic enzyme replacement therapy is safe and effective at treating pancreatic exocrine insufficiency. There are multiple causes of pancreatic exocrine insufficiency including chronic pancreatitis, cystic fibrosis and pancreatic cancer.

Pancreatic enzyme supplements

It's important to take enough enzymes to break down and digest your food, and most adults take two to four 25,000-unit tablets or capsules with each meal or snack. You may be started on a low dose at first, but your doctor may gradually increase it until you reach the appropriate dose. It can take a week or two to adjust to a new dose.

Pancreatic Enzymes and Pancreatitis: My Experience

I was expecting an immediate change in my pancreatitis symptoms with pancreatic enzymes, but that was not my experience. After adding pancreatic enzymes to my meals, it still took almost one year for the rest of my gastrointestinal system to recover from years of sub-standard performance due to pancreatitis.

Panel Says Lilly Pancreatic-Enzyme Drug Doesn't Seem Effective

A Food and Drug Administration panel said it didn't appear that a new type of a pancreatic-enzyme replacement product developed by an Eli Lilly & Co. subsidiary is effective.

PERT – Pancreatic Enzyme Replacement Therapy for Cystic Fibrosis

There are several brands of enzymes available in different strengths, all of them containing three digestive enzymes – lipase, protease, and amylase. Lipase digests fat, protease digests protein, and amylase digests carbohydrates. Fat is the most difficult for the body to digest, so lipase is the enzyme that must be dosed most accurately.

What to Know About Pancreatic Enzyme Replacement Therapy

Once you take enzymes, don’t delay eating. While pancreatic enzymes are generally safe and well tolerated, taking too much of them can lead to more side effects, including abdominal cramping and nausea, says Kim. Wait until your first bite of food to take your first dose — this way, you won’t need to take more if you end up delaying your meal.

Resources

Exocrine Pancreatic Insufficiency

There’s not a lot of information written and targeted at patients, and there’s also gaps in the medical literature and research studies regarding optimal titration of enzymes (known as Pancreatic Enzyme Replacement Therapy, or PERT). I spent some time figuring out how to optimally dose and titrate PERT and other enzyme sources, essentially developing a method for creating a lipase:fat and protease:protein ratio for better dosing enzymes. These are some of the posts that I’ve written about EPI (also known as PEI) that might be of use to anyone else with EPI.

Zenpep

Meets the ACG guideline for EPI and CP in a single capsule.

Creon

CREON (pancrelipase) is a prescription medicine used to treat people who cannot digest food normally because their pancreas does not make enough enzymes. This condition is called EPI (exocrine pancreatic insufficiency) and may be due to cystic fibrosis, chronic pancreatitis, pancreatectomy, or other conditions.

Nutrizym

Each capsule contains Pancreas Powder 154mg with not less than the following activities: Lipase 10,000 FIP Units, Protease 500 FIP Units and Amylase FIP 9,000 Units.

Pancreaze

Choosing Pancreaze over Creon (or vice versa) is typically due to individual patient response to the specific formulation, cost and insurance coverage, or specific capsule sizes/strengths. Both are prescription pancrelipase medications for pancreatic exocrine insufficiency (EPI) and contain the same active enzymes (lipase, amylase, and protease).