Exocrine Pancreatic Insufficiency: Treatment and Lifestyle Changes
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Treatment of Exocrine Pancreatic Insufficiency: Medication and Lifestyle Changes

Treatment of Exocrine Pancreatic Insufficiency: Medication and Lifestyle Changes
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Updated on April 3, 2025
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In a person with exocrine pancreatic insufficiency (EPI), the pancreas doesn’t make enough of the enzymes needed for proper digestion.

 As a result, the digestive process and nutrient absorption are disrupted, which can lead to malnutrition and gastrointestinal symptoms.

 Fortunately, EPI is treatable with medication and diet changes.

Before you start EPI treatment, discuss your options with a healthcare professional; they can work with you to provide the safest and most effective care.

Medication

The main treatment for EPI is pancreatic enzyme replacement therapy (PERT).

PERT is a prescription medication that replaces the digestive enzymes that the pancreas no longer makes in people with EPI.

 Its main component is pancrelipase, a mixture of lipase, protease, and amylase. These digestive enzymes help digest fat, protein and carbohydrates, respectively, and they support normal digestion and allow the body to absorb nutrients.

The U.S. Food and Drug Administration (FDA) has approved five pancrelipase products:

  • Creon
  • Zenpep
  • Pancreaze
  • Viokace
  • Pertzye
The FDA withdrew approval for another PERT medication, Ultresa, in 2019.

People with EPI need to take PERT with every snack or meal to digest properly and resolve symptoms, and they typically need to take the medication for the rest of their lives.

An exception to this is children with a condition called Schwachman-Diamond syndrome, which can cause EPI. Around half of children with this condition start to produce the necessary hormones as they grow, so they may not need to continue taking PERT.

Manufacturers make PERT products from pig pancreas extracts. If this conflicts with your religious or ethical beliefs, talk to your healthcare provider about alternatives.

Dosage and Directions

PERT is available as a capsule, usually in two sizes: 10,000 units (mainly for children) and 25,000 units.

 Most adults need to take 25,000 to 40,000 units. Your healthcare team, including a physician, gastroenterologist, and dietitian, will recommend a dosage, starting at the low end and then gradually increasing to a maximum of 75,000 to 90,000 units until symptoms improve.

People typically take one capsule with the first mouthful of any meal. If you’re having a longer meal, take half the capsule when starting and one right after you finish. The American Gastrointestinal Association (AGA) recommends taking PERT with a cold beverage and never taking it on an empty stomach.

The side effects of PERT may include an upset stomach or constipation. If you experience these, let your doctor know. They may be able to adjust the dosage or prescribe a different product. Side effects often get better over time.

Lifestyle Measures

EPI causes nutritional deficiencies, so maintaining a healthy diet is crucial for keeping nutrient levels stable and maintaining bodily functions.

 If you have EPI, aim to follow these recommendations:

Eat a nutritious diet. For PERT to work efficiently, the AGA recommends eating a nutritious diet that includes a wide variety of fruits, vegetables, whole grains, and healthy proteins. Some people find it easier to eat several smaller meals throughout a day rather than three main meals.

Moderate fat intake. The AGA recommends that people with EPI consume a moderate amount of fat, which typically accounts for around 30 to 40 percent of total daily calories and translates to approximately 60 to 80 grams of fat per day for a standard 2,000-calorie diet. This approach helps ensure that you have adequate nutrition while minimizing symptoms of fat malabsorption.

Consume plenty of calories. Unwanted weight loss and growth issues are common in people with EPI, as their digestive systems can’t absorb enough of the food they eat. Getting sufficient calories in meals is crucial if you have EPI.

 For children with cystic fibrosis, a condition that affects the pancreas, a high-calorie, high-fat diet is vital for growth and development.

Take supplements as prescribed. Your doctor may prescribe vitamin and mineral supplements, including vitamins A, D, E, and K.

Talk to your doctor before making any decisions having to do with diet changes, new medications, supplements, or herbal remedies.

The Takeaway

  • Exocrine pancreatic insufficiency is a condition in which the pancreas doesn’t make the enzymes needed for proper digestion.
  • PERT is a prescription treatment for EPI, and people with the condition usually need to take it for the rest of their lives.
  • People with EPI should eat a moderate-fat diet that provides enough nutrients, as they will likely have problems absorbing nutrients (especially fat-soluble vitamins) and calories from food.
  • Consult with a healthcare professional if you experience PERT side effects or before taking medications, supplements, or herbal remedies.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. The Digestive Process: What Is the Role of Your Pancreas in Digestion? Johns Hopkins Medicine.
  2. Exocrine pancreatic insufficiency (EPI). American Gastroenterological Association.
  3. Exocrine Pancreatic Insufficiency (EPI). Loma Linda University Health.
  4. Ghodeif AO et al. Pancreatic Insufficiency. StatPearls. January 16, 2023.
  5. Exocrine Pancreatic Insufficiency (EPI). National Pancreas Association.
  6. Pancrelipase. MedlinePlus. August 20, 2024.
  7. Pancreatic enzymes. Pancreatic Cancer Action Network.
  8. Liebel-Flarsheim Company LLC, et al. Withdrawal of Approval of 11 New Drug Applications. U.S. Food and Drug Administration. July 3, 2019.
  9. Exocrine Pancreatic Insufficiency (EPI). Cleveland Clinic. June 10, 2021.
  10. Pancreatic Enzyme Replacement Therapy (PERT). Pancreatic Cancer Action. November 28, 2024.
  11. Whitcomb DC et al. AGA Clinical Practice Update on the Epidemiology, Evaluation, and Management of Exocrine Pancreatic Insufficiency: Expert Review. Gastroenterology. November 2023.
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Yuying Luo, MD

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Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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