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How to Dose Pancreatic Enzymes for EPI Patients

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Dr. Steven Freedman explains how the severity of EPI is determined and what dose of pancreatic enzymes you should be on for PERT (Pancreatic Enzyme Replacement Therapy). Learn when to take your capsules and how to know if you’re on the right dose.

My name is dr stephen friedman from the beth israel deaconess medical center in harvard medical school in boston massachusetts today i’ll be discussing dosing of pancreatic enzymes in patients with excrement pancreatic insufficiency or epi so first what dose of enzymes should you be on we base this on the degree of epi as well as the size and type of a meal the

More severe the epi or the larger the meal or more fat the more enzymes you would need for digestion so how do we determine if a patient has mild moderate or severe epi we based this on how long someone has had pancreatic disease whether they have pancreatitis versus cystic fibrosis and cf or cystic fibrosis patients have more severe epi we also look at whether

Or not there’s a history of pancreatic surgery as you can imagine if you remove parts of the pancreas you’re going to have more severe epi we also look at fecal elastase levels the lower the value the more severe the epi and finally we look at individual symptoms do they have oily diarrhea or weight loss so how does the size of a meal an amount of fat factor in

Normally your own pancreas senses the size of a meal in the amount of fat larger meals more fat requires more enzymes and especially lipays for digestion and if you put these two factors together the degree of epi and the size of a meal the amount of fat we can consider grouping individuals into three categories for mild epi and lower fat meals we would recommend

Two to three 25 000 lipase unit capsules for higher fat meal you would increase that probably to four to five capsules with that meal if you instead have moderate epi that would probably be in the range of four to six twenty five thousand light-based unit capsules with a meal and for larger fattier meals you’d go up to six to seven capsules and finally for more

Severe epi that’s usually in the range of seven to nine twenty-five 000 lipase unit capsules with a meal and perhaps 9 to 10 capsules with a very fatty meal so what about timing your enzymes with the meal that you’re consuming what’s important is how long it takes you to eat that meal if you eat everything within 20 minutes you can probably take all the enzyme

Capsules with the first bite of that meal and by the way you want the enzymes mixing with that meal you don’t want to take the enzymes and wait 10 to 20 or 30 minutes because then the enzymes will pass through then the foods coming through and there’s not going to be efficient digestion so within 20 minutes of a meal uh take them all in the first bite if instead

It takes you 20 to 40 minutes to eat a meal take half the number of capsules with the first bite of the meal and the other half with the end of the meal and if it takes you more than 40 minutes to eat a meal you want to divide it up so you’re taking a third of the number of capsules with the first bite a third in the middle and third at the end of the meal so

If you’re on six capsules two of the first bite two in the middle two at the end of the meal so finally how do you know if you’re on the right dose of enzymes so do you still have oily diarrhea and importantly it sticks to the walls a toilet bowl is sensitive marker that you’re truly having pancreatic steatoria or insufficiency are you still having continued

Weight loss and so for either of those you’re probably going to go up on the dosing by perhaps two capsules with each meal and see over the next one to two weeks does that make a difference if you’re malabsorbing fat soluble vitamins such as a d e in k your physician may want to recheck those enzymes on with higher doses of perts usually within like four weeks

Of going up on the dose do you have other gi symptoms though these can be non-specific such as bloating and gas or abdominal pain and distension again we may want to see over one to two weeks we’re going up on the dosing of your enzyme does it help with these symptoms if not your physician may want to look for other causes of these symptoms here i hope this is

Helpful and please let us know if you have any questions we’re happy to respond thank you you

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How to Dose Pancreatic Enzymes for EPI Patients By Mission Cure