Initiating Pancreatic Enzyme Replacement Therapy (PERT) — Consider Titrating PERT Dose, Assess for Other Causes — Clinical Pathway: All Settings

Clinical Pathway for Pancreatic Enzyme Replacement Therapy (PERT) in Children with or at Risk for Exocrine Pancreatic Insufficiency (EPI)

Consider Titrating PERT Dose, Assess for Other Causes

Consider and verify:

Adherence to Enzyme Regimen Child is taking the enzymes prior to eating
Optimize Enzyme Regimen
  • Enzymes are not past their expiration date
  • Enzymes are being properly stored at room temperature and have not been exposed to temperature extremes
  • Splitting the dose of enzymes if meals last longer than 30 mins
  • Changing brand of enzymes
  • Adding a gastric acid blocking medication
    • H2 receptor antagonist or proton-pump inhibitor
  • Note:
    • Usually increase by 1 cap per meal/snack until a maximum of 2,500 units lipase/kg/meal
    • or
    • Until symptoms resolve
    • Discuss enzyme dose changes with enzyme expert prior to initiating change
Assess for Other Causes
  • Stool burden
  • GERD
  • Infectious cause
  • Change in gut flora
  • Dietary changes
  • Other conditions requiring GI consult