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Optimising PERT for Persistent Steatorrhoea — SCE Palliative Medicine MCQ

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ModerateGI SymptomsOptimising PERT for Persistent SteatorrhoeaSCE Palliative Medicine

A 55‑year‑old man with advanced pancreatic cancer has ongoing steatorrhoea despite taking Creon 25 000 units with meals and a PPI. What should be investigated first?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — PERT timing (must be taken during meals, not before or after), distribution across the meal, and adequacy of total lipase dosing

Explanation lettering: E = shown as A · D = shown as C · C = shown as D · A = shown as E

PERT failure in pancreatic cancer is most often due to suboptimal dosing or administration technique. UK clinical guidance emphasises taking enzymes with meals, spreading the dose across the meal, and using adequate lipase dosing (starting from approx. 25 000–50 000 units per meal according to local guideline) with dietary team involvement. Imaging (Option C) or changing brands (Option D) are not first‑line without confirming these modifiable factors. Discontinuing PERT (B) is inappropriate, and coeliac testing (E) is misplaced given known pancreatic exocrine insufficiency.

Reference: CUH NHS PERT patient information (May 2026); BNSSG NHS PERT prescribing & monitoring guideline (2021/24); PubMed review on PEI management (2017), https://www.cuh.nhs.uk/patient-information/information-for-people-taking-pancreatic-enzymes-for-pancreatic-insufficiency/