Exocrine Pancreatic Insufficiency — RACP Adult Medicine MCQ

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EasyGastroenterologyExocrine Pancreatic InsufficiencyRACP Adult Medicine

A 50-year-old man presents with weight loss, steatorrhoea, and new-onset diabetes over 6 months. He has a 20-year history of heavy alcohol use. CT shows pancreatic calcifications and ductal dilatation. Faecal elastase is <100 μg/g. What is the most appropriate treatment for his exocrine pancreatic insufficiency?

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Correct answer: B — Pancreatic enzyme replacement therapy (PERT)

Chronic pancreatitis with pancreatic calcifications, ductal dilatation, steatorrhoea, and faecal elastase <200 μg/g confirms exocrine pancreatic insufficiency. Pancreatic enzyme replacement therapy (PERT) with meals and snacks is the treatment. Adequate dosing is 40,000–50,000 lipase units with meals and 25,000 with snacks. PPI co-administration improves PERT efficacy by reducing gastric acid degradation.

Reference: GESA – 2024 – Chronic Pancreatitis; ESPEN 2024 EPI Guidelines