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Chronic Pancreatitis PERT — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyChronic Pancreatitis PERTRACP Adult Medicine

A 55-year-old man with chronic pancreatitis develops steatorrhoea despite pancreatic enzyme replacement. His enzyme dose is suboptimal. What is the recommended dosing strategy for pancreatic enzyme replacement therapy (PERT)?

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

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Correct answer: D — 25,000–50,000 lipase units with main meals and 10,000–25,000 with snacks

Explanation lettering: E = shown as B · B = shown as D · D = shown as E

PERT dosing for chronic pancreatitis-related exocrine insufficiency is 25,000–50,000 lipase units with main meals and 10,000–25,000 units with snacks. Enzymes should be taken WITH food (not before or after). If steatorrhoea persists, the dose can be increased and a PPI added (gastric acid reduces enzyme activity). Very high doses (>75,000 lipase units per meal) rarely provide additional benefit and may cause fibrosing colonopathy. Monitoring of fat-soluble vitamins (A, D, E, K) is important.

Reference: eTG – 2025 – Gastrointestinal; Australasian Pancreatic Club – 2024 – CP Guidelines