What dietary modifications should I recommend to a patient diagnosed with exocrine pancreatic insufficiency?

Dietary modifications for a patient with exocrine pancreatic insufficiency (EPI) should focus on optimizing nutritional intake and managing malabsorption.

• Encourage the patient to increase calorie intake by increasing portion sizes and consuming high-energy foods to address potential weight loss or inadequate weight gain.
• If increasing portion size and high-energy foods are insufficient, consider a trial of oral nutritional supplements to boost calorie and nutrient intake.
• If oral nutritional supplements are ineffective, consider enteral tube feeding supplementation or, for adults, a short-term trial of an appetite stimulant (up to 3 months), noting that this is off-label use.
• Pancreatic enzyme replacement therapy (PERT) should be offered and optimized to minimize symptoms or signs of malabsorption, as this is essential for nutrient digestion and absorption.
• Consider acid suppression therapy (e.g., H2 receptor antagonists or proton pump inhibitors) if malabsorption symptoms persist despite optimal PERT, although this is off-label use.
• Ensure the patient receives specialist dietitian advice on nutritional needs and enzyme therapy management.

These dietary modifications aim to improve nutritional status and manage malabsorption in EPI effectively.

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