PANCREATIC EXOCRINE INSUFFICIENCY (PEI)

Faecal Elastase-1 is the first-line, non-invasive test; low values support PEI.

Faecal Fat Quantification (72-hour collection) confirms steatorrhoea in unclear cases.

Direct Pancreatic Function Testing (secretin/cholecystokinin stimulation) is the gold standard but invasive and used selectively.

Supportive Work-up includes fat-soluble vitamin levels (A, D, E, K), nutritional assessment, and pancreatic imaging (ultrasound/CT/MRCP) to identify the underlying cause (e.g., chronic pancreatitis, ductal disease, post-surgical changes).

Treatment focuses on replacing missing enzymes, optimizing digestion, and preventing malnutrition.

• Pancreatic Enzyme Replacement Therapy (PERT) — first-line: enteric-coated lipase-dominant capsules with every meal/snack; dose-titrate to stool normalization and weight stabilization.
• Acid Management & Meal Strategy: consider acid suppression if gastric acidity inactivates enzymes; spread fat intake across meals rather than restricting excessively.
• Nutrition Repletion: monitor and replace fat-soluble vitamins (A, D, E, K), B12, folate; address weight loss and bone health.
• Treat the Cause: chronic pancreatitis care (alcohol abstinence, pain control), post-surgical pathways, CF care, or oncologic management as appropriate.
• Microbiome Support (adjunct): probiotics post-stabilization for gas/bloat; soluble fibre as tolerated (avoid excess insoluble fibre that binds enzymes).
• Emerging: enzyme formulations with improved acid stability; adjunct bile-acid therapies when bile insufficiency coexists.

1. REPOPULATING YOUR GUT MICROBIOME WITH THE RIGHT GOOD BACTERIA
   Repopulating your gut microbiome with the right good bacteria to improve its function and role within your health will start resolving your symptoms.
   Ensure you only take a probiotic that meets pharmaceutical grade standards to ensure efficacy and that dose delivery for symptom improvement, (uses gold-standard strains backed by clinical evidence for efficacy, with a minimum dose of 10 Billion CFU’s, protects it bacterial dose by ensuring shelf stability and full stomach acid protection with targeted delivery of the bacteria to your intestine, and meets all other quality metrics).The bacteria in your microbiome improves digestion and nutrient absorption, acts at the guts pharmacy – making vitamins, producing SCFA’s and other important metabolites, like serotonin. It is both the boss of and manager of our immune system. They Influence our brain and hormones, improve our mood + how our brain work. The microbiome also influence our Metabolic and Hormonal system/health.
2. HEALING THE WHOLE GUT SYSTEM, IMPROVING THE STRUCTURE, ENVIRONMENT AND FUNCTION
   This condition can affect the gut structure, environment and function, leading to an overall decline in the performance of the whole gut system. This results in gut inflammation, increased oxidative levels altered colonic PH levels. It impairs; immune capabilities, cell function, barrier function, digestion and metabolic health. Which makes it harder for good bacteria to survive in your gut, and easier for pathogens to take over – leading to a negative-cyclical feedback loop that keeps you unhealthy, compromised and struggling with severe symptoms.