A Quick Guide to Pancreatic Enzyme Replacement Therapy

Learn about medications that can help improve digestion for people who have exocrine pancreatic insufficiency (EPI).

Exocrine pancreatic insufficiency (EPI) is a condition where the body does not have the enzymes it needs to digest carbohydrates, proteins, and fats—macronutrients the body needs to remain healthy and function normally.

These enzymes are made in the pancreas—an organ located in the abdomen, between the stomach and the spine. The pancreas is connected to the small intestine (and more specifically, the duodenum, the first part of the small intestine). Enzymes released from the pancreas play a key role in the digestive process as food moves through the small intestine.

When these enzymes are not present in adequate amounts, the body is unable to fully digest food. EPI can cause a variety of uncomfortable gastrointestinal symptoms (such as gas, pain, bloating, constipation, diarrhea, and fatty bowel movements) as well as unexplained weight loss and malnutrition (which are a result of the body being unable to absorb nutrients).

A mainstay of treatment for this condition is a medication called PERT (pancreatic enzyme replacement therapy). As the name implies, this type of medication contains the pancreatic enzymes that the body is unable to produce (or produce in adequate amounts) when a person has EPI.

How are these medications taken?

PERT medications are taken as pills. These pills are designed to pass through the stomach (and stomach acid) and break down in the small intestine—where pancreatic enzymes are normally released.

These pills are taken with meals and snacks and will help the body digest foods. Improving digestion will help reduce GI symptoms and will also help the body better absorb nutrients from food.

If you are prescribed a PERT medication, your healthcare provider will give you detailed instructions on when and how to take these pills, including what dosages to take. EPI and its impact on the body is a little bit different for each person. Likewise, the dosage will vary from person to person, and it may also vary depending on the symptoms a person is experiencing.

PERT medications can be swallowed with cold or room temperature liquids. However, these medications should not be consumed with hot liquids—heat can damage the enzymes and stop them from working. Also, pills should not be stored in a warm place (such as a pocket) or in direct sunlight.

What enzymes are in PERT medications?

PERT medications contain three enzymes, which are needed to digest proteins, carbohydrates, and fats.

  • Proteases, which are needed to digest proteins.
  • Amylases, which are needed to digest carbohydrates.
  • Lipases, which are needed to digest fats.

There are several different brands of PERT medications available, which contain different ratios of these enzymes. Having different options is helpful. If one medication is not working as well as you need it to, your healthcare provider might recommend switching to a different brand, which might work better.

How are these medications made?

The enzymes in PERT medications are extracted from the pancreas glands of pigs. This is because the abdominal organs of pigs—including the pancreas—function basically the same as those in humans.

This can be problematic for people who are allergic to pork products. It can also be problematic for people who are vegetarian or vegan, or who do not eat pork for religious reasons. Many Jewish and Muslim religious leaders support the use of PERT medications by people who have EPI.

There are no vegan/vegetarian alternatives to PERT medications that have been demonstrated to work effectively to treat EPI. People with EPI are advised to be wary of products that make these claims.

What if I have trouble swallowing pills?

PERT medications should not be chewed, cut, or crushed. If you have trouble swallowing pills, talk to your healthcare provider, who can provide guidance and strategies on how to make taking your medication easier.

Where do I learn more about PERT?

PERT medications are only one part of treating EPI. Treatment must also focus on treating the underlying condition that is causing EPI and addressing any nutritional imbalances caused by having EPI. In other words, EPI is a different experience for everyone. Your best source of information will be your healthcare provider.

Medically reviewed in January 2022.

Article sources open article sources

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Cleveland Clinic. "Exocrine Pancreatic Insufficiency (EPI)."
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Johns Hopkins Medicine. "Pancreas Basics."
Johns Hopkins Medicine. "The Digestive Process: What Is the Role of Your Pancreas in Digestion?"
Identify EPI. "What are the symptoms of EPI?"
Katrina VB. Claghorn. "Pancreatic Enzyme Replacement Therapy (PERT)." OncoLink. July 1, 2021.
Gregory T. Brennan, and Muhammad Wasif Saif. “Pancreatic Enzyme Replacement Therapy: A Concise Review.” JOP : Journal of the Pancreas, 2019. Vol. 20, No. 5.
Pancreatic Cancer Action. "Pancreatic Enzyme Replacement Therapy (PERT)."
Goshen College. "Human/Pig Comparisons."
Francois Meurens, Artur Summerfield, et al. "The pig: a model for human infectious diseases." Elsevier Public Health Emergency Collection, 2021. Vol. 20, No. 1.
Gyanprakash A. Ketwaroo and David Y. Graham. "Rational Use of Pancreatic Enzymes for Pancreatic Insufficiency and Pancreatic Pain." Advances in Experimental Medicine and Biology, 2019. Vol. 1148.
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