Exocrine Pancreatic Insufficiency

In late 2021/early 2022, I realized I have moderate exocrine pancreatic insufficiency (EPI). There’s not a lot of information written and targeted at patients, and there’s also gaps in the medical literature and research studies regarding optimal titration of enzymes (known as Pancreatic Enzyme Replacement Therapy, or PERT). I spent some time figuring out how to optimally dose and titrate PERT and other enzyme sources, essentially developing a method for creating a lipase:fat and protease:protein ratio for better dosing enzymes (and building an app called “PERT Pilot” to help other people do the same, now available for iOS and Android).

These are some of the posts that I’ve written about EPI (also known as PEI) that might be of use to anyone else with EPI.

Screenshots from PERT Pilot, a free iOS app designed to make pancreatic enzyme replacement therapy easier for people with exocrine pancreatic insufficiency (known as EPI or PEI). PERT Pilot allows you to lo what you eat and what enzymes you took, so you can visualize and understand what dose works for you in relationship to what you eat. You can edit meals and update symptoms or outcomes any time. And now, in v0.2.5 and beyond, you can track your symptoms based on frequency & severity using the EPI/PEI-SS. The EPI/PEI-SS is a symptom survey that helps score symptoms based on frequency and severity, so you can see how things are changing over time. A gif showing a square moving along a spectrum from "too little" to "too much enzyme". Too little enzyme and you have symptoms, not enough and you reduce but don't eliminate symptoms. Enough enzymes and you eliminate symptoms. Too much risks constipation.

 

A comic showing a doctor saying take 2 pills, a patient questioning what to do with a different sized meal; a second panel showing two different sized meals; a third panel showing the patient thinking through how much to take; and a 4th panel showing the patient realizing that different meals need different doses.