The pancreas does not deliver enough enzymes. This is not a page that diagnoses pancreatic cancer. There is no dedicated NHS.uk PEI page — Guts UK is the UK patient home. Community experiences, not medical advice.
Pancreatic exocrine insufficiency (PEI; you may also see the US abbreviation EPI) means the pancreas does not deliver enough enzymes — lipase, amylase, and proteases — and bicarbonate into the small bowel. The result is maldigestion, especially of fat. The pancreas has a large reserve, so PEI usually follows substantial damage, a blockage, or asynchrony after surgery.
There is no dedicated NHS.uk PEI page. Guts UK is the UK patient home. NICE NG104 covers monitoring in pancreatitis. NICE QS177 covers pancreatic enzyme replacement therapy (PERT) in unresectable pancreatic cancer. Exact UK community prevalence of PEI is unknown. Pancreatic Cancer UK figures of 60–90% apply in a pancreatic-cancer frame only — not to the general population.
Guts UK lists cystic fibrosis, acute pancreatitis with necrosis, chronic pancreatitis, pancreatic cancer, and pancreatic surgery. PEI can also follow total gastrectomy. After bariatric surgery, Guts UK says PEI may affect up to 2 in 10 people. In diabetes, Guts UK gives ranges rather than a single midpoint: PEI could happen in 1 in 10 up to 1 in 2 people with type 1 diabetes, and 1 in 20 up to 1 in 2 people with type 2 diabetes. Type 3c (pancreatogenic) diabetes overlaps. NICE notes a lifetime diabetes risk in chronic pancreatitis as high as 80%.
Guts UK also states that 8 in 10 people with chronic pancreatitis eventually develop PEI.
Opioids and codeine can mask diarrhoea. Absence of classic oily stools does not exclude PEI if dietary fat is low. Do not use a low-fat diet to “treat” PEI — it only hides fat-maldigestion. This page does not diagnose pancreatic cancer from these symptoms. AGA 2023 advises against very-low-fat diets when managing EPI, and supports monitoring nutrition including fat-soluble vitamins and bone density over time. That matches Guts UK's warning that cutting fat only hides steatorrhoea and worsens malnutrition.
UK PERT supply has been disrupted in 2026. Guts UK (June 2026) says problems will probably last until the end of 2026. Further information is on Guts UK, SPS, and PSGBI. This page does not offer stockpile advice. Licensed UK brands include Creon, Nutrizym, and Pancrex — not Creon only. Imported alternatives exist via a GP or pharmacy.
PEI is sometimes mislabelled IBS-D. If symptoms persist on adequate PERT plus a PPI, clinicians look at bile acid malabsorption, SIBO, and coeliac disease — they do not stack health-shop enzymes. Gastroparesis and post-gastric-surgery asynchrony can mimic or sit with PEI. A GI-MAP (or other private multiplex stool test) is not a diagnosis of PEI and must not be used to self-start PERT.
Diagnosis is clinical, plus faecal elastase-1 (FE-1) when needed. FE-1 is not GI-MAP. Even NHS FE-1 misses mild-to-moderate PEI. Watery stool risks a false-positive; repeat the test if the sample is watery. Phillips et al. (BMJ Open Gastroenterology 2021;8:e000643) summarise that FE-1 <200 µg/g suggests moderate PEI and <100 µg/g severe PEI, and that sensitivity of the <200 cut-off is only 25–65% in mild PEI. A single low FE-1 on diarrhoea is not enough to self-diagnose.
Minimum adult starting doses are commonly 50,000 lipase units with meals and 25,000 with snacks. Pancreatic Cancer UK also describes 50,000–75,000 with meals and 25,000–50,000 with snacks. Doses are titrated by a clinician and dietitian — not copied from a forum.
NICE NG104: monitor exocrine function and nutrition at least every 12 months (every 6 months if under 16); bone density every 2 years; HbA1c every 6 months. NICE QS177: offer enteric-coated pancreatin for unresectable pancreatic cancer.
All licensed PERT is pork-derived. Guts UK, Pancreatic Cancer UK, and the NICE QS177 equality note record that UK Jewish and Muslim authorities generally permit it when there is no alternative. Do not stop prescribed PERT because of pork origin without a conversation with a clinician and, if you wish, a faith leader.
PERT is prescribed and titrated. Health-shop enzymes are not a substitute, and this page does not diagnose pancreatic cancer.
Anecdotal themes:
We cite UK sources first: Guts UK, NICE, Pancreatic Cancer UK, and a UK-relevant review of FE-1. There is no dedicated NHS.uk PEI page.
Patient information on causes, symptoms, FE-1, PERT, pork origin, and why low-fat diets are not a treatment.
Visit ResourceReview of PEI and FE-1: <200 µg/g moderate, <100 severe; sensitivity 25–65% in mild PEI.
Visit ResourceMonitor exocrine function and nutrition at least yearly (6-monthly under 16); bone density every 2 years; HbA1c every 6 months.
Visit ResourceQuality statement 4: enteric-coated pancreatin for unresectable pancreatic cancer, with an equality note on porcine origin.
Visit ResourcePatient information on how to take PERT, including meal and snack dose ranges in a pancreatic-cancer setting.
Visit ResourceLive UK supply disruption for Creon, Nutrizym, and Pancrex. Problems probably last until the end of 2026. This is not stockpile advice.
Visit ResourceThe American Gastroenterological Association's 2023 clinical practice update on exocrine pancreatic insufficiency says faecal elastase is the most appropriate initial test and must be done on a semi-solid or solid stool sample. A result below 100 µg/g gives good evidence of EPI; results between 100 and 200 µg/g are indeterminate. That supports the warning that watery samples risk a false picture — it does not replace UK Phillips cut-offs, and it is not a licence to self-read a shop stool panel. The update also says PERT is required once EPI is diagnosed, products are porcine in origin, enzymes should be taken during the meal, and very-low-fat diets should be avoided when managing EPI. PMID 37737818.
Visit Resource Visit ResourceCommunity experiences, not medical advice. This page is for education only. It is not a diagnosis of PEI or of pancreatic cancer, and it is not a treatment plan. Do not start or stop PERT, switch brands during a shortage, or begin a low-fat diet from this page. Always discuss tests and enzymes with your GP or specialist.