What if pancreatic enzyme replacement therapy does not help?

PERT only works when it is taken with food and taken properly. If you are taking enough, your symptoms should get better. For some people the symptoms may go away. You might find our tips on how to take it helpful.

If you still have symptoms or you are losing weight, speak to your dietitian, nurse or doctor. They can check if you are taking enough PERT, and make sure that you are taking it properly. Some people may need to change the brand of PERT they take.

What are proton pump inhibitors (PPIs)?

Sometimes, the doctor will give you medicines called proton pump inhibitors (PPIs). PPIs include omeprazole and lansoprazole. They stop the stomach from producing too much acid, which can affect how well the PERT works.

Usually, PPIs are tablets or capsules that you take once or twice a day. Speak to your doctor about these medicines and ask if they would help.

What else can cause symptoms?

If you are taking PERT and you still have symptoms, there may be other causes for these. For example, opioid painkillers (such as morphine), antibiotics, iron supplements, some anti-sickness medicines or chemotherapy can all cause changes to your poo.

Speak to your medical team about your symptoms.

What happens if I take too many enzymes?

Any extra enzymes you take will pass through your body and come out in your poo. They won’t cause any harm. If you take lots more than you need it may cause some itching around your anus (bottom). This is nothing to worry about.

If you feel unwell, speak to your doctor or nurse. Make sure you take your PERT at your next meal as usual.

Are there any side effects of PERT?

It is not common to get side effects from PERT, but some people get tummy pain, wind, or they may feel or be sick. These symptoms are often caused by the dose of PERT being too low, rather than a side effect.

Increasing the dose may help. Try keeping a food diary for a few days to see what dose helps. Or your doctor may need to change the brand of PERT you take.

Does PERT cause constipation?

Some people may have constipation (when you find it harder to poo). There could be many reasons for constipation. If you had runny poo before because of digestion problems, taking PERT may stop this, and you might feel constipated. Other medicines such as opioid painkillers can cause constipation. You may need a medicine called a laxative if you take opioids.

If you have constipation, speak to your doctor or nurse. They can work out what’s causing it and how to manage it. Do not stop taking your PERT.

If you have any questions about how to take PERT, speak to your dietitian, nurse or doctor.

Updated March 2025

Review date March 2028