What if pancreatic enzyme replacement therapy doesn’t help my symptoms?

If you are taking pancreatic enzymes but your diet symptoms don’t get better, speak to your doctor, nurse or dietitian.

Pancreatic enzymes only work when they are taken with food, and taken properly. You might find it helpful to read our tips on how to take them. If you are taking enough enzymes, your symptoms should get better, and for some people the symptoms may go away.

What if the enzymes do not help?

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 enzymes, and make sure that you are taking them properly. Some people need to change the brand of enzymes they take.

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

Other causes of 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 enzymes at your next meal as usual.

Are there any side effects of pancreatic enzymes?

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

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 enzymes you take.

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 enzymes, speak to your medical team.

If you go into hospital

If you go into hospital, tell the staff that you need to take PERT to help you digest your food. Sometimes hospital staff only give PERT when they give other medicines, but this might not be at meal times. Explain that PERT only works if you take it when you eat, and that you need more if you are eating more.

Ask the hospital staff if you can keep PERT with you to take with any food, including snacks and milky drinks. Some hospitals may let you do this. You could show them this booklet. If they don’t let you keep it, speak to your medical team or dietitian as they may be able to help.

What can I do when taking PERT?

  • If you have not been prescribed PERT and have any digestion symptoms, ask your doctor, dietitian or nurse about it.
  • Take more PERT if you still have symptoms.
  • Keep a diary of what you eat and how much PERT you take each time. This will help you find the right dose for different foods.
  • If you have any questions about how to take PERT, get in touch with our specialist nurses on our Support Line.
  • Tell your dietitian, nurse or doctor if you are still getting symptoms even when you are taking PERT. There may be another cause, which they can help you with.

Questions to ask your doctor, nurse or dietitian

  • Would pancreatic enzymes help with my symptoms?
  • How do I take pancreatic enzymes?
  • I still have some symptoms even though I am taking enzymes. Should I increase the dose?
  • What should I do if my symptoms don’t get better?

Get support with PERT and digestion

PERT can make a big difference to how you feel, but we know it can sometimes be hard to work out how to get the right dose. Speak to your dietitian, nurse or doctor with any questions.

We also provide a lot of support to help you make sure you are taking it properly and deal with digestion problems.

  • Speak to our specialist nurses on our free Support Line about PERT or symptoms.
  • We also run our Ask a Dietitian webinar, where dietitians explain more about diet and PERT. You can watch previous webinars, or sign up to attend future sessions.
Get the support you need
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"Getting my Creon dosage right has been a challenge but advice I found on the Pancreatic Cancer UK website helped enormously and nearly two and a half years on I feel myself again."

Updated March 2023

Review date March 2025