Digestive Care, Inc.

How to Manage EPI: Enzymes, pH, and Nutrition Education – Creating a Strategy

by | Jul 14, 2026

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Core Treatment: Pancreatic Enzyme Replacement Therapy (PERT)

PERTZYE® (pancrelipase) is indicated for the treatment of Exocrine Pancreatic Insufficiency (EPI) in adult and pediatric patients.

How PERT works:

PERTZYE is a prescription medicine used to treat people who cannot digest food normally because their pancreas does not make enough enzymes. PERTZYE capsules contain a mixture of digestive enzymes including lipases, proteases and amylases from pig pancreas. Lipase helps digest the fat you eat, protease digests the proteins, and amylase digests the carbohydrates. Click here to watch a video on how PERTZYE works in the body.

PERT Treatment Goals for EPI symptoms: 

  • Reduce steatorrhea (fatty stools) 
  • Improve nutrient absorption
  • Promote weight gain or stabilization 

Important Safety Information about PERTZYE

PERTZYE may increase the risk of having a rare bowel disorder called fibrosing colonopathy, especially if taken at a high dose for a long time in children with cystic fibrosis. This condition is serious and may require surgery. The risk of having this condition may be reduced by following the dosing instructions that your doctor gives you.

Call your doctor right away if you have any unusual or severe:

– stomach area (abdominal) pain

– nausea

– bloating

– vomiting

– trouble passing stool (constipation)

– diarrhea

Take PERTZYE exactly as prescribed by your doctor. Do not take more PERTZYE than directed by your doctor.

Role of pH in EPI Treatment

pH plays a role in how enzyme therapy works. Why pH matters:

Pancreatic enzymes (especially lipase) are inactivated in acidic environments. This means that a lower, acidic pH can decrease the enzyme activity before digestion can occur. Some PERT are designed to be able to withstand these conditions.

The enteric-coated microspheres in PERTZYE are formulated to release pancreatic enzymes at an approximate pH of 5.5 or greater. The enteric-coating protects the microspheres from the low pH of stomach acid, allowing the digestive enzymes to be released when they reach the small intestine. PERTZYE is the only pancreatic enzyme replacement therapy with bicarbonate buffering, which may help to optimize the pH microenvironment around the microspheres to maximize lipase activity.1, 2 The PERTZYE formulation also contains other inactive ingredients.

Do not crush or chew the PERTZYE capsules or their contents and do not hold the capsule or capsule contents in your mouth. Crushing or chewing the PERTZYE capsules may cause irritation in your mouth or change the way PERTZYE works in your body. Always take Pertzye with a meal or snack and drink plenty of liquid to ensure complete swallowing of the PERTZYE capsules or PERTZYE capsule contents-food mixture. Do not take more capsules in a day than the number your doctor tells you to take (total daily dose).

See the Instructions for Use at the end of the Medication Guide for detailed instructions about how to give PERTZYE by mouth and through a gastrostomy tube.

Nutritional Management & Education

Nutrition is a cornerstone of EPI care and is often underemphasized.

Key nutritional considerations: 

  • Dietary Fat Intake
    • Your doctor may change your dose based on the amount of fatty foods you eat or based on your weight.
  • Fat-Soluble Vitamins
    • Patients may be at risk of deficiencies in: Vitamins A, D, E, K
  • Monitoring and labs
    • Weight trends
    • Vitamin levels
    • Bone health (especially vitamin D deficiency)
  • Take PERTZYE capsules exactly as your doctor tells you. Contact your doctor if you continue to have signs and symptoms of malabsorption (not absorbing nutrients from food) such as abdominal pain, abdominal bloating, fatty stools, or weight loss. Your dose may need to be changed.

How Nutritional Education Helps


EPI management can be behavior-dependent. Understanding it well can help patients manage their behaviors in a way that benefits them. 

Nutritional Education with EPI can: 

  • Ensure correct enzyme timing and dosing
  • Prevent undernutrition and weight loss
  • Help patients understand which symptoms signal a need for a dosage change

A patient who works with their prescriber to understand enzyme dosages may have improved symptoms and improved adherence to therapy. 

For patients with EPI:

  • PERT is essential for replacing missing digestive enzymes
  • pH plays a role in how enzyme therapy works
  • Nutritional education may provide long-term improvement. 

Adhering to all 3 of these strategies creates a path towards EPI management! 

Interested in optimizing your treatment plan? Eligible patients prescribed PERTZYE may qualify for a nutrition support program that includes dietitian consultations at no additional cost. Click here to learn more about the My EPI Plan and see if you’re eligible. 

The most common side effects of PERTZYE include diarrhea, upset stomach (indigestion), and cough. Other potential serious side effects are irritation of the inside of your mouth; increase in blood uric acid levels (hyperuricemia); and severe allergic reactions, including trouble with breathing, skin rashes, swollen lips, or itching. Tell your doctor if you have any side effect that bothers you or that does not go away.

Click here to read the Full Prescribing Information and Medication Guide.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

 1 PERTZYE® (pancrelipase) prescribing information. Digestive Care, Inc., Bethlehem, PA; July 2017

2 Manual of Clinical Enzyme Measurements. Freehold, NJ: Worthington Biochemical Corporation; 1972:1-56

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