- Pancreatic enzymes in the focus of therapy: contemporary strategies for managing exocrine pancreatic insufficiency
Pancreatic enzymes in the focus of therapy: contemporary strategies for managing exocrine pancreatic insufficiency
Modern Pediatrics. Ukraine. (2025).5(149): 63-75. doi: 10.15574/SP.2025.9(149).6375
Nyankovska О. S.1,2, Nyankovskyy S. L.1,2, Pakulova-Trotska Y. V.1, Tytusa A. V.1, Trotskyy H. M.1, Kachmaryk-Boisyn L. P.1
1Danylo Halytsky Lviv National Medical University, Ukraine
2Faculty of Health Sciences and Psychology, Collegium Medicum, University of Rzeszów, Poland
For citation: Nyankovska ОS, Nyankovskyy SL, Pakulova–Trotska YV, Tytusa AV, Trotskyy HM, Kachmaryk–Boisyn LP. (2025). Pancreatic enzymes in the focus of therapy: contemporary strategies for managing exocrine pancreatic insufficiency. Modern Pediatrics. Ukraine. 5(149): 63-75. doi: 10.15574/SP.2025.9(149).6375.
Article received: Jun 30, 2025. Accepted for publication: Sep 10, 2025.
Exocrine pancreatic insufficiency (EPI) is a common clinical condition in both children and adults, characterized by malabsorption, nutritional deficiencies, and reduced quality of life.
The aim – to review modern approaches to diagnosis and enzyme replacement therapy for EPI.
In pediatric practice, the leading causes of EPI include cystic fibrosis, chronic pancreatitis, congenital genetic syndromes, celiac disease, and postoperative conditions involving the gastrointestinal tract. Early diagnosis is based on clinical symptoms, laboratory markers (particularly fecal elastase-1), and comprehensive nutritional assessment.
Pancreatic enzyme replacement therapy (PERT) remains the cornerstone of EPI management. Its effectiveness depends on individualized dosing, timing of enzyme intake, and appropriate dietary support. In cases of persistent symptoms despite PERT, it is essential to evaluate dosage adequacy, administration regimen, and the presence of comorbid gastrointestinal disorders.
This article summarizes current European and North American guidelines on PERT use in children, offering practical recommendations for clinicians.
No conflict of interest was declared by the authors.
Keywords: exocrine pancreatic insufficiency, pancreatic enzyme replacement therapy, pancreatin, cystic fibrosis, chronic pancreatitis, fecal elastase, children, enzyme preparations.
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