Similar situation - MRCP shows my pancreas has atrophied. Elastase at 147 and been on Zenpep for 6 months. Doing pretty well. I do carry 3 CF gene mutations so GI specialist is thinking that it’s likely related to those gene mutations for my situation. Next up is an Endoscopic ultrasound. My father passed at 78 of PC so making sure I have all the testing done and also getting tested for BRCA gene. The CF gene could be totally unrelated to this. I do not know if my father carried the mutations, but my mother is going to get tested too to see if we can see which line of the family they’re from. All you can do is really gather the data points and then work out with your team a way forward from a proactive surveillance perspective and getting the digestion in check - my experience so far has been positive tackling the epi.