ZENPEP is a prescription medicine for people who cannot digest food normally because their pancreas does not make enough enzymes. ZENPEP may help your body use fats, proteins, and sugars from food. The most common adverse events are abdominal pain, flatulence, headache, cough, decreased weight, early satiety, and contusion. Fibrosing colonopathy (colonic stricture) is associated with high-dose use of pancreatic enzyme replacement, typically when dosing exceeds 2,500 lipase units/kg of body weight per meal (or greater than 10,000 lipase units/kg of body weight per day). The underlying mechanism of fibrosing colonopathy remains unknown. ZENPEP is not known to cause acid reflux or Barretts esophagitis. However, occasionally, people with colonic strictures can get acid reflux resulting in Barretts esophagitis; therefore, it is important for you to stop the ZENPEP (which can worsen clonic strictures) until your GI doctor can determine the cause of your Barretts. Side note: Barrett esophagus is a change in the layer of the esophagus which predisposes to the development of adenocarcinoma of the esophagus. It is caused by chronic gastric reflux into the esophagus. Weight loss, smoking cessation, robust dietary intake of fruits and vegetables, and moderate wine consumption may decrease risk of Barrett esophagus and lower progression to esophageal cancer. Your GI doctor should have given you high doses of protonix or similar medications. Unfortunately, neither suppression of gastric acid production via high-dose proton pump inhibitors (for example, protonix) nor reduction in esophageal acid exposure via antireflux surgery induces regression of Barrett esophagus. These therapies may, however, decrease cancer risk.