Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency: When is it indicated, what is the goal and how to do it?

Advances in Medical Sciences

Volumn 56, Issue 1, 2011, Pages 1-5

  Dominguez Munoz J ^a  

^a Instituto de Salud Carlos III   (Spain)

Author keywords

chronic pancreatitis; maldigestion; nutritional status; pancreatic enzyme substitution therapy; pancreatic exocrine insufficiency

Indexed keywords

BICARBONATE; FECES LIPID; FERRITIN; MICROSPHERE; PANCREAS ENZYME; PREALBUMIN; PROTON PUMP INHIBITOR; TRIACYLGLYCEROL LIPASE; VITAMIN;

ACUTE PANCREATITIS; ARTICLE; BACTERIAL OVERGROWTH; CHRONIC PANCREATITIS; CYSTIC FIBROSIS; DIET THERAPY; DIGESTIVE SYSTEM FUNCTION DISORDER; DISEASE ASSOCIATION; DUODENUM; ENTERIC COATED TABLET; ENZYME ACTIVITY; ENZYME REPLACEMENT; GASTROINTESTINAL SURGERY; HIGH FIBER DIET; LIPID ABSORPTION; LOW FAT DIET; MALNUTRITION; MONOTHERAPY; NUTRIENT; NUTRITIONAL ASSESSMENT; NUTRITIONAL STATUS; PANCREAS CANCER; PANCREAS EXOCRINE INSUFFICIENCY; PANCREAS SECRETION; PANCREAS SURGERY; PH; STEATORRHEA; STOMACH EMPTYING; TREATMENT INDICATION; TREATMENT RESPONSE; WEIGHT REDUCTION;

EID: 79958146786     PISSN: 18961126     EISSN: 18984002     Source Type: Journal    
DOI: 10.2478/v10039-011-0005-3     Document Type: Review

References (25)

1. Layer P, Yamamoto H, Kalthoff L, Clain JE, Bakken LJ, DiMagno EP. The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology. 1994 Nov;107(5):1481-7 (Pubitemid 24328288)
2. Montalto G, Soresi M, Carroccio A, Scafidi E, Barbagallo CM, Ippolito S, Notarbartolo A. Lipoproteins and chronic pancreatitis. Pancreas. 1994 Jan;9(1):137-8
3. Lankisch PG. Natural course of chronic pancreatitis. Pancreatology. 2001;1(1):3-14 (Pubitemid 33674909)
4. Nøjgaard C, Bendtsen F, Becker U, Andersen JR, Holst C, Matzen P. Danish patients with chronic pancreatitis have a four-fold higher mortality rate than the Danish population. Clin Gastroenterol Hepatol. 2010 Apr;8(4):384-90
5. Stein J, Purschian B, Bieniek U, Caspary WF, Lembcke B. Near-infrared reflectance analysis: a new dimension in the investigation of malabsorption syndromes. Eur J Gastroenterol Hepatol. 1994 Oct; 6(10):889-94 (Pubitemid 24287909)
6. Domínguez-Muñoz JE, Iglesias-García J, Vilariño- Insua M, Iglesias-Rey M. 13C-mixed triglyceride breath test to assess oral enzyme substitution therapy in patients with chronic pancreatitis. Clin Gastroenterol Hepatol. 2007 Apr;5(4):484-8 (Pubitemid 46575367)
7. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007 Apr;9(2):116-22 (Pubitemid 46647523)
8. Domínguez-Muñoz JE, Iglesias-García J. Oral pancreatic enzyme substitution therapy in chronic pancreatitis: is clinical response an appropriate marker for evaluation of therapeutic efficacy? JOP. 2010 Mar 5;11(2):158-62
9. Holtmann G, Kelly DG, Sternby B, DiMagno EP. Survival of human pancreatic enzymes during small bowel transit: effects of nutrients, bile acids, and enzymes. Am J Physiol. 1997 Aug;273(2 Pt 1):G553-8
10. Suzuki A, Mizumoto A, Rerknimitr R, Sarr MG, DiMagno EP. Effect of bacterial or porcine lipase with low- or high-fat diets on nutrient absorption in pancreatic-insufficient dogs. Gastroenterology. 1999 Feb;116(2):431-7 (Pubitemid 29055367)
11. Isaksson G, Lundquist I, Ihse I. Effect of dietary fiber on pancreatic enzyme activity in vitro. Gastroenterology. 1982 May;82(5 Pt 1):918-24
12. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005 Jul;54 Suppl 6:vi1-28
13. DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973 Apr 19;288(16):813-5
14. Lankisch PG, Lembcke B, Wemken G, Creutzfeldt W. Functional reserve capacity of the exocrine pancreas. Digestion. 1986;35(3):175-81 (Pubitemid 16001678)
15. Domínguez-Muñoz JE, Iglesias-García J, Iglesias- Rey M, Figueiras A, Vilariño-Insua M. Effect of the administration schedule on the therapeutic efficacy of oral pancreatic enzyme supplements in patients with exocrine pancreatic insufficiency: a randomized, three-way crossover study. Aliment Pharmacol Ther. 2005 Apr 15;21(8):993-1000 (Pubitemid 40529733)
16. Safdi M, Bekal PK, Martin S, Saeed ZA, Burton F, Toskes PP. The effects of oral pancreatic enzymes (Creon 10 capsule) on steatorrhea: a multicenter, placebo-controlled, parallel group trial in subjects with chronic pancreatitis. Pancreas. 2006 Aug;33(2):156-62 (Pubitemid 44174563)
17. Stern RC, Eisenberg JD, Wagener JS, Ahrens R, Rock M, doPico G, Orenstein DM. A comparison of the efficacy and tolerance of pancrelipase and placebo in the treatment of steatorrhea in cystic fibrosis patients with clinical exocrine pancreatic insufficiency. Am J Gastroenterol. 2000 Aug;95(8):1932-8
18. Domínguez-Muñoz JE, Iglesias-García J, Iglesias- Rey M, Vilariño-Insua M. Optimising the therapy of exocrine pancreatic insufficiency by the association of a proton pump inhibitor to enteric coated pancreatic extracts. Gut. 2006 Jul;55(7):1056-7 (Pubitemid 43962635)
19. Domínguez-Muñoz JE. Management of maldigestion in chronic pancreatitis: a practical protocol. In: Domínguez- Muñoz JE, ed. Clinical Pancreatology for practising gastroenterologists and surgeons. Blackwell Publishing: Oxford, 2005: p. 288-93
20. DiMagno EP, Malagelada JR, Go VL, Moertel CG. Fate of orally ingested enzymes in pancreatic insufficiency. Comparison of two dosage schedules. N Engl J Med. 1977 Jun 9;296(23):1318-22 (Pubitemid 8103698)
21. Guarner L, Rodríguez R, Guarner F, Malagelada JR. Fate of oral enzymes in pancreatic insufficiency. Gut. 1993 May;34(5):708-12 (Pubitemid 23146902)
22. Casellas F, Guarner L, Vaquero E, Antolín M, de Gracia X, Malagelada JR. Hydrogen breath test with glucose in exocrine pancreatic insufficiency. Pancreas. 1998 May;16(4):481-6 (Pubitemid 28217534)
23. Pieramico O, Dominguez-Muñoz JE, Nelson DK, Böck W, Büchler M, Malfertheiner P. Interdigestive cycling in chronic pancreatitis: altered coordination among pancreatic secretion, motility, and hormones. Gastroenterology. 1995 Jul;109(1):224-30
24. Carroccio A, Pardo F, Montalto G, Iapichino L, Soresi M, Averna MR, Iacono G, Notarbartolo A. Use of famotidine in severe exocrine pancreatic insufficiency with persistent maldigestion on enzymatic replacement therapy. A long-term study in cystic fibrosis. Dig Dis Sci. 1992 Sep;37(9):1441-6
25. Proesmans M, De Boeck K. Omeprazole, a proton pump inhibitor, improves residual steatorrhea in cystic fibrosis patients treated with high dose pancreatic enzymes. Eur J Pediatr. 2003 Nov;162(11):760-3 (Pubitemid 37410022)