Lipase Supplementation Therapy: Standards, Alternatives, and Perspectives

  title={Lipase Supplementation Therapy: Standards, Alternatives, and Perspectives},
  author={Peter Layer and Jutta Keller},
Treatment of steatorrhea by lipase supplementation therapy has become more successful in the last decade due to better understanding of the physiology and pathophysiology of the digestive process. Porcine lipase has been the therapeutic standard for several decades and will continue to be the treatment of choice in pancreatic exocrine insufficiency. Modern therapeutic concepts recommend administration of 25,000–40,000 units of porcine lipase per meal using pH-sensitive pancreatin microspheres… 

Delayed release pancrelipase for treatment of pancreatic exocrine insufficiency associated with chronic pancreatitis

There is no current standard test for evaluating adequacy of therapy in CP patients and studies have shown that optimization of therapy based on symptoms may be inadequate, so goals of therapybased on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.

Enzyme replacement therapy for pancreatic insufficiency: present and future

Pancreatic enzyme replacement therapy is currently the mainstay of treatment for nutrient malabsorption secondary to pancreatic insufficiency and data demonstrate efficacy in reducing steatorrhea and fat mal absorption.

The role of enzyme supplementation in digestive disorders.

  • M. Roxas
  • Biology
    Alternative medicine review : a journal of clinical therapeutic
  • 2008
Safety and efficacy of enzymes derived from microbial species in the treatment of conditions such as malabsorption and lactose intolerance is promising and use of microbe-derived lipase has shown promise with studies indicating benefit similar to pancreatic enzymes, but at a lower dosage concentration and with a broader pH range.

A first approach for an evidence-based in vitro digestion method to adjust pancreatic enzyme replacement therapy in cystic fibrosis

In this study, an in vitro digestion model was set up to determine the theoretical optimal dose (TOD) of enzymatic supplement for a selection of foods, which is the dose that allows for maximum lipolysis extent, a first step towards an evidence-based method for PERT dosing.

Properties of different pancreatin preparations used in pancreatic exocrine insufficiency

Although all pancreatin preparations contain the declared lipase units and are acid-stable, a wide variation was observed in the particle size, surface, acid resistance, release of enzymes, pharmacokinetics and batch consistency.

Efficacy of Lower Than Standard Doses of Pancreatic Enzyme Supplementation Therapy During Acid Inhibition in Patients With Pancreatic Exocrine Insufficiency

Lower than recommended oral doses of pancreatic enzymes are therapeutically effective with respect to fat absorption and symptom reduction during strong acid inhibition with omeprazole.

Role of Acid Suppression in Exocrine Pancreatic Insufficiency: A Therapeutic Principle

The addition of PPIs to PEPs in patients with EPI results in a higher duodenal pH and thus a reduced inactivation of the residual enzyme secretion of patients, an earlier dissolution of PEP's from enteric coating, and a prevention of bile salt precipitation.

Pancrelipase: an evidence-based review of its use for treating pancreatic exocrine insufficiency

Pancreatic exocrine insufficiency (PEI) is often observed in patients with pancreatic diseases, including chronic pancreatitis, cystic fibrosis, and tumors, or after surgical resection. PEI often

Yarrowia lipolytica Lipase 2 Is Stable and Highly Active in Test Meals and Increases Fat Absorption in an Animal Model of Pancreatic Exocrine Insufficiency.

The yeast lipase YLLIP2 is stable and has high levels of activity against test meal triglycerides in a large pH range, with and without bile, and was highly stable and poorly degraded by pepsin.

Digestión in vitro de grasas en pacientes sometidos a terapia de sustitución enzimática: puesta a punto del método y ensayos de digestión de leche

A protocol has been set up for the simulation of food matrices in vitro digestions in individuals undergoing the enzyme replacement therapy and the effect of both different enzyme/substrate ratios and pH in the intestinal stage as determinant factors in the lipids of milk digestion process is analysed.



Pancreatic enzyme replacement therapy

Recommendations based on modern therapeutic concepts: 25,000 to 40,000 units of lipase per meal using pH-sensitive pancreatin microspheres, with dosage increases, compliance checks, and differential diagnosis in case of treatment failure.

Bacterial lipase and high-fat diets in canine exocrine pancreatic insufficiency: a new therapy of steatorrhea?

The combination of adequate mixing of small amounts (milligrams) of bacterial lipase and high-fat meals abolishes canine steatorrhea and may abolish human pancreatic steatorRhea.

Therapy of pancreatogenic steatorrhoea: does acid protection of pancreatic enzymes offer any advantage?

It is concluded that therapy with acid-protected pancreatin may simplify and improve treatment of exocrine pancreatic insufficiency in the presence of gastric hyper- or normo-acidity.

Treatment failure after substitution of generic pancrelipase capsules. Correlation with in vitro lipase activity.

Data indicate that the enteric coating of the generic product was defective and that the substituted product was not bioequivalent to the prescribed brand, and the Food and Drug Administration should institute regulations over this group of products.

[Comparison of fungal lipase and pancreatic lipase in exocrine pancreatic insufficiency in man. Study of their in vitro properties and intraduodenal bioavailability].

Results showed that lack of degradation in acidic milieu is not the only valuable criterion for the choice of an efficient lipase preparation and the role of other potential factors such as gastric emptying as well as proteolytic degradation of the enzyme should be considered as well.

Therapeutic Potential and Clinical Efficacy of Acid‐Resistant Fungal Lipase in the Treatment of Pancreatic Steatorrhoea due to Cystic Fibrosis

It is concluded that A. niger lipase is resistant to acid and protease and survives intact within the stomach postprandially but has no therapeutic effect when used alone, and it is discussed why this might be.

Use of famotidine in severe exocrine pancreatic insufficiency with persistent maldigestion on enzymatic replacement therapy

Famotidine is a useful adjuvant to pancreatic enzyme therapy in patients with severe pancreatic insufficiency and persistent maldigestion on large doses of pancreatic supplements; in fact, famotidine improves not only fat absorption but the nutritional status of the patients.

Rationale for the use of cimetidine in pancreatic insufficiency.

Supplemental cimetidine may be useful in the medical management of patients who fail to respond to routine pancreatic extract therapy alone, and should retard or prevent inactivation of ingested enzymes and also increase their intragastric concentration, with resulting enhancement of luminal duodenal enzyme activity.

Pancreatic enzymes: secretion and luminal nutrient digestion in health and disease.

Current knowledge about secretion and luminal fate of pancreatic enzymes and their effects on nutrient digestion in health and chronic pancreatitis are summarized and rationale, rationale, current standards, options, and future aspects of enzyme replacement therapy are discussed.

Pancreatic enzyme replacement therapy: comparative effects of conventional and enteric-coated microspheric pancreatin and acid-stable fungal enzyme preparations on steatorrhoea in chronic pancreatitis.

In patients with chronic pancreatitis and prior Whipple's procedure, Pankreon-Granulat should be administered for enzyme replacement while in patients with an intact upper gastrointestinal tract, Kreon should beadministered, in the treatment of steatorrhoea in chronic pancitis.