Lipase Supplementation Therapy: Standards, Alternatives, and Perspectives

@article{Layer2003LipaseST,
  title={Lipase Supplementation Therapy: Standards, Alternatives, and Perspectives},
  author={Peter Layer and Jutta Keller},
  journal={Pancreas},
  year={2003},
  volume={26},
  pages={1-7}
}
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.

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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.
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