Pancreatic enzyme replacement

@article{Graham2005PancreaticER,
  title={Pancreatic enzyme replacement},
  author={David Yates Graham},
  journal={Digestive Diseases and Sciences},
  year={2005},
  volume={27},
  pages={485-490}
}
  • D. Graham
  • Published 1 June 1982
  • Medicine
  • Digestive Diseases and Sciences
The effect of the addition of sodium bicarbonate, aluminum hydroxide, magnesium hydroxide, calcium carbonate, or cimetidine to supplemental pancreatic enzyme therapy was investigated in patients with severe exocrine pancreatic insufficiency. Steatorrhea was reduced with the administration of three enzyme tablets with meals (73 vs 29 g/24 hr). The coadministration of enzyme tablets with either sodium bicarbonate (16.6 g/24 hr,P=0.08), or aluminum hydroxide (18.4 g/24 hr,P=0.029) yielded a… 

Figures and Tables from this paper

Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency in the 21(st) century.
TLDR
Approaches for improving the results of enzyme therapy are described including changing to, or adding, a different product, adding non-enteric coated enzymes, use of antisecretory drugs and/or antacids, and changing the timing of enzyme administration.
Comparative effects of adjuvant cimetidine and omeprazole during pancreatic enzyme replacement therapy
In a double-blind, randomized crossover study, the hypotheses were tested that more powerful inhibition of gastric acid secretion by adjuvant omeprazole further improves the efficacy of pancreatic
Omeprazole, a proton pump inhibitor, improves residual steatorrhoea in cystic fibrosis patients treated with high dose pancreatic enzymes
TLDR
omeprazole improves fat digestion and absorption in cystic fibrosis patients with residual faecal fat loss despite maximal pancreatic enzyme substitution.
Use of pancreatic schilling test to determine efficiency of pancreatic enzyme delivery in pancreatic insufficiency
TLDR
It is illustrated that the administration of enzymes in a form of entericcoated microspheres does not enhance the delivery of proteolytic enzymes to the small intestine when compared to conventional highdose enzyme replacement.
Rational Use of Pancreatic Enzymes for Pancreatic Insufficiency and Pancreatic Pain.
TLDR
The rational use of enteric coated and unprotected replacement pancreatic enzymes for treatment of malabsorption due to pancreatic insufficiency and for pancreatic pain is described and mechanisms causing pain that may be amenable to therapy with pancreatic enzyme mechanisms are focused on.
Study of the gastrointestinal bioavailability of a pancreatic extract product (Zenpep) in chronic pancreatitis patients with exocrine pancreatic insufficiency.
Duodenal instillation of pancreatin does not abolish steatorrhea in patients with pancreatic insufficiency
TLDR
It is concluded that more than just intragastric destruction of lipase underlies the frequent failure of orally ingested pancreatin to normalize fat absorption in pancreatic insufficiency.
Improvement of fecal fat excretion after addition of omeprazole to pancrease in cystic fibrosis is related to residual exocrine function of the pancreas
TLDR
The addition of omeprazole to pancrease is most successful in CF patients with residual pancreatic function, determined by urinary PABA excretion or incremental PP.
Treatment of Exocrine Pancreatic Insufficiency
TLDR
Reasons for inadequate treatment of fat malabsorption include giving an insufficient amount of pancreatic enzymes, improper timing and dosing of enzymes, and destruction of the ingested enzymes by acid denaturation and proteolytic digestion.
Enzyme Contents of Pancreatic Extract Preparations
Exogenous pancreatic enzyme supplementation may be required in a variety of inherited pancreatic insufficiency conditions, including cystic fibrosis (CF) and Schwachman syndrome, and after surgical
...
1
2
3
4
...

References

SHOWING 1-10 OF 22 REFERENCES
Effect of cimetidine and sodium bicarbonate on pancreatic replacement therapy in cystic fibrosis.
TLDR
Dietary intake appears to be a significant factor in determining the faecal output of fat and nitrogen in patients with pancreatic insufficiency and should be considered when determining the optimum amount of pancreatic supplementation.
Rationale for the use of cimetidine in pancreatic insufficiency.
TLDR
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.
Comparative effects of antacids, cimetidine and enteric coating on the therapeutic response to oral enzymes in severe pancreatic insufficiency.
TLDR
Cimetidine may be a useful adjunct to oral pancreatic extract therapy in some patients with severe pancreatic insufficiency who fail to respond to pancreatic enzyme replacement alone.
Enzyme Replacement Therapy of Exocrine Pancreatic Insufficiency in Man
TLDR
Lipase activity in vitro correlated with potency in vivo for tablet and capsules, with tablets and capsules being effective in reducing steatorrhea by 56.1±9 per cent and 48.6±10 per cent.
Relationship between bile acid malabsorption and pancreatic insufficiency in cystic fibrosis.
TLDR
Qualitative bile acid patterns in controls, in infants after an ileal resection, and in patients with CF or with coeliac disease showed that the percentage of primary BA followed closely the total amount excreted except in situations where antibiotics were administered.
The use of L-arginine and sodium bicarbonate in the treatment of malabsorption due to cystic fibrosis.
TLDR
It is reported that the oral administration of L-arginine resulted in a reduction of steatorrhea and gain of body weight in cystic fibrosis patients, perhaps by acting as a mild detergent and thus reducing the viscosity of intestinal mucus and increasing the emulsification of dietary fats.
Pancreatic extracts in the treatment of pancreatic exocrine insufficiency.
TLDR
The aim of the specific therapy is to replace the pancreatic enzymes, which can no longer be secreted, by orally administered enzymes, so that the enzymic activities attained in the duodenum and small intestine become sufficient to prevent maldigestion of the principal foodstuffs.
Fat assimilation after massive distal pancreatectomy.
TLDR
Fat assimilation was determined by 219 daily balance studies in seven patients who had had massive distal pancreatectomy for pancreatitis with preservation of the integrity of the gut lumen with respect to pH, lipase concentration and hydrolytic products of neutral fat.
...
1
2
3
...