Pancreatic enzyme therapy for pancreatic exocrine insufficiency

Pancreatic exocrine insufficiency with steatorrhea is a major consequence of pancreatic diseases (eg, chronic pancreatitis, cystic fibrosis, severe acute necrotizing pancreatitis, pancreatic cancer), extrapancreatic diseases such as celiac disease and Crohn's disease, and gastrointestinal and p...

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Bibliographic Details
Published in:Current gastroenterology reports 2007-05, Vol.9 (2), p.116-122
Main Author: Domínguez-Muñoz, J Enrique
Format: Article
Language:English
Subjects:
Exocrine Pancreatic Insufficiency - complications
Exocrine Pancreatic Insufficiency - drug therapy
Exocrine Pancreatic Insufficiency - physiopathology
Feeding Behavior
Gastric Emptying - physiology
Humans
Lipase - metabolism
Microspheres
Pancreatic Extracts - administration & dosage
Postprandial Period
Steatorrhea - etiology
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Summary:Pancreatic exocrine insufficiency with steatorrhea is a major consequence of pancreatic diseases (eg, chronic pancreatitis, cystic fibrosis, severe acute necrotizing pancreatitis, pancreatic cancer), extrapancreatic diseases such as celiac disease and Crohn's disease, and gastrointestinal and pancreatic surgical resection. Recognition of this entity is highly relevant to avoid malnutrition-related morbidity and mortality. Therapy for pancreatic exocrine insufficiency is based on the oral administration of pancreatic enzymes aiming at providing the duodenal lumen with sufficient active lipase at the time of gastric emptying of nutrients. Administration of enzymes in the form of enteric-coated minimicrospheres avoids acid-mediated lipase inactivation and ensures gastric emptying of enzymes in parallel with nutrients. Nevertheless, such factors as acidic intestinal pH and bacterial overgrowth may prevent normalization of fat digestion even in compliant patients. The present article critically reviews current therapeutic approaches to pancreatic exocrine insufficiency.
ISSN:1522-8037
1534-312X
DOI:10.1007/s11894-007-0005-4