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

Krishnamurty DM, Rabiee A, Jagannath SB, Andersen DK - Ther Clin Risk Manag (2009)

Bottom Line: In patients with treatment failure, apart from evaluating drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation.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.Goals of therapy based on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins University School of Medicine; Department of Medicine.

ABSTRACT
Pancreatic enzyme supplements (PES) are used in chronic pancreatitis (CP) for correction of pancreatic exocrine insufficiency (PEI) as well as pain and malnutrition. The use of porcine pancreatic enzymes for the correction of exocrine insufficiency is governed by the pathophysiology of the disease as well as pharmacologic properties of PES. Variability in bioequivalence of PES has been noted on in vitro and in vivo testing and has been attributed to the differences in enteric coating and the degree of micro-encapsulation. As a step towards standardizing pancreatic enzyme preparations, the Food and Drug Administration now requires the manufacturers of PES to obtain approval of marketed formulations by April 2010. In patients with treatment failure, apart from evaluating drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation. The choice of PES (enteric coated versus non-enteric coated) and the need for acid suppression should be individualized. 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. Goals of therapy based on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.

No MeSH data available.


Related in: MedlinePlus

Onset of pancreatic exocrine insufficiency in patients with alcoholic and nonalcoholic etiologies. Reproduced with permission from Layer P, Keller J. 2003. Lipase supplementation therapy: standards, alternatives, and perspectives. Pancreas, 26:1–7. Copyright © 2003 Lippincott Williams & Wilkins.Abbreviations: CP, chronic pancreatitis; iCP, idiopathic chronic pancreatitis.
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f1-tcrm-5-507: Onset of pancreatic exocrine insufficiency in patients with alcoholic and nonalcoholic etiologies. Reproduced with permission from Layer P, Keller J. 2003. Lipase supplementation therapy: standards, alternatives, and perspectives. Pancreas, 26:1–7. Copyright © 2003 Lippincott Williams & Wilkins.Abbreviations: CP, chronic pancreatitis; iCP, idiopathic chronic pancreatitis.

Mentions: Approximately 50% of CP patients experience steatorrhea within a median of 10–12 years after the onset of CP, but this may vary based on the etiology of CP.13,14 Early studies classified CP into two broad types: alcoholic (ACP) or non-alcoholic (NACP) (which is further subdivided into early-onset and late-onset NACP) (see Figure 1). Early-onset NACP occurs in children and adolescents and is often characterized by pain, but with longer preservation of pancreatic function and later development of calcifications as compared to alcoholic CP and late-onset NACP. PEI is less common with NACP than ACP.14


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

Krishnamurty DM, Rabiee A, Jagannath SB, Andersen DK - Ther Clin Risk Manag (2009)

Onset of pancreatic exocrine insufficiency in patients with alcoholic and nonalcoholic etiologies. Reproduced with permission from Layer P, Keller J. 2003. Lipase supplementation therapy: standards, alternatives, and perspectives. Pancreas, 26:1–7. Copyright © 2003 Lippincott Williams & Wilkins.Abbreviations: CP, chronic pancreatitis; iCP, idiopathic chronic pancreatitis.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710383&req=5

f1-tcrm-5-507: Onset of pancreatic exocrine insufficiency in patients with alcoholic and nonalcoholic etiologies. Reproduced with permission from Layer P, Keller J. 2003. Lipase supplementation therapy: standards, alternatives, and perspectives. Pancreas, 26:1–7. Copyright © 2003 Lippincott Williams & Wilkins.Abbreviations: CP, chronic pancreatitis; iCP, idiopathic chronic pancreatitis.
Mentions: Approximately 50% of CP patients experience steatorrhea within a median of 10–12 years after the onset of CP, but this may vary based on the etiology of CP.13,14 Early studies classified CP into two broad types: alcoholic (ACP) or non-alcoholic (NACP) (which is further subdivided into early-onset and late-onset NACP) (see Figure 1). Early-onset NACP occurs in children and adolescents and is often characterized by pain, but with longer preservation of pancreatic function and later development of calcifications as compared to alcoholic CP and late-onset NACP. PEI is less common with NACP than ACP.14

Bottom Line: In patients with treatment failure, apart from evaluating drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation.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.Goals of therapy based on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins University School of Medicine; Department of Medicine.

ABSTRACT
Pancreatic enzyme supplements (PES) are used in chronic pancreatitis (CP) for correction of pancreatic exocrine insufficiency (PEI) as well as pain and malnutrition. The use of porcine pancreatic enzymes for the correction of exocrine insufficiency is governed by the pathophysiology of the disease as well as pharmacologic properties of PES. Variability in bioequivalence of PES has been noted on in vitro and in vivo testing and has been attributed to the differences in enteric coating and the degree of micro-encapsulation. As a step towards standardizing pancreatic enzyme preparations, the Food and Drug Administration now requires the manufacturers of PES to obtain approval of marketed formulations by April 2010. In patients with treatment failure, apart from evaluating drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation. The choice of PES (enteric coated versus non-enteric coated) and the need for acid suppression should be individualized. 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. Goals of therapy based on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.

No MeSH data available.


Related in: MedlinePlus