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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

Current standard enzyme treatment of steatorrhea in chronic pancreatitis. 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.
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f3-tcrm-5-507: Current standard enzyme treatment of steatorrhea in chronic pancreatitis. 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.

Mentions: Since pancreatic steatorrhea does not occur until pancreatic lipase output is decreased by more than 90%,10 the initial dose recommendations for PES is based on achieving 10% of normal postprandial lipolytic activity in the duodenal lumen. Based on these recommendations, the PES preparation must be able to produce 60 IU/min of lipase activity in postprandial chyme throughout the digestive period. A dose of 25–40,000 IU is thus recommended for the digestion of a regular meal55 which may be increased up to 2–3 fold in cases where it appears to lack a therapeutic effect (Figure 3).


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)

Current standard enzyme treatment of steatorrhea in chronic pancreatitis. 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.
© Copyright Policy
Related In: Results  -  Collection

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

f3-tcrm-5-507: Current standard enzyme treatment of steatorrhea in chronic pancreatitis. 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.
Mentions: Since pancreatic steatorrhea does not occur until pancreatic lipase output is decreased by more than 90%,10 the initial dose recommendations for PES is based on achieving 10% of normal postprandial lipolytic activity in the duodenal lumen. Based on these recommendations, the PES preparation must be able to produce 60 IU/min of lipase activity in postprandial chyme throughout the digestive period. A dose of 25–40,000 IU is thus recommended for the digestion of a regular meal55 which may be increased up to 2–3 fold in cases where it appears to lack a therapeutic effect (Figure 3).

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