Pancreatitis, chronic pancreatic enzymes

These drug are prescribed as replacement therapy for those with pancreatic enzyme insufficiency. Conditions or diseases that may cause a decrease in or absence of pancreatic digestive enzymes include cystic fibrosis, chronic pancreatitis, cancer of the pancreas,... 

Studies of both acute and chronic pancreatitis in humans and in animals support the hypothesis that free radicals are involved in the pathogenesis of pancreatitis. There is some conflicting data from the animal work, which may in part be due to differences in the models used. It does also indicate that free radicals are not the only factors involved and su ests that activation of pancreatic enzymes are also imprortant, particularly in the development of haemorrhagic pancreatitis (Sanfey, 1991). The findings of decreased antioxidant defences and the success of treatment reported in chronic pancreatitis with a cocktail of antioxidants and with allopurinol surest further studies are required to establish the role of antioxidants in pancreatic disease and its prevention. 

Choose appropriate pancreatic enzyme supplementation for patients with chronic pancreatitis. 

Treatment of chronic pancreatitis is aimed at removing the cause (ethanol abuse or biliary stones), providing analgesia, supplementing with pancreatic enzyme preparations, and implementing dietary restrictions. 

Ethanol abuse may cause precipitation of pancreatic enzymes in the ducts of the pancreas leading to chronic inflammation and damage. Ethanol itself may be directly toxic to the pancreatic cells. Gallstones may obstruct the ampulla of Vater causing pancreatic enzymes or bile to move in a retrograde fashion into the pancreas.1... 

The goals of pharmacotherapy for chronic pancreatitis are (1) prevention and resolution of chronic abdominal pain and (2) correction of dietary malabsorption with exogenous pancreatic enzymes. 

Supplementation with pancreatic enzymes may reduce the pain and fatty diarrhea associated with chronic pancreatitis (Table 20-3). Best results are achieved in patients who have mild non-alcoholic pancreatic disease. Common pancreatic enzyme supplements contain lipase, amylase, and protease in varying proportions. Thus, the dose can be tailored to the patient s requirement for exogenous enzyme supplementation and response to therapy. 

Pancreatic enzyme replacement or supplement when enzymes are absent or deficient, such as with chronic pancreatitis, cystic fibrosis, or ductal obstruction from cancer of the pancreas or common bile duct to reduce malabsorption treatment of steatorrhea associated with bowel resection or postgastrectomy syndrome PO 1-3 capsules ortablets before or with meals or snacks. May increase to 8 tablets/dose. 

Steatorrhea occurs in patients whose lipase output is at 10% or less of normal. Lipase and other pancreatic enzyme insufficiencies are observed in cystic fibrosis and chronic alcoholic pancreatitis. Patients with various liver diseases may also present with steatorrhea [18]. For these patients, pancreatic enzymes—mainly lipase, protease, and amylase—extracted with alcohol from porcine pancreases have been shown to provide amelioration of diarrhea. These enzymes are enriched and formulated in... 

Exocrine pancreatic insufficiency is most commonly caused by cystic fibrosis, chronic pancreatitis, or pancreatic resection. When secretion of pancreatic enzymes falls below 10% of normal, fat and protein digestion is impaired and can lead to steatorrhea, azotorrhea, vitamin malabsorption, and weight loss. Pancreatic enzyme supplements, which contain a mixture of amylase, lipase, and proteases, are the mainstay of treatment for pancreatic enzyme insufficiency. Two major types of preparations in use are pancreatin and pancrelipase. Pancreatin is an alcohol-derived extract of hog pancreas with relatively low concentrations of lipase and proteolytic enzymes, whereas pancrelipase is an enriched preparation. On a per-weight basis, pancrelipase has approximately 12 times the lipolytic activity and more than 4 times the proteolytic activity of pancreatin. Consequently, pancreatin is no longer in common clinical use. Only pancrelipase is discussed here. 

Patients most often requiring provision of digestive enzymes include (hose with chronic pancreatitis, mostly secondary to alcoholism, children and adults with cystic fibrosis, and patients with pancreatic carcinomas (fig. 12). In addition to these conditions, pancreatic enzymes are sometimes used because of their analgesic effect for chronic pancreatitis [65]. 

Due. Treatment of pain in chronic pancreatitis with pancreatic enzymes. Am-... 

Small quantities of pancreatic enzymes are released from the pancreas into the bloodstream even physiologically and are detectable as low serum activities and/or concentrations of lipase, amylase, trypsinogen, and chymotrypsino-gen, respectively. Since progressive destruction of the organ occurs in chronic pancreatitis, this should theoretically be reflected by decreased serum enzymes, but so far these tests are not clinically useful because of their low accuracy. 

Enzyme replacement therapy (ERT) is a therapeutic approach in which the specific enzyme that is absent or inactive in affected individuals is replaced with a functional enzyme molecule. Pancreatic enzyme preparations of porcine or bovine origin have been available in the United States for treatment of exocrine pancreatic insufficiency (EPI) in children and adults with cystic fibrosis and chronic pancreatitis since before the enactment of the Federal Food, Drug and Cosmetic Act of 1938 (ref FDA guidance on EIP April 2004). A... 

The major application of the assays that measure CHY activity in stool is in the investigation of chronic pancreatic insufficiency. CHY in feces is often reduced below the lower reference limit in such subjects in whom steatorrhea has developed, but it is not usefid in identifying subjects with early pancreatic insufficiency. (See Table 48-15.) CHY measurement in patients with chronic pancreatic insufficiency treated with oral pancreatic enzyme supplements may indicate whether the therapy is adequate or whether increased supplementation is necessary. 

The treatment of uncomplicated CP is aimed primarily at the control of chronic abdominal pain (see Fig. 39-4) and the correction of malabsorption with pancreatic enzymes (Fig. 39-5). Diabetes associated with CP may require exogenous insulin. 

Brown A, Hughes M, Tenner S, et al. Does pancreatic enzyme supplementation reduce pain in patients with chronic pancreatitis A meta-analysis. Am J Gastroenterol 1997 92 2032-2035. 

I. Ihse. Treatment of pain in chronic pancreatitis with pancreatic enzymes. Pancreatic Enzymes in Health and Diseases (P. Lankisch, ed.). Springer, Berlin, 1991, pp. 89-94. 

Inadequate digestion, which is seen in chronic pancreatitis as a consequence of insufficient pancreatic enzyme release. 

Pain is the other cardinal symptom of chronic pancreatitis. The rationale for its treatment with pancreatic enzymes is based on the principle of negative feedback inhibition of the pancreas by the presence of duodenal proteases. The release of cholecystokinin (CCK), the principal secreta-gogue for pancreatic enzymes, is triggered by CCK-releas-ing monitor peptide in the duodenum, which normally is denatured by pancreatic trypsin. In chronic pancreatitis, trypsin insufficiency leads to persistent activation of this peptide and an increased release of CCK, which is thought to cause pancreatic pain because of continuous stimulation of pancreatic enzyme output and increased intraductal pressure. Delivery of active proteases to the duodenum (which can be done reliably only with uncoated preparations) therefore is important for the interruption of this loop. Although enzymatic therapy has become firmly entrenched for the treatment of painful pancreatitis, the evidence supporting this practice is equivocal at best. 

PANCREATIC ENZYMES Chronic pancreatitis is a debilitating syndrome that results in symptoms from loss of glandular function (exocrine and endocrine) and inflammation (pain). The goals of pharmacologic therapy are prevention of malabsorption and palliation of pain. The cornerstone of therapy for malabsorption is the use of pancreatic enzymes. 

Pain is the other cardinal symptom of chronic pancreatitis. The rationale for its treatment with pancreatic enzymes is based on the principle of negative feedback inhibition of the pancreas by the presence of duodenal proteases. The evidence supporting this practice is equivocal at best. 

The client with chronic pancreatitis is prescribed the pancreatic enzyme Pancrease. Which data indicate that the dosage should be increased ... 

An increase in midepigastric pain is a symptom of peptic ulcer disease or gastrointestinal reflux disease and does not indicate the effectiveness of the pancreatic enzyme. The client with chronic pancre-... 

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