Steatorrhea Cystic fibrosis

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. 

Abnormalities in protein digestion In individuals with a deficiency in pancreatic secretion (for example, due to chronic pancreatitis, cystic fibrosis, or surgical removal of the pancreas), the digestion and absorption of fat and protein is incomplete. This results in the abnormal appearance of lipids (called steatorrhea, see p. 175) and undigested protein in the feces. 

B. Lactose and sucrose are digested by disaccharidases on the brush border of intestinal epithelial cells. Starch is digested by salivary and pancreatic amylase. Therefore, its digestion would be less affected by a lack of pancreatic juice than fat, which is digested mainly by pan-creatic lipase. A common finding in cystic fibrosis is steatorrhea (fatty stools). 

Figure 48-8 Fecal excretion (mean and SD) of chymotrypsin, fat, and immunoreactive elastase during a 24-hour collection period in 12 patients with cystic fibrosis and steatorrhea with and without enzyme replacement therapy. (From Stein JJung M, Sziegoleit A, Zeuzem S, Caspary WF, Lembcke B. immunoreactive elastase / c//njco/ eva/uat/on of a new non-invasive test of pancreatic function, din Cbem 1996 42 222 6.)...

Ion exchange resins (colestipol,colestyramine), which complex with the brie salts and can interfere with the absorption of the oil-soluble vitamins Aluminum antacids can complex with some of the vitamins and, when used chronically, most definitely can cause hypophosphatemia Cystic fibrosis, which can cause fat malabsorption (steatorrhea) attributed to inadequate production of pancreatic lipases... 

P. A. and Laster, L. (1974) Steatorrhea and azotorrhea and their relation to growth and nutrition in adolescents and young adults with cystic fibrosis. J. Pediatr. 84, 328-334. 

M. Brady, K. Rickard, P. Yu, and H. Eigen. Effectiveness of enteric coated pancreatic enzymes given before meals in reducing steatorrhea in children with cystic fibrosis. J. Am. Diet. Assoc. 92 813 (1992). 

Corn seed-derived dog gastric lipase is under development by Meristem Therapeutics for the treatment of gastric lipase deficiency (steatorrhea), neonatal deficient pancreatic function, or when pancreatic function is compromised by diseases such as cystic fibrosis or chronic alcoholism [159]. The absence of gastric lipase in steatorrhea patients prevents the digestion of food lipids. Pre-term infants have difficulty digesting lipids and, unless they are breast-fed, have no access to this enzyme. 

Pancreatin, a pancreatic enzyme, is indicated in exocrine pancreatic secretion insufficiency, as a digestive aid in cystic fibrosis, steatorrhea, and for other disorders of fat metabolism secondary to insufficient pancreatic enzymes. 

Two diseases causing steatorrhea deserve further attention cystic fibrosis and sprue. Cystic fibrosis is a hereditary dysfunction of the mucous and serous exocrine glands (lung, pancreas, salivary gland, sweat glands, etc.) and is sometimes associated with cirrhosis of the liver. The disease has been described mainly in whites, rarely in Negroes. Cystic fibrosis is probably transmitted by an autosomal recessive mammalian gene. 

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