In a double-blind study on 19 patients with the diagnosis of chronic pancreatitis, the effects of treatment with a granulated pancreatic enzyme preparation (Pankreon) were compared with those of placebo administration. One week of treatment with each preparation was preceded by one week without any medication. The patients kept daily records of their symptoms, plotting the severity of pain on an analog scale. Weekly assessments of the mean pain level were also made by an examiner questioning the patients. Recordings of body weights and pancreas and liver laboratory tests were done weekly. Fifteen of 19 patients noted less pain during the week of treatment with pancreatic enzymes as compared to that of placebo treatment (P less than 0.05). The average reduction of pain, as calculated for all patients, was 30% as evaluated by both patients (P less than 0.01) and the examiner (P less than 0.05). No differences were found in other parameters examined. A possible explanation of the findings could be an effect on the intraductal pressure by intraluminal trypsin.

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Trypsin, amylase, lipase and phospholipase activities were assayed in buffer solutions and in human duodenal juice after incubation with different types of dietary fiber. In buffer solutions, trypsin activity was slightly reduced and amylase activity heavily reduced by pectin of low methylic esterification (LM pectin). Lipase activity was markedly reduced by LM pectin and also moderately reduced by pectin of high methylic esterification (HM pectin). Phospholipase was hardly influenced at all by fiber. Activities of pancreatic enzymes in human duodenal juice were examined after in vitro incubation with pectins, guar gum, wheat bran and ispaghula. Ispaghula did not affect the enzymes except for lipase activity, which was moderately inhibited. The other fiber preparations examined reduced amylase activity by 35–100% at fiber concentrations of up to 1.5 g%, lipase by 40–95% and trypsin by 40–85%. LM pectin had the strongest inhibitory effect among the different fiber preparations studied. Phospholipase activity was only influenced by the pectins, which caused a 75 % reduction. It is concluded that dietary fiber of different kinds has the capacity to inhibit pancreatic enzyme activities. This inhibitory effect is dependent on the type of fiber and differently affects the different enzymes. Further, the inhibition seems to be more pronounced when exerted in human duodenal juice than in conventional buffer systems.

In totally pancreatectomized patients breath 14CO2 excretion after ingestion of 14C-labeled triolein was significantly increased by a granulated pancreatic enzyme preparation and was reduced when pectin was added to the enzyme supplement. In the same patients pectin reduced trypsin, lipase, and amylase activities of jejunal aspirates after a test meal supplemented with pancreatic enzyme substitution, which was shown to give good enzyme activities in the intestine. In patients with chronic pancreatitis, breath 14CO2 excretion was reduced by wheat bran, which also caused a reduction in lipase and amylase activities of duodenal aspirates after a test meal. The findings demonstrate the efficiency of treatment with a granulated pancreatic enzyme preparation in restoring intraluminal enzyme activities and fat absorption in patients with pancreatic insufficiency. They also show that pectin and wheat bran may induce fat malabsorption and inhibit digestive enzyme activities in vivo.