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

Krishnamurty, Devi Mukkai; Rabiee, Atoosa; Andersen, Dana K.

doi:10.2147/tcrm.s3196

Cited by 13 publications

(19 citation statements)

References 115 publications

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“…A comprehensive table of these medications has been summarized in other reviews. 3 , 76 A major focus of regulation of these products has been on the active enzyme content and accuracy of packaging. While instability of the enzymes results in delivery medications that contain less than the packaged amount of enzyme, the practice of “overfilling” in an effort to address enzyme degradation may result in excess enzyme content, resulting in formulations that deliver inadequate or excess amounts of enzyme.…”

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

“…However, is not recommended to exceed 10,000 IU of lipase per kg of body weight per meal. 3 , 5 , 71 , 76 Pediatric dosing is detailed in the products’ respective package inserts. Ultimately 50,000, 100,000 and 150,000 IU of lipase per day will decrease steatorrhea by 45%, 60%, and 70%, respectively.…”

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

“… 135 Folic acid deficiency has been associated with use of pancreatin extracts which may form insoluble complexes with folate. 76 Irritation of the oral mucosa may be avoided by not chewing the medications, or mixing them in foods with a pH > 4.5 (package inserts). A theoretical risk exists of xenotic viral infections, although such cases have not been reported.…”

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

“…Some studies suggest that the acid-resistant coating of enzyme preparations may be responsible for the fibrosing colonopathy, as it has also been demonstrated with other medications that use the same methacrylic copolymer coating. 76 , 139 – 143 In addition, as these cases largely occurred with high-dose enzyme therapy (>50,000 IU/kg daily), limits are suggested for maximum dosage and delivery. Caution should be used when doses exceed 2500 IU/kg per meal.…”

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

“… 147 Finally, if all the above steps fail, diagnostic evaluation for other etiologies for continued steatorrhea is warranted, including small intestinal bacterial overgrowth, giardiasis, blind loop syndrome, and other absorptive problems. 37 , 71 , 76 …”

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

See 4 more Smart Citations

Enzyme replacement therapy for pancreatic insufficiency: present and future

Fieker¹,

Philpott²,

Armand³

2011

CEG

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Pancreatic enzyme replacement therapy is currently the mainstay of treatment for nutrient malabsorption secondary to pancreatic insufficiency. This treatment is safe and has few side effects. Data demonstrate efficacy in reducing steatorrhea and fat malabsorption. Effective therapy has been limited by the ability to replicate the physiologic process of enzyme delivery to the appropriate site, in general the duodenum, at the appropriate time. The challenges include enzyme destruction in the stomach, lack of adequate mixing with the chyme in the duodenum, and failing to deliver and activate at the appropriate time. Treatment is begun when clinically significant malabsorption occurs resulting in steatorrhea and weight loss. Treatment failure is addressed in a sequential fashion. Current research is aimed at studying new enzymes and delivery systems to improve the efficiency of action in the duodenum along with developing better means to monitor therapy.

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Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

See 3 more Smart Citations

Enzyme replacement therapy for pancreatic insufficiency: present and future

Fieker¹,

Philpott²,

Armand³

2011

CEG

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Exocrine pancreatic insufficiency and pancreatic exocrine replacement therapy in clinical practice

Berry,

Bilbo

2024

Nut in Clin Prac

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Exocrine pancreatic insufficiency (EPI) is a complex condition that disrupts normal digestion and absorption. Patients with EPI may suffer from mild to debilitating malabsorption with a constellation of symptoms that can have a significant effect on quality of life and nutrition status. Pancreatic enzyme replacement therapy (PERT) is effective and safe to treat EPI and is the standard of care for this condition. A wide variety and various forms of these products exist, as well as numerous guidelines and recommendations. Obtaining PERT for patients can oftentimes be cost prohibitive. Determining the presence and extent of EPI can be challenging and patient specific, making it difficult for practitioners. This narrative review will explore these issues, as well as several disease states potentially affected by EPI, and review current management strategies.

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Review article: enzyme supplementation in cystic fibrosis, chronic pancreatitis, pancreatic and periampullary cancer

Imrie

Connett²,

Hall

et al. 2010

Aliment Pharmacol Ther

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ConclusionsPancreatic exocrine insufficiency may result in malnutrition, but enzyme supplementation can greatly improve quality of life in these patients. Introduction: raising awareness of pancreatic exocrine insufficiency -does your patient need enzyme supplementation?Guest Editor: C. W. ImrieLister Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK. INTRODUCTIONThe pancreas has very important endocrine and exocrine components. The endocrine pancreas secretes many hormones including insulin, glucagon and somatostatin into the blood, while the exocrine pancreas secretes digestive enzymes including lipase, elastase, amylase, trypsin and chymotrypsin into the duodenum via its duct system. Loss of exocrine function is usually manifest by poor fat absorption before carbohydrate and protein malabsorption occurs. As vitamins A, D, E and K are fat soluble, these are also badly absorbed.There are a number of genetic, molecular and clinical factors which can impair pancreatic function. The major causes include hereditary pancreatitis, severe acute pancreatitis (AP), cystic fibrosis (CF), chronic pancreatitis (CP) as well as pancreatic and ampullary tumours. When exocrine pancreatic secretion is impaired, the regular intake of exogenous enzyme supplementation is important for supportive or palliative care, but is often overlooked, or the degree of replacement therapy inadequate. WHAT IS PANCREATIC EXOCRINE INSUFFICIENCY VS. NORMAL PANCREATIC EXOCRINE RESPONSE?Pancreatic exocrine response For a short period following a meal, pancreatic enzymes are secreted into the duodenum at a level three-to sixfold above interdigestive levels. This is followed by a three-to fourfold sustained increase in enzyme output (for at least 2 h) before secretory rates return to within the interdigestive range (Table 1). 1The caloric content, nutrient composition and physical properties of a meal determine the degree and duration of the digestive enzyme response, with meals containing 500 kcal being sufficient to induce a maximal response. Lipids are the strongest stimulants of pancreatic enzyme secretion and diets high in fat content are associated with higher enzyme output than diets rich in carbohydrates or proteins. Stimulation of enzyme output occurs following the release of cholecystokinin in response to duodenal free fatty acids. Enzyme response to a solid meal is more sustained than that to an identical meal that has been homogenized, partly because gastric emptying of a solid meal is slower leading to prolonged stimulation of enzyme output. Higher levels of pancreatic secretory response may also occur in response to a solid meal. 1Pancreatic exocrine insufficiency Pancreatic exocrine insufficiency is characterized by a deficiency in, or absence of the three major groups of pancreatic enzymes: amylase, proteases and lipases, which digest starches, proteins and fats respectively. These deficiencies prevent normal breakdown and digestion of food leading to nutrient malabsorption. The accompanying decrease in duodenal bicarbonate d...

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

Cited by 13 publications

References 115 publications

Enzyme replacement therapy for pancreatic insufficiency: present and future

Enzyme replacement therapy for pancreatic insufficiency: present and future

Exocrine pancreatic insufficiency and pancreatic exocrine replacement therapy in clinical practice

Review article: enzyme supplementation in cystic fibrosis, chronic pancreatitis, pancreatic and periampullary cancer

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