Fate of orally ingested enzymes in pancreatic insufficiency: comparison of two pancreatic enzyme preparations

Abstract

The effect on steatorrhoea of a pH-sensitive enteric-coated pancreatic preparation (Eurobiol 25 000) was compared with a conventional pancreatic enzyme preparation (Eurobiol) in six adult patients with exocrine pancreatic insufficiency. In addition, the fate of orally ingested pancreatic enzymes in the upper digestive tract was evaluated by measuring gastric and duodenal pH, amount of enzymes in the stomach, duodenal enzyme output, and fat absorption at the angle of Treitz for the 4 hours following a standard meal. When compared with placebo, Eurobiol and Eurobiol25 000 reduced daily faecal fat excretion by 24 % (not significant) and 43 % ( P < 0.05), respectively. With the conventional preparation, enzyme output and fat absorption at the duodeno-jejunal flexure were significantly improved ( P < 0.05). Marked inter-individual differences in duodenal enzyme recovery (lipase 3 % to 80%; chymotrypsin 26% to 100%) and, consequently, in the reduction of steatorrhoea (0% to 67%) were observed, with the gastric emptying rate emerging as a key determinant factor. With the enteric-coated

Pancreatic enzyme therapy for pancreatic exocrine insufficiency

“…In studies including a very small number of patients (ranging from 6 to 8) with pancreatic exocrine insufficiency due to both chronic pancreatitis and cystic fibrosis, uncoated pancreatin preparations have been shown to reduce steatorrhea significantly, but fat digestion and absorption remain far from normal in most patients [25][26][27][28]. Enteric-coated preparations, by protecting lipase from acid inactivation, appear to be superior to uncoated standard preparations in improving fat digestion in most studies [26][27][28] but not in others [25].…”

In vitro comparative study of three pancreatic enzyme preparations: dissolution profiles, active enzyme release and acid stability

“…A comparison of Eurobiol and Creon enzyme release in vivo has not been performed or reported so far, but the pH-sensitive enteric-coated Eurobiol 25000 was, however, compared with a conventional pancreatic enzyme preparation (similar to Eurobiol 12500) in adult patients with exocrine pancreatic insufficiency. 43 Whereas the enteric-coated formulation was more efficient in reducing daily fat excretion ()43% for Eurobiol 25000 vs. )24% for noncoated Eurobiol), the enzyme output and fat adsorption at the duodeno-jejunal junction were significantly higher with the conventional enzyme preparation vs. the enteric-coated one. Similar data were obtained by other groups.…”

“…From these findings, it was proposed that the efficacy of enteric-coated pancreatin drug products could be enhanced by adding unprotected enzymes, especially in patients with rapid gastric emptying. 43 These observations also provide a basis to explain the higher efficacy of enteric-coated pancreatin drug products in the presence of proton pump inhibitors (PPI): by increasing the duodenal pH, PPI might induce a faster release of pancreatic enzyme in the small intestine.…”

S3-Leitlinie Chronische Pankreatitis: Definition, Ätiologie, Diagnostik, konservative, interventionell endoskopische und operative Therapie der chronischen Pankreatitis. Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS)

“…Solch niedrige Werte liegen intragastral während der überwiegenden Zeit der postprandialen Periode und bei exokriner Insuffizienz auch intraduodenal vor, wegen der eingeschränkten Bikarbonatsekretion [86]. Ohne begleitende Säuresuppression senken Präparate mit Säureschutz die Stuhlfettausscheidung stärker als solche ohne [352]. [353].…”