New Methods for Assessment of Enzyme Activity: Do They Help to Optimize Enzyme Treatment?

Abstract

Several factors related to the patient and the pancreatin formulation influence the efficacy of enzyme supplementation. Up to now, only few tests exist to judge the efficacy of enzyme replacement therapy in pancreatic insufficiency. Tube tests and fecal fat excretion studies are cumbersome, time-consuming and unpleasant. Recently, several breath tests for the detection of pancreatic insufficiency have been developed. The cholesteryl octanoate breath test differentiated between healthy controls and patients with pancreatic insufficiency already after a 30-min collection period. Using this test, it was demonstrated that a pancreatin preparation containing small microspheres (1.0-1.2 mm) induces high duodenal lipolytic activity parallel to gastric emptying of food. In contrast, the gastric emptying of large microspheres (1.8-2.0 mm) is significantly delayed. The cholesteryl octanoate breath test detects pancreatic insufficiency within 30-60 min and offers the possibility of monitoring the in vivo release of pancreatin preparations.

Effect of ingestion order of the fat component of a solid meal on intragastric fat distribution and gastric emptying assessed by MRI

“…For example, in patients with chronic exocrine pancreatic insufficiency, fat empties faster than in healthy subjects (8, 27), and floating of fat is more pronounced in healthy subjects than in these patients (10). Knowledge about the intragastric distribution of fat and how fat empties into the small intestine relative to the aqueous or solid phases of a meal may, thus, provide important insights for the design and effectiveness of orally administered drugs, such as digestive enzymes (28, 29). For example, the efficacy of lipase in cystic fibrosis depends on the simultaneous presence with fat in the small intestinal lumen (28, 29).…”

“…Knowledge about the intragastric distribution of fat and how fat empties into the small intestine relative to the aqueous or solid phases of a meal may, thus, provide important insights for the design and effectiveness of orally administered drugs, such as digestive enzymes (28, 29). For example, the efficacy of lipase in cystic fibrosis depends on the simultaneous presence with fat in the small intestinal lumen (28, 29). Our findings may also be of relevance in other conditions.…”

Pancreatic exocrine insufficiency in diabetes mellitus

“…Минимикросферы -препарат выбора для ЗФТ ввиду минимального размера частиц, обеспечивающих наиболее физиологичный процесс пищеварения. Применение более крупных частиц панкреатина ассоциировано с более низкой эффективностью ЗФТ [55]. Высокие профили эффективности и безопасности минимикросфер панкреатина подтверждены множественными клиническими исследованиями [14,17,[37][38][39][40][41].…”

Functional Changes after Pancreatoduodenectomy: Diagnosis and Treatment

“…In several studies [47,48,49,50,51,52] the enteric-coated (mini-)microspheres are generally the preferred pharmacological formulation of pancreatic enzymes. The coating with a pH sensitive polyacryl acid layer, which only dissolves at a pH level >5.5, maintains the enzyme integrity in the stomach and therefore improves the efficacy of the enzyme supplements.…”