Digestive Enzymes

In pancreatic exocrine insufficiency, the aim of therapy is to prevent weight loss and diarrhoea and, in children, to maintain adequate growth. The problem of getting enough enzyme to the duodenum concurrently with food is not as simple as it might appear. Gastric emptying varies with the composition of meals, e.g. high fat, calories or protein cause delay, and the pancreatic enzymes taken by mouth are destroyed by gastric acid. On the other hand, only one-tenth of the normal pancreatic output is sufficient to prevent steatorrhoea. Acid suppression by proton pump inhibitors improves the efficacy of pancreatic enzyme supplements.

Preparations are of animal origin and variable potency. Pancreatin, as Cotazym and Nutrizym, appears to be satisfactory. A reasonable course is to start the patient on the recommended dose of a reliable formulation and to vary this according to the individual's needs, and the size and composition of meals. Enteric-coated formulations (pancreatin granules, tablets) are available. High-potency pancreatic enzymes should not be used in patients with cystic fibrosis as they may cause ileocaecal and large bowel strictures.

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