Appropriate pancreatic function tests and indication for pancreatic enzyme therapy following surgical procedures on the pancreas

Lankisch, P. G.

doi:10.1159/000055888

Cited by 11 publications

(9 citation statements)

References 78 publications

(66 reference statements)

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“…Such factors as decreased postprandial stimulation of pancreatic secretion due to the disruption of neural reflexes; reduced cholecystokinin release; primarily decreased pancreatic secretion; arrival of big, hard-todigest nutrient particles in the jejunal lumen due to pylorus resection; and postprandial asynchrony between gastric emptying of nutrients and biliopancreatic secretion have been implicated [10,20••,44-46]. Despite the relevance of pancreatic exocrine insufficiency in the nutritional status of patients who have undergone surgery, the number of studies evaluating the usefulness of pancreatic enzyme substitution therapy in this setting is limited, and data regarding the best preparation to be used are scarce [46]. Uncoated powder preparations may be preferred in cases of low gastric acidity and partial or total gastric resection.…”

Section: Pancreatic Exocrine Insufficiency After Surgerymentioning

confidence: 99%

Pancreatic enzyme therapy for pancreatic exocrine insufficiency

Domínguez‐Muñoz

2007

Curr Gastroenterol Rep

138

106

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Pancreatic exocrine insufficiency with steatorrhea is a major consequence of pancreatic diseases (eg, chronic pancreatitis, cystic fibrosis, severe acute necrotizing pancreatitis, pancreatic cancer), extrapancreatic diseases such as celiac disease and Crohn's disease, and gastrointestinal and pancreatic surgical resection. Recognition of this entity is highly relevant to avoid malnutrition-related morbidity and mortality. Therapy for pancreatic exocrine insufficiency is based on the oral administration of pancreatic enzymes aiming at providing the duodenal lumen with sufficient active lipase at the time of gastric emptying of nutrients. Administration of enzymes in the form of enteric-coated minimicrospheres avoids acid-mediated lipase inactivation and ensures gastric emptying of enzymes in parallel with nutrients. Nevertheless, such factors as acidic intestinal pH and bacterial overgrowth may prevent normalization of fat digestion even in compliant patients. The present article critically reviews current therapeutic approaches to pancreatic exocrine insufficiency.

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Section: Pancreatic Exocrine Insufficiency After Surgerymentioning

confidence: 99%

Pancreatic enzyme therapy for pancreatic exocrine insufficiency

Domínguez‐Muñoz

2007

Curr Gastroenterol Rep

138

106

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“…Despite the relevance of EPI in assessing the nutritional status of patients who have had surgery, the number of studies evaluating the usefulness of PERT in this setting is limited and data regarding the best preparation to be used are scarce. 15 Uncoated powder preparations may be preferred in cases of low gastric acidity and partial or total gastric resection, although entericcoated enzyme microspheres have been shown to be associated with a higher body weight gain compared with uncoated preparations in patients after duodenopancreatectomy. 16 In fact, body weight after surgery increases very slowly when uncoated enzymes are used, whereas a much more relevant increase in body weight is obtained by the oral administration of enteric-coated preparations in the form of microspheres (Fig.…”

Section: Therapymentioning

confidence: 99%

Pancreatic enzyme replacement therapy: exocrine pancreatic insufficiency after gastrointestinal surgery

Domínguez‐Muñoz

2009

HPB

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Exocrine pancreatic insufficiency (EPI) and resultant maldigestion occurs in up to 80% of patients following gastric, duodenal or pancreatic surgery. Accurate diagnosis is required to determine the appropriate intervention, but the conventional method of faecal fat quantification is time-consuming and not always readily available. The optimized (13)C-mixed triglyceride ((13)C-MTG) breath test is an accurate alternative post-surgery. Pancreatic enzyme replacement therapy (PERT) is indicated post-surgery in patients with clinically evident steatorrhoea, weight loss or maldigestion-related symptoms. Given its favourable safety profile, PERT is also appropriate in asymptomatic patients with high faecal fat excretion as such patients are at high risk for nutritional deficits. However, published data evaluating PERT in this setting are limited. Uncoated powder preparations may be preferred in cases of low gastric acidity and partial or total gastric resection. In clinical studies, enteric-coated microspheres were associated with greater weight gain after surgery vs. uncoated preparations. This was confirmed in a recent study using the (13)C-MTG breath test; fat absorption increased from <40% without therapy to almost 60% with enteric-coated minimicrospheres (40 000 lipase units/meal), with >60% of patients achieving normal breath test results (i.e. normal fat digestion) during PERT. A therapeutic algorithm for the treatment of EPI after surgery is also discussed.

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“…56 Recommendations for postoperative enzyme substitution are difficult because the number of studies demonstrating its usefulness after gastrointestinal procedures in general and after pancreatic surgery is limited. 57 Patients need enzyme replacement therapy after pancreatectomy. 55 Enzyme replacement therapy is also necessary in most patients with partial pancreatic resection and preexistent pancreatic disease.…”

Section: Dosing In Special Patient Populationsmentioning

confidence: 99%

“…Those individuals having a drainage operation or distal resection may benefit from enteric-coated microspheres. 57 Patients with a total pancreatectomy should be prescribed conventional enteric-coated enzyme preparations as granules. This formulation will also benefit patients having a duodenumpreserving resection of the head of the pancreas when a histamine 2 (H 2 )-receptor antagonist or proton pump inhibitor is added.…”

Section: Dosing In Special Patient Populationsmentioning

confidence: 99%

“…Patients undergoing a Whipple procedure should be given enteric-coated microspheres in addition to a drug prescribed to reduce intestinal transit time. 57 In patients with a gastrostomy or jejunalplaced feeding tubes, the administration of pancreatic enzymes presents a challenge. The goal of dosing enzymes during enteral feeding administration is to expose all the formula to the pancreatic enzymes.…”

Section: Dosing In Special Patient Populationsmentioning

confidence: 99%

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Pancreatic Enzyme Pharmacotherapy

2007

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Supplemental pancreatic enzyme preparations are provided to patients with conditions of pancreatic exocrine deficiency such as chronic pancreatitis and cystic fibrosis. These patients frequently experience steatorrhea, which occurs from inadequate fat absorption. The delivery of sufficient enzyme concentrations into the duodenal lumen simultaneously with meals can reduce nutrient malabsorption, improve the symptoms of steatorrhea, and in some cases alleviate the pain associated with chronic pancreatitis. Current clinical practices dictate administration of lipase 25,000-40,000 units/meal by using pH-sensitive pancrelipase microspheres, along with dosage increases, compliance checks, and differential diagnosis in cases of treatment failure. Despite the large number of specialty enzyme replacements available commercially, many patients remain dissatisfied with standard therapy, and future developments are needed to optimize treatment in these individuals.

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Appropriate pancreatic function tests and indication for pancreatic enzyme therapy following surgical procedures on the pancreas

Cited by 11 publications

References 78 publications

Pancreatic enzyme therapy for pancreatic exocrine insufficiency

Pancreatic enzyme therapy for pancreatic exocrine insufficiency

Pancreatic enzyme replacement therapy: exocrine pancreatic insufficiency after gastrointestinal surgery

Pancreatic Enzyme Pharmacotherapy

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