Comparative Study of Varying Regimens to Improve Steatorrhoea and Creatorrhoea in Cystic Fibrosis: Effectiveness of an Enteric-Coated Preparation With and Without Antacids and Cimetidine

Gow, Robert M.; Francis, P.; Bradbear, RA; Shepherd, Ross W.

doi:10.1016/s0140-6736(81)91276-9

Cited by 89 publications

(27 citation statements)

References 12 publications

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“…102 Treatments have included cimetidine, both with conventional enzymes 96,99,100 and with enteric-coated, acid-resistant microspheres. 98 Ranitidine 4 mg/kg/day in two divided doses, maximum 300 mg b.d., 103 omeprazole 20 mg daily in adults and 0.7-1.4 mg/kg/day in children, 104,105 and lansoprazole 15 mg daily will improve absorption in many patients whose absorption is poorly controlled on 10,000 IU lipase per kg doses of enzymes. 106 Finally, taurine-conjugated bile acids are in relatively short supply due to the gastrointestinal losses that occur in CF and the relatively greater compensatory production of glycine-conjugated bile acids.…”

Section: Failure To Control Gastrointestinal Symptomsmentioning

confidence: 99%

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Littlewood

Wolfe

Conway

2005

Pediatric Pulmonology

102

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Summary. Intestinal malabsorption is severe and of early onset in virtually all people who have cystic fibrosis. The main cause is deficiency of pancreatic enzymes. Bicarbonate deficiency, abnormal bile salts, mucosal transport problems, motility differences, and anatomical structural changes are other contributory factors. Effective treatment should allow a normal to high-fat diet to be taken, control symptoms, correct malabsorption, and achieve a normal nutritional state and growth. Appropriate pancreatic enzyme replacement therapy will achieve normal or near-normal absorption in most people with cystic fibrosis. Early identification and treatment of intestinal malabsorption is critical to achieving optimal nutritional status. The occurrence of fibrosing colonopathy in a few patients on very high doses of those enzymes which have the copolymer Eudragit L30 D55 in their covering resulted in guidelines in the UK to avoid doses equivalent to more than 10,000 IU lipase per kg per day, and also to avoid preparations containing this copolymer in children and adolescents. For patients not responding to 10,000 IU lipase per kg per day review of adherence to treatment, change of enzyme preparation, variation in time of administration, and reduction in gastric acid may improve absorption. The importance of early investigation to exclude other gastrointestinal disorders as a cause of the patient's symptoms, rather than merely increasing the dose of enzymes, is stressed. With modern pancreatic enzymes in doses up to or only slightly in excess of 10,000 IU lipase per kg per day, adequate control of gastrointestinal symptoms and absorption can be achieved, and a normal nutritional state and growth rate maintained in most people with cystic fibrosis.

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Section: Failure To Control Gastrointestinal Symptomsmentioning

confidence: 99%

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Littlewood

Wolfe

Conway

2005

Pediatric Pulmonology

102

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“…59-62] or to have no effect [55,63] when added to conventional enzyme preparations. It has also been shown to abolish steatorrhea when given together with a microencapsulated compound [64]. An analysis of these studies revealed that the effect of cimetidine primarily depended on the amount of lipase given orally [13], Furthermore, the level of gastric secretion, which may be linked to the age of the patient and to the activity of chronic pancreatitis, also affects the results of adjuvant therapy with cimetidine.…”

Section: Lankischmentioning

confidence: 99%

Enzyme Treatment of Exocrine Pancreatic Insufficiency in Chronic Pancreatitis

Lankisch

1993

Digestion

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Exocrine pancreatic insufficiency combined with pancreatic pain and endocrine pancreatic insufficiency are the leading symptoms of chronic pancreatitis. Due to the large functional reserve capacity of the gland, decompensation, i.e. steatorrhea, does not occur before lipase excretion is reduced to ≤10% of normal. Pancreatic enzyme substitution is indicated when fecal fat excretion exceeds a critical value (normally > 15 g/day) and/or when weight loss is present. A number of studies have dealt with the problems of gastric acid inactivation of pancreatic enzyme preparations as well as their gastric emptying nonsimultaneously with the food. For the present, it is recommended that pancreatic enzyme substitution in patients with proven exocrine pancreatic insufficiency and normal gastric acid secretion be given in multiunit, acid-protected dosages. In patients with gastric hyposecretion and in those who underwent partial or total gastrectomy, enzyme substitution should be administered as granules to enable mixing and simultaneous transport of enzymes with the chyme. The ultimate aim of further scientific and clinical research remains the total abolishment of pancreatic steatorrhea.

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“…Cimetidine supple mentation was reported to abolish steatorrhoca [13], to decrease it [13,[48][49][50][51] or to have no effect [44,52] when it was added to conventional enzyme replacement, and to abolish steatorrhoea when given together with a microencapsulated preparation [53]. Further analysis of these studies showed that the effect of cimetidine strongly de pended on the amount of lipase given orally [54].…”

Section: Failure To Respondmentioning

confidence: 99%

“…In several trials involv ing cystic fibrosis patients, cimetidine was not always effective [48][49][50]53], These pa tients often have increased gastric secretion [48], It is likely that one reason for the failure of cimetidine in some of these patients was an inadequate reduction of gastric activity [54],…”

Section: Failure To Respondmentioning

confidence: 99%

Conservative Treatment of Chronic Pancreatitis

Lankisch¹

1987

Digestion

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Pain relief and compensatory therapy of exocrine and endocrine pancreatic insufficiency is the aim of conservative treatment of chronic pancreatitis. Pain relief may be achieved by analgetics, dietary restrictions, alcohol abstinence, enzyme substitution, and operative procedures. Decompensated exocrine pancreatic insufficiency, i.e. steatorrhea, is a late complication of chronic pancreatitis. It requires diet, vitamin, and enzyme replacement. Failure of the latter may be due to inactivation of the enzymes by gastric acid. Finally, diabetes mellitus, secondary to chronic pancreatitis, is managed with diet and insulin. Pancreatogenic diabetes responds only for a short period, if at all, to oral antidiabetics.

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Comparative Study of Varying Regimens to Improve Steatorrhoea and Creatorrhoea in Cystic Fibrosis: Effectiveness of an Enteric-Coated Preparation With and Without Antacids and Cimetidine

Cited by 89 publications

References 12 publications

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Enzyme Treatment of Exocrine Pancreatic Insufficiency in Chronic Pancreatitis

Conservative Treatment of Chronic Pancreatitis

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