Fibrosing colonopathy in an adult owing to over use of pancreatic enzyme supplements

Bansi, Dev; Ab, Price; Russell, Chris; Sarner, M.

doi:10.1136/gut.46.2.283

Cited by 32 publications

(9 citation statements)

References 8 publications

(5 reference statements)

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“…These recommendations are based largely on the Cystic Fibrosis Foundation Consensus Conference Guidelines 57 . Excessive pancreatic enzyme dosing has been linked to stenotic fibrosing colonopathy in patients with CF and also in a case report for the post‐Whipple procedure 1 , 58 , 59 . Enzymes can also cause side effects of bloating, cramping, fullness, and nausea.…”

Section: Pancreatic Enzymesmentioning

confidence: 99%

Pancreatic Enzyme Replacement Therapy During Pancreatic Insufficiency

Berry

2014

Nut in Clin Prac

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Pancreatic stimulation and therefore digestion is a tightly controlled and hormonally mediated process. Any alterations affecting any of the systematic steps for successful digestion and absorption to occur will impair appropriate pancreatic enzymatic secretion, entry into the bowel lumen, functionality once inside the lumen, and thus appropriate mixing with foods and nutrients. Many causes of pancreatic insufficiency may require the initiation of pancreatic enzyme therapy, including but not limited to cystic fibrosis, pancreatic cancer, acute and chronic pancreatitis, and pancreatic surgery. This purpose of this article is to help clarify the conditions that cause pancreatic insufficiency, how to determine if the patient is malabsorbing, and the best use of pancreatic enzyme replacement therapy for treatment in these conditions. The first step in determining if pancreatic enzyme therapy is appropriate is to determine if the patient is malabsorbing specifically due to pancreatic exocrine insufficiency. An overview of the methods used to determine pancreatic insufficiency is provided, as well as appropriate treatment methods. Recent Food and Drug Administration regulations require a more thorough process, including randomized controlled trials to prove the safety and efficacy of pancreatic enzymes, to approve them for use. The studies used to verify efficacy also are examined. Last, dosing guidelines and some unconventional ways to administer pancreatic enzymes, such as during enteral feedings, are reviewed.

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Section: Pancreatic Enzymesmentioning

confidence: 99%

Pancreatic Enzyme Replacement Therapy During Pancreatic Insufficiency

Berry

2014

Nut in Clin Prac

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“…It presents with symptoms of persistent distal intestinal obstruction in the subclinical course of colonic fibrosis, or even colitis with bloody uncontrollable diarrhea due to ulcerative inflammation, with mucosal and submucosal fibrosis, resembling Crohn's disease and often demanding initial treatment with mesalazine. At the same time, enzyme dosage should be reduced to the recommended levels of 500–2,500 lipase units/kg per meal 58 . Surgical intervention is often necessary, with total parenteral nutrition for a time.…”

Section: Cystic Fibrosis In Childhoodmentioning

confidence: 99%

Longitudinal Cystic Fibrosis Care

Antunovic

Lukač

Vujović

2012

Clin Pharmacol Ther

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Cystic fibrosis is a complex disease entity that presents considerable lifelong challenges. Implementation of medical and surgical treatment options involves multisystem interventions to prevent and treat lung and gastrointestinal manifestations of cystic fibrosis and associated comorbidities. From birth through adulthood, cystic fibrosis care entails a longitudinal regimen aimed at achieving relief of disease symptoms and enhanced life expectancy. With increased knowledge of the molecular behavior of the cystic fibrosis transmembrane conductance regulator (CFTR) in health and disease, clinical practice has been enriched by the prospect of novel strategies, including mutation-specific drug and gene therapy targeting restoration of corrupted transepithelial ion transport. Emerging paradigms of comprehensive care increasingly enable personalized solutions to address the root cause of disease-transforming management options for individuals with cystic fibrosis.

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“…As more concern is focused on the effect of pthalates, which are commonly present in the polymer coating, the impact of this component will likely be evaluated further 136. The most concerning adverse effect associated with enzyme replacement is fibrosing colonopathy, which has been described in cystic fibrosis patients receiving <24,000 IU of lipase/kg daily 137,138. It results in submucosal collagen deposition with fibrosis and varying degrees of stricturing.…”

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

“… 136 The most concerning adverse effect associated with enzyme replacement is fibrosing colonopathy, which has been described in cystic fibrosis patients receiving <24,000 IU of lipase/kg daily. 137 , 138 It results in submucosal collagen deposition with fibrosis and varying degrees of stricturing. Some studies suggest that the acid-resistant coating of enzyme preparations may be responsible for the fibrosing colonopathy, as it has also been demonstrated with other medications that use the same methacrylic copolymer coating.…”

Section: Pancreatic Enzyme Replacement Therapymentioning

confidence: 99%

Enzyme replacement therapy for pancreatic insufficiency: present and future

Fieker¹,

Philpott²,

Armand³

2011

CEG

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Pancreatic enzyme replacement therapy is currently the mainstay of treatment for nutrient malabsorption secondary to pancreatic insufficiency. This treatment is safe and has few side effects. Data demonstrate efficacy in reducing steatorrhea and fat malabsorption. Effective therapy has been limited by the ability to replicate the physiologic process of enzyme delivery to the appropriate site, in general the duodenum, at the appropriate time. The challenges include enzyme destruction in the stomach, lack of adequate mixing with the chyme in the duodenum, and failing to deliver and activate at the appropriate time. Treatment is begun when clinically significant malabsorption occurs resulting in steatorrhea and weight loss. Treatment failure is addressed in a sequential fashion. Current research is aimed at studying new enzymes and delivery systems to improve the efficiency of action in the duodenum along with developing better means to monitor therapy.

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Fibrosing colonopathy in an adult owing to over use of pancreatic enzyme supplements

Cited by 32 publications

References 8 publications

Pancreatic Enzyme Replacement Therapy During Pancreatic Insufficiency

Pancreatic Enzyme Replacement Therapy During Pancreatic Insufficiency

Longitudinal Cystic Fibrosis Care

Enzyme replacement therapy for pancreatic insufficiency: present and future

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