Impact of Pancreatic Enzymes on Enteral Fat and Nitrogen Absorption in Short Bowel Syndrome

Abstract

Objectives: Patients with short bowel syndrome (SBS) can have a high morbidity rate. To minimize morbidity, enteral autonomy is the primary goal in clinical management of patients with SBS. This is often difficult to achieve because of significant malabsorption. To date, there are limited therapies that improve absorption in patients with SBS. The impact of pancreatic enzyme replacement treatment on enteral absorption has not been studied in this population and was the primary aim of this study. Subjects/methods: This was an interventional study in 11 subjects (6 pediatric subjects ages 4.0-17.9 years, 5 adult subjects 18-75 years) that compared enteral absorption in each subject before and after pancreatic enzyme medication (Creon). Coefficient of fat absorption (CFA) and coefficient of nitrogen absorption (CNA) were used as markers of enteral absorption of fat and protein, respectively. Results: There was no statistically significant mean change in CFA and CNA before and after pancreatic enzyme medication therapy. Six subjects demonstrated an increase in CFA and 8 subjects demonstrated an increase in CNA after the use of pancreatic enzyme medication therapy. Conclusions: There was no statistically significant improvement in enteral fat and protein absorption in the cohort as a whole, though several subjects demonstrated an improvement. These results suggest that some patients with SBS may benefit from treatment with pancreatic enzymes. Further studies are needed to better evaluate the effect of pancreatic enzyme therapy on enteral absorption in subjects with SBS and to characterize factors that may predict a positive response.

Fat malabsorption in short bowel syndrome: A review of pathophysiology and management

“…The primary outcome was the coefficient of fat absorption over a 72‐h window. In all 11 patients, no statistical improvement in enteral fat absorption was observed, although six patients did exhibit an increase in coefficient of fat absorption after using pancreatic enzymes 85 . The conclusion from this trial was that oral pancreatic enzyme replacement therapy is ineffective and not recommended for SBS.…”

“…In all 11 patients, no statistical improvement in enteral fat absorption was observed, although six patients did exhibit an increase in coefficient of fat absorption after using pancreatic enzymes. 85 The conclusion from this trial was that oral pancreatic enzyme replacement therapy is ineffective and not recommended for SBS. Additional studies could be pursued given the small sample size, but rapid transit and decreased intestinal length are significant limitations to oral pancreatic enzyme replacement.…”

“…Although both CF and SBS involve fat malabsorption, the mechanisms differ and thus may require different treatment approaches. The effect of orally administered pancreatic enzyme replacement in mostly enterally fed patients with intestinal failure was evaluated in a phase 2 clinical trial 85 (Table 5). The primary outcome was the coefficient of fat absorption over a 72-h window.…”

“…The effect of orally administered pancreatic enzyme replacement in mostly enterally fed patients with intestinal failure was evaluated in a phase 2 clinical trial 85 (Table 5). The primary outcome was the coefficient of fat absorption over a 72‐h window.…”

Short bowel syndrome: Complications and management

“…Finally, there is currently no evidence suggesting a role for pancreatic enzyme replacement in SBS, as there is not a deficiency in pancreatic exocrine secretion in the vast majority of patients with SBS. A recent study by Sainath et al 15 did evaluate the use of pancreatic enzymes in a small cohort of 11 patients (6 pediatric and 5 adult patients). Although an improvement in the coefficient of fat absorption and coefficient of nitrogen absorption was seen in some patients, they did not reach statistical significance.…”