Pathogenesis of fibrosing colonopathy: the role of methacrylic acid copolymer

Prescott, P.; Bakowski, Marie T.

doi:10.1002/(sici)1099-1557(199910/11)8:6<377::aid-pds448>3.3.co;2-3

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…[49][50][51][52] All were taking Nutrizym GR, the only standard-strength product available in the UK that contains the copolymer Eudragit L30 D55. Despite the rarity of the complication, the occurrence and severity of the condition had a major influence on attitudes to pancreatic enzyme treatment.…”

Section: Choice Of Pancreatic Enzyme Preparationmentioning

confidence: 99%

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Littlewood

Wolfe

Conway

2005

Pediatric Pulmonology

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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: Choice Of Pancreatic Enzyme Preparationmentioning

confidence: 99%

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Littlewood

Wolfe

Conway

2005

Pediatric Pulmonology

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“…Worldwide to date there have been 85 reported cases of fibrosing colonopathy, including 18 in the United Kingdom (Bakowski M, personal communication). There has been debate over the role of high strength enzyme preparations or the use of high doses of enzymes in the aetiology of this condition, but it now seems likely that a methacrylic acid co-polymer (Eudragit) in the enteric coating of some preparations is the culprit 29. The risk of fibrosing colonopathy in patients receiving non-Eudragit-containing products, even at higher doses, appears extremely small.…”

Section: Nutritionmentioning

confidence: 99%

Recent advances in cystic fibrosis

Doull

2001

Arch Dis Child

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The median life expectancy for cystic fibrosis is now over 30 years, and it is projected that in newborn infants it will become more than 40 years. The identification of the cystic fibrosis gene and its product, cystic fibrosis transmembrane conductance regulator (CFTR), has widened the spectrum of the disease from the classical case of the infant with cystic fibrosis to the elderly childless man with unexplained bronchiectasis. There is increasing evidence of the advantages of newborn screening for cystic fibrosis and subsequent specialist care. Management concentrates on optimising nutritional status and preventing lung infection and inflammation. (Arch Dis Child 2001;85:62-66)

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“…118 Recent studies have demonstrated that intake of high doses of methacrylic copolymer used as acid resistant coating in PES rather than the lipase itself may be the cause of fibrosing colonopathy. [119][120][121] This condition has also been reported in patients who have never received PES, but rather a different drug coated with methacrylic copolymer. 122 Pancreatin extracts are also prone to form insoluble complexes with folic acid, with the result that folic acid deficiency can develop in patients receiving PES.…”

Section: Adverse Effectsmentioning

confidence: 77%