Retrospective Analysis to Investigate the Effect of Concomitant Use of Gastric Acid–Suppressing Drugs on the Efficacy and Safety of Pancrelipase/Pancreatin (CREON®) in Patients With Pancreatic Exocrine Insufficiency

Sander-Struckmeier, Suntje; Beckmann, Katrin; Solingen, Gwendolyn Janssen-van; Pollack, Paul

doi:10.1097/mpa.0b013e31828784ef

Cited by 37 publications

(19 citation statements)

References 43 publications

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“…The current treatment of EPI is enzyme replacement with porcine pancreatic extracts. Fat absorption can be improved with enteric-coated formulations of these exogenous pancreatic enzymes, associated also with proton pump inhibitors to increase the duodenal pH and enhance enzyme stability and activity (9)(10)(11). In some patients with severe EPI, pancreatic enzyme replacement therapy may not lead to the reduction of steatorrhea, suggesting that other mechanisms interplay with the reduced lipase secretion.…”

Section: Alterations Of Ba Circulation and Levels May Results From Thementioning

confidence: 99%

Postprandial bile acid levels in intestine and plasma reveal altered biliary circulation in chronic pancreatitis patients

Humbert

Rainteau

Tuvignon

et al. 2018

Journal of Lipid Research

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Bile acid (BA) secretion and circulation in chronic pancreatitis (CP) patients with exocrine pancreatic insufficiency (EPI) were investigated by simultaneously measuring postprandial levels of individual BAs in duodenal contents and blood plasma using LC-MS/MS. CP patients and healthy volunteers (HVs) were intubated with gastric and duodenal tubes prior to the administration of a test meal and continuous aspiration of duodenal contents. Pancreatic lipase outputs in CP patients were very low (0.7 ± 0.2 mg) versus HVs (116.7 ± 68.1 mg; < 0.005), thus confirming the severity of EPI. Duodenal BA outputs were reduced in CP patients (1.00 ± 0.89 mmol; 0.47 ± 0.42 g) versus HVs (5.52 ± 4.53 mmol; 2.62 ± 2.14 g; < 0.15). Primary to secondary BA ratio was considerably higher in CP patients (38.09 ± 48.1) than HVs (4.15 ± 2.37; < 0.15), indicating an impaired transformation of BAs by gut microbiota. BA concentrations were found below the critical micellar concentration in CP patients, while a high BA concentration peak corresponding to gallbladder emptying was evidenced in HVs. Conversely, BA plasma concentration was increased in CP patients versus HVs suggesting a cholangiohepatic shunt of BA secretion. Alterations of BA circulation and levels may result from the main biliary duct stenosis observed in these CP patients and may aggravate the consequences of EPI on lipid malabsorption.

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Section: Alterations Of Ba Circulation and Levels May Results From Thementioning

confidence: 99%

Postprandial bile acid levels in intestine and plasma reveal altered biliary circulation in chronic pancreatitis patients

Humbert

Rainteau

Tuvignon

et al. 2018

Journal of Lipid Research

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“…It has been claimed that the use of proton pump inhibitors (PPIs) in addition to pancreatic extracts can lead to a significant improvement of fat digestion in patients with EPI receiving uncoated pancreatic enzyme formulations and resistant to enzyme substitution therapy [35]. However, analysis of data coming from clinical trials enrolling patients with EPI suggests that the efficacy of pancrelipase/pancreatin is not affected by concomitant use of antacids such as PPI or H2RA, as determined by end-of-treatment values of coefficient of fat absorption-therefore supporting the treatment guidelines' recommendation that acid suppression is not routinely required along with PERT [36].…”

Section: Pancreatic Enzyme Replacement Therapy After Gastric Resectionmentioning

confidence: 98%

Pancreatic enzyme replacement therapy after gastric resection: An update

Antonini

Crippa

Falconi

et al. 2018

Digestive and Liver Disease

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Exocrine pancreatic insufficiency (EPI) is one of the possible mechanisms of fat maldigestion following gastric surgery, together with reduced food intake, loss of gastric reservoir, small bowel bacterial overgrowth and rapid small bowel transit. Oral pancreatic enzyme replacement therapy (PERT) is the mainstay of treatment for EPI. The efficacy and safety of pancreatic enzyme substitution in patients following gastric resection remains unclear. This review article summarizes relevant studies addressing PERT after gastric resection.

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“…Steatorrhea in severe pancreatic insufficiency is very difficult to resolve completely. Only a 60-70% reduction is usually achieved using PERT [84] because of the numerous interactions between pancreatic maldigestion, intestinal ecology, and intestinal inflammation. Fat-soluble vitamins and micronutrients, such as zinc and selenium, should be routinely assessed and administered whenever necessary [85].…”

Section: Goal Of the Treatmentmentioning

confidence: 99%

Pancreatic Enzyme Replacement Therapy in Pancreatic Cancer

Pezzilli

Caccialanza

Capurso

et al. 2020

Cancers

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Pancreatic cancer is an aggressive malignancy and the seventh leading cause of global cancer deaths in industrialised countries. More than 80% of patients suffer from significant weight loss at diagnosis and over time tend to develop severe cachexia. A major cause of weight loss is malnutrition. Patients may experience pancreatic exocrine insufficiency (PEI) before diagnosis, during nonsurgical treatment, and/or following surgery. PEI is difficult to diagnose because testing is cumbersome. Consequently, PEI is often detected clinically, especially in non-specialised centres, and treated empirically. In this position paper, we review the current literature on nutritional support and pancreatic enzyme replacement therapy (PERT) in patients with operable and non-operable pancreatic cancer. To increase awareness on the importance of PERT in pancreatic patients, we provide recommendations based on literature evidence, and when data were lacking, based on our own clinical experience.

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Retrospective Analysis to Investigate the Effect of Concomitant Use of Gastric Acid–Suppressing Drugs on the Efficacy and Safety of Pancrelipase/Pancreatin (CREON®) in Patients With Pancreatic Exocrine Insufficiency

Cited by 37 publications

References 43 publications

Postprandial bile acid levels in intestine and plasma reveal altered biliary circulation in chronic pancreatitis patients

Postprandial bile acid levels in intestine and plasma reveal altered biliary circulation in chronic pancreatitis patients

Pancreatic enzyme replacement therapy after gastric resection: An update

Pancreatic Enzyme Replacement Therapy in Pancreatic Cancer

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