The Diagnosis and Treatment of Achylia Pancreatica

Abstract

Studies on the effect of achylia pancreatica on digestion and absorption in experimental animals have been numerous and consistent. It has been clearly demonstrated that exclusion of pancreatic juice from the intestine results in a decided increase in the quantity of fat and nitrogen,1 starch2 and the total carbohydrate 3 eliminated in the feces. In view of the uniformity of these results, the negative results reported by some of the older workers 4 can be attributed to a simple failure to exclude all pancreatic juice from the intestine.5Reports on the value of substitution therapy in experimental achylia pancreatica have not been entirely harmonious. Pratt, Lamson and Marks,5 Cruickshank,6 Nasset, Pierce and Murlin,7 Selle8 and Schmidt, Beazell, Crittenden and Ivy 9 all observed a significant reduction in the quantity of nitrogen wasted in the feces when adequate substitution therapy was instituted. Coffey, Mann and Bollman,10 on the other hand, were unable to demonstrate any specific effect. In agreement with Selle 8 the latter authors also found that enzyme therapy was without effect on the quantity of fat wasted in the feces. In contrast, Schmidt, Beazell, Crittenden and Ivy,9 Pratt, Lamson and Marks 5 and Cruickshank G all reported that oral enzyme therapy had a decidedly favorable effect on fat utilization. We2 found that substitution therapy effected reductions in fecal starch as great as 50 per cent. Coffey, Mann and Bollman 10 obtained similar results in studies on the utilization of total carbohydrate.Clinical studies on the effect of achylia pancreática on food utilization and on the effect of enzyme therapy have been surprisingly consistent. With few exceptions it has been reported that achylia pancreática is char¬ acterized by a noticeable failure in the absorption of both fat and nitrogen and that substitution therapy is of demonstrable therapeutic value. Observations on certain well studied cases reported in the literature, in which the effect of substitution therapy was deter¬ mined, are summarized in table 1. The results obtained during control periods illustrate the magnitude of the disturbance in digestion and absorption that occurs when pancreatic juice is excluded from the intestine in man.Since the number of well studied patients are few, and since oral pancreatic enzyme therapy in man is not generally considered to be of value, a view that is inconsistent with most of the results of animal experi¬ mentation, we have undertaken to determine the effec¬ tiveness of oral pancreatic enzyme therapy in human patients with achylia pancreática.We have carefully studied 4 patients in whom a definite diagnosis of achylia pancreática has been estab¬ lished and have observed the effect of the oral admin¬ istration of pancreatic enzymes on them for from a few months to three and a half years. BRIEF HISTORIES OF THE PATIENTS STUDIEDThe following brief reports include the significant information gained from the history and the examina¬ tions made prior to our study : Case 1.-W. M., a white woman aged 65, i...

Exocrine insufficiency in pancreatic diseases and other digestive disorders: diagnosis and management

“…В то время было известно, что перорально вводимые ферменты разрушаются в желудочном соке и что они наиболее эффективны при приеме в щелочной среде [44]. Обзор исследований начала XX в. по использованию ферментов ПЖ для лечения стеатореи, вторичной по отношению к внешнесекреторной недостаточности ПЖ, показал широкий разброс в эффективности, обусловив снижение частоты выявления стеатореи в среднем на 50% [45,46]. Целью терапии ферментами ПЖ является восстановление нормального всасывания жира путем доставки «достаточного количества активной липазы в нужное место -в двенадцатиперстную кишку и проксимальную часть тощей кишки, причем в нужное время, т. е. параллельно с опорожнением желудка от питательных веществ» [47].…”

Rational Use of Pancreatic Enzymes for Pancreatic Insufficiency and Pancreatic Pain

“…One common strategy has been to administer large quantities of pancreatic enzymes in an attempt to overpower the gastric barrier. Experience has shown that this rarely restores normal fat absorption (Beazell et al 1941; DiMagno et al 1977; Harris et al 1955; Jordan and Grossman 1959; Littman and Hanscom 1969). The option of using enteric coating to protect the enzymes has also had limited success as it has been plagued both by separation of the enteric coated enzymes from the meal and the fact that the proximal intestine often remains acidic which delays dissolution of the coating and release of the enzymes to the distal small intestine and colon (Aloulou et al 2008; Delchier et al 1991).…”

The economic consequences of the introduction of Creon Micro into the basal therapy of exocrine pancreas deficiency due to cystic fibrosis in the children presenting with mucoviscidosis

“…Соответственно необходимо было применять 10-кратно повышенные дозы и/или одновременно использовать соду, чтобы справиться с инактивацией ферментов в желудке. Обзор исследований, выполненных в первой половине XX в., показал, что эффективность ферментов по предотвращению стеатореи варьировала в больших пределах, но приводила к ее уменьшению на 50% [14]. Поскольку ферментные препараты появились до принятия в 1938 г. Федерального закона США о продуктах, лекарствах и косметике (Federal Food, Drug and Cosmetics Act), который установил необходимость доказательства эффективности и безопасности лекарственных препаратов перед их выводом на рынок, то требовать для этих препаратов клинических испытаний длительное время было нельзя.…”