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Useful Information On Pancreatin

The pancreas is a large gland that lies in the upper abdomen, behind the lower part of the stomach. It serves two major functions. One is to produce the hormones insulin and glucagon, which help regulate metabolism. The other is to produce pancreatic juice, a secretion delivered into the upper part of the small intestine (duodenum), where it aids digestion.

Pancreatin is a mixture of the fat dissolving enzyme, lipase, the protein enzymes such as protease, and those that break down carbohydrates like amylase. The enzymes in pancreatin may come from pork or beef. If you are vegetarian or have allergies or religious restrictions to any of these items, you should know this. Pancreatic enzymes are not standardized, and contain a variety of enzymes, including trypsin, chymotrypsin, lipase, amylase, colipase, and ribonuclease.

These enzymes catalyze the hydrolysis of fats into glycerol and fatty acids, protein into proteoses and derived substances, and starch into dextrins and sugars.

Pancreatin tablets are prescribed for patients who are unable to digest food properly because of an insufficient amount of natural pancreatic secretions. This deficit may be caused by disorders of the pancreas, for example, cystic fibrosis or pancreatitis.

When malabsorption is due to reduced exocrine pancreatic function, improved digestion of food can lead to enhanced nutrient absorption, prevention of weight loss and diarrhea, reduction of steatorrhea, and promotion of weight gain.

Enzymes work best when taken just before, during and immediately after a meal. When possible, swallow the pills whole. Do not chew.

It is chiefly in the management of pancreatic exocrine insufficiency that supplementation with digestive enzymes is beneficial to the nutritional status and gastrointestinal functioning of selected patients. Anecdotal reports suggest that some dyspeptic and functional gastrointestinal conditions may sometimes benefit from a trial of such therapy.

Exocrine pancreatic insufficiency combined with pancreatic pain and endocrine pancreatic insufficiency are the leading symptoms of chronic pancreatitis. Due to the large functional reserve capacity of the gland, decompensation, i.e. steatorrhea, does not occur before lipase excretion is reduced to < or = 10% of normal. Pancreatic enzyme substitution is indicated when fecal fat excretion exceeds a critical value (normally > 15 g/day) and/or when weight loss is present. A number of studies have dealt with the problems of gastric acid inactivation of pancreatic enzyme preparations as well as their gastric emptying nonsimultaneously with the food. For the present, it is recommended that pancreatic enzyme substitution in patients with proven exocrine pancreatic insufficiency and normal gastric acid secretion be given in multiunit, acid-protected dosages. In patients with gastric hyposecretion and in those who underwent partial or total gastrectomy, enzyme substitution should be administered as granules to enable mixing and simultaneous transport of enzymes with the chyme. The ultimate aim of further scientific and clinical research remains the total abolishment of pancreatic steatorrhea.

Known Hazards: Excessive doses of pancreatic enzyme replacement may result in gastrointestinal adverse effects, ie, nausea, vomiting, diarrhea, and abdominal cramps/pain. Very high doses have been reported to cause hyperuricosuria and hyperuricemia. Patients with a history of sensitivity to pork products, trypsin, pancrelipase, or pancreatin may develop allergic reactions.

- DIGESTIVES, INCLUDING ENZYMES. Department of Pharmacology University of Cape Town
- Lankisch PG. Enzyme treatment of exocrine pancreatic insufficiency in chronic pancreatitis. Digestion 1993;54 Suppl 2:21-9

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