title: Enzyme substitution in pancreatic disease.
abstract: Pancreatic enzyme substitution may principally be used in few indications, whereof most of them are only relative. The most obvious indication is malabsorption in chronic pancreatic insufficiency, which is always associated with an advanced form of the disease. Only when the exocrine secretory capacity of the pancreas is 2% or less does the patient exhibit diarrhea with a daily excretion of 25 g of fat or more on a normal diet. There are also strong indications that pain can be controlled in some patients with chronic pancreatitis, and the mechanism for this can be given a plausible explanation. As the pancreatic enzymes (with a few interesting exceptions) are resistant to the hydrochloric acid of the stomach, the galenic preparation must be given attention, and means of reducing the amount of acid in the stomach can be considered. However, the patients' compliance is just as important; the dosage must be individualized. The enzyme preparations must be easy to handle and all patients on regular medication must be given full information of the goals of the therapy. The socio-psychological side effects of the chronic disease should also be considered to get an optimal effect of the enzyme substitution in pancreatic disease.
mesh_terms: D002908:Chronic Disease; D002927:Cimetidine / Q000627:therapeutic use; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy*; D006801:Humans; D008286:Malabsorption Syndromes / Q000188:drug therapy*; D010194:Pancreatin / Q000627:therapeutic use*; D010195:Pancreatitis / Q000188:drug therapy*
chemical_list: D002927:Cimetidine; D010194:Pancreatin