Comparative evaluation of a high lipase pancreatic enzyme preparation and a standard pancreatic supplement for treating exocrine pancreatic insufficiency in chronic pancreatitis.
OBJECTIVE
To compare the efficacy and safety of two enzyme-containing preparations, Pancrease HL (Cilag) containing 25,000 units of lipase per capsule and Creon (Triosol) with 8000 units of lipase per capsule, in patients with chronic pancreatitis and exocrine insufficiency.


METHODS
The study is a monocentric open crossover prospective study including 25 patients entered from March 1993 to May 1994.


METHODS
Chronic pancreatitis was alcohol-related in 23 patients, previous surgery was performed in 9, 16 had diabetes and all had steatorrhoea (fat balance > 10g/24h).


METHODS
Patients were investigated during four periods of 2 weeks, each one corresponding to a new treatment regimen: Pancrease HL, 3 capsules/day or Creon, 9 capsules/day, with or without omeprazole 20 mg/day. Stools were collected on the last 3 days at the end of each period when the patients were on a standard diet with a fixed daily intake of 100 g fat/day.


RESULTS
Faecal fat, protein and energy excretion did not differ when both preparations were compared at roughly pharmaceutically equivalent doses. No significant improvement in fat and protein absorption was observed when omeprazole was taken with the pancreatic enzymes. However, omeprazole treatment was associated with a marked decrease in the fat-protein content ratio, suggesting an improvement in the fat digestive process but a decrease in the efficiency of protein digestion. Drug safety was comparable in the four groups of treatment.


CONCLUSIONS
Pancrease HL with high lipase activity provides effective pancreatic enzyme replacement therapy in patients with chronic pancreatitis at an appreciably lower number of capsules per day than with standard preparations.
Delhaye
M
M
Medicosurgical Department of Gastroenterology, Erasme Hospital, Free University of Brussels, Belgium.
Meuris
S
S
Gohimont
A C
AC
Buedts
K
K
Cremer
M
M
D018592:Cross-Over Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008049:Lipase / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010184:Pancreatic Extracts / Q000627:therapeutic use*; D010194:Pancreatin / Q000627:therapeutic use*; D010195:Pancreatitis / Q000150:complications / Q000188:drug therapy*; D019512:Pancreatitis, Alcoholic / Q000150:complications / Q000188:drug therapy*; D020799:Pancrelipase; D011446:Prospective Studies
D005765:Gastrointestinal Agents; D010184:Pancreatic Extracts; D020799:Pancrelipase; D010194:Pancreatin; D008049:Lipase; D009853:Omeprazole