title: Pancreatic enzyme supplementation in cystic fibrosis patients before and after fibrosing colonopathy.
abstract: BACKGROUND
  In 1994 we cared for nine cystic fibrosis patients with fibrosing colonopathy. To evaluate the relationship between fibrosing colonopathy and supplemental pancreatic enzymes we reviewed our dosing of enzymes prior to fibrosing colonopathy development and then evaluated the subsequent effect of drastically reducing pancreatic enzyme dose.
  
  
  METHODS
  We retrospectively reviewed pancreatic enzyme dosing for 267 cystic fibrosis patients with pancreatic insufficiency. The supplemental enzyme history of nine patients with fibrosing colonopathy was contrasted with the history of 258 nonaffected patients. The pancreatic enzyme doses of 75 patients taking at least 6,000 U lipase/kg/meal were systematically reduced to approximately 2,000 lipase units/kg/meal. We evaluated the effect of this dose reduction on change in height and weight z scores one year after achievement of stable enzyme dose.
  
  
  RESULTS
  In the year prior to diagnosis patients with fibrosing colonopathy took a significantly larger pancreatic enzyme dose, whether assessed by highest dose or cumulative dose, than did nonaffected patients. Similar results were observed after controlling for sex and age. All 75 patients on at least 6,000 U lipase/kg/meal were able to tolerate a significant reduction in dose while achieving clinically acceptable nutrient absorption, with no change over one year in height and weight z scores.
  
  
  CONCLUSIONS
  Our data demonstrate a strong relationship between very high doses of pancreatic enzyme supplementation and formation of fibrosing colonopathy. These very high doses do not appear to be needed for adequate nutrient absorption and growth.
authors.affiliation: Section of Pediatric Pulmonology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Stevens
authors.forename: K M
authors.initials: KM
authors.lastname: Maguiness
authors.forename: J
authors.initials: J
authors.lastname: Hollingsworth
authors.forename: D K
authors.initials: DK
authors.lastname: Heilman
authors.forename: S K
authors.initials: SK
authors.lastname: Chong
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000473:pathology; D003108:Colonic Diseases / Q000188:drug therapy* / Q000209:etiology; D003550:Cystic Fibrosis / Q000150:complications* / Q000188:drug therapy; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005355:Fibrosis; D006801:Humans; D008049:Lipase / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D010179:Pancreas / Q000201:enzymology*; D012189:Retrospective Studies
chemical_list: D008049:Lipase