title: The effect of pancreatic enzyme supplementation in patients with steatorrhoea after total gastrectomy.
abstract: OBJECTIVE
  To assess the influence of pancreatic enzyme supplementation on symptoms, energy intake, bowel habits, and fat malassimilation in patients after total gastrectomy.
  
  
  METHODS
  A prospective, double-blind, randomized, parallel, placebo-controlled, multi-centre trial.
  
  
  METHODS
  Institutionalized patients in three gastroenterological rehabilitation clinics.
  
  
  METHODS
  52 institutionalized patients with a faecal fat output > or = 14 g/day, operated on for malignant gastric disease a median of 198 days (interquartile range (IQR) 47-608) previously, and free from recurrence and/or metastasis.
  
  
  METHODS
  Nine sachets of pancreatic enzymes per day (each containing lipase 36,000, amylase 27,000, protease 2400 FIP (Federation International Pharmaceutique)) or identical-looking placebo were given for 14 days.
  
  
  METHODS
  Abdominal symptoms, energy intake, bowel habits and fat malassimilation.
  
  
  RESULTS
  After treatment, patients on enzyme therapy felt better overall (P = 0.006), but no improvement of a specific symptom could be identified. During the intervention, the median kilojoule intake per kilogram body weight was 9% higher in the placebo group (170.8 (IQR 146.9-202.6)) than in the enzyme-treated group (157.0 (IQR 134.8-170.4)) (P = 0.03). Enzyme treatment did not result in a significant difference between the placebo and the enzyme-treated group regarding bowel habits or fat malassimilation.
  
  
  CONCLUSIONS
  The effect of high-dose pancreatic enzymes supplementation on symptoms and steatorrhoea after total gastrectomy is marginal and does not justify its routine use.
authors.affiliation: Department of Gastroenterology, Academisch Ziekenhuis, Maastricht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Brägelmann
authors.forename: U
authors.initials: U
authors.lastname: Armbrecht
authors.forename: D
authors.initials: D
authors.lastname: Rosemeyer
authors.forename: B
authors.initials: B
authors.lastname: Schneider
authors.forename: W
authors.initials: W
authors.lastname: Zilly
authors.forename: R W
authors.initials: RW
authors.lastname: Stockbrügger
mesh_terms: D000368:Aged; D000681:Amylases / Q000008:administration & dosage / Q000627:therapeutic use; D015992:Body Mass Index; D002446:Celiac Disease / Q000188:drug therapy* / Q000209:etiology; D003672:Defecation / Q000502:physiology; D004041:Dietary Fats / Q000008:administration & dosage; D004311:Double-Blind Method; D010450:Endopeptidases / Q000008:administration & dosage / Q000627:therapeutic use; D002149:Energy Intake; D005243:Feces / Q000737:chemistry; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008049:Lipase / Q000008:administration & dosage / Q000627:therapeutic use; D050356:Lipid Metabolism; D008055:Lipids / Q000032:analysis; D008286:Malabsorption Syndromes / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010194:Pancreatin / Q000627:therapeutic use*; D010919:Placebos; D011446:Prospective Studies
chemical_list: D004041:Dietary Fats; D005765:Gastrointestinal Agents; D008055:Lipids; D010919:Placebos; D010194:Pancreatin; D008049:Lipase; D000681:Amylases; D010450:Endopeptidases