The effect of pancreatic enzyme supplementation in patients with steatorrhoea after total gastrectomy.
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.
Brägelmann
R
R
Department of Gastroenterology, Academisch Ziekenhuis, Maastricht, The Netherlands.
Armbrecht
U
U
Rosemeyer
D
D
Schneider
B
B
Zilly
W
W
Stockbrügger
R W
RW
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
D004041:Dietary Fats; D005765:Gastrointestinal Agents; D008055:Lipids; D010919:Placebos; D010194:Pancreatin; D008049:Lipase; D000681:Amylases; D010450:Endopeptidases