title: An enteral therapy containing medium-chain triglycerides and hydrolyzed peptides reduces postprandial pain associated with chronic pancreatitis.
abstract: OBJECTIVE
  Pain in patients with chronic pancreatitis is difficult to manage. We examined if an enteral formulation containing medium-chain triglycerides (MCT) and hydrolyzed peptides would (1) minimally stimulate the exocrine pancreas by blunting cholecystokinin release and (2) decrease pain in patients with chronic pancreatitis.
  
  
  METHODS
  In the first part of the study, on separate days, 6 healthy controls consumed a standard enteral formulation, an enteral formulation containing MCT and hydrolyzed peptides, and a high-fat meal. Baseline and postprandial plasma cholecystokinin (CCK) concentrations were analyzed. Subsequently, 8 patients with chronic pancreatitis were enrolled and instructed to complete a visual analog pain assessment for a baseline period of 2 weeks followed by three cans per day of the enteral formulation containing MCT and hydrolyzed peptides for 10 weeks.
  
  
  RESULTS
  Mean CCK levels for our control subjects were 0.46 +/- 0.29 pM at baseline, 10.75 +/- 0.45 pM in response to the high-fat meal, and 7.9 +/- 1.25 pM in response to the standard enteral formulation. Of note, CCK levels were 1.43 +/- 0.72 pM in response to the enteral supplement containing MCT and hydrolyzed peptides. In patients with chronic pancreatitis, the average improvement in pain scores from baseline to the conclusion of the study was 61.8% (p = 0.01). This corresponded to a clinical improvement in 6 of the 8 patients.
  
  
  CONCLUSIONS
  A complete enteral supplement containing MCT and hydrolyzed peptides minimally increases plasma CCK levels. This therapy may be effective in reducing postprandial pain associated with chronic pancreatitis.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass 02215, USA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Shea
authors.forename: Michele D
authors.initials: MD
authors.lastname: Bishop
authors.forename: Eliza M
authors.initials: EM
authors.lastname: Parker
authors.forename: Andres
authors.initials: A
authors.lastname: Gelrud
authors.forename: Steven D
authors.initials: SD
authors.lastname: Freedman
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002766:Cholecystokinin / Q000097:blood; D002908:Chronic Disease; D004750:Enteral Nutrition; D006801:Humans; D006868:Hydrolysis; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D010195:Pancreatitis / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D010455:Peptides / Q000008:administration & dosage* / Q000737:chemistry; D019518:Postprandial Period; D014280:Triglycerides / Q000008:administration & dosage* / Q000737:chemistry
chemical_list: D010455:Peptides; D014280:Triglycerides; D002766:Cholecystokinin