Delayed release pancrelipase for treatment of pancreatic exocrine insufficiency associated with chronic pancreatitis.
Pancreatic enzyme supplements (PES) are used in chronic pancreatitis (CP) for correction of pancreatic exocrine insufficiency (PEI) as well as pain and malnutrition. The use of porcine pancreatic enzymes for the correction of exocrine insufficiency is governed by the pathophysiology of the disease as well as pharmacologic properties of PES. Variability in bioequivalence of PES has been noted on in vitro and in vivo testing and has been attributed to the differences in enteric coating and the degree of micro-encapsulation. As a step towards standardizing pancreatic enzyme preparations, the Food and Drug Administration now requires the manufacturers of PES to obtain approval of marketed formulations by April 2010. In patients with treatment failure, apart from evaluating drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation. The choice of PES (enteric coated versus non-enteric coated) and the need for acid suppression should be individualized. There is no current standard test for evaluating adequacy of therapy in CP patients and studies have shown that optimization of therapy based on symptoms may be inadequate. Goals of therapy based on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.
Krishnamurty
Devi Mukkai
DM
Johns Hopkins University School of Medicine; Department of Medicine.
Rabiee
Atoosa
A
Jagannath
Sanjay B
SB
Andersen
Dana K
DK
J Clin Pharmacol. 1994 Feb;34(2):158-66
8163716
Digestion. 1986;35(3):175-81
3781113
Am J Physiol Endocrinol Metab. 2007 Jan;292(1):E324-30
16954337
Can J Gastroenterol. 2003 Oct;17(10):597-603
14571298
Ann Intern Med. 1982 Oct;97(4):549-52
6922690
Digestion. 1978 Jul-Aug;17(4):365-9
669079
Pharmacotherapy. 2007 Jun;27(6):910-20
17542772
N Engl J Med. 1976 Jul 29;295(5):246-8
934188
Gut. 1993 May;34(5):708-12
8504976
Am J Gastroenterol. 1995 Sep;90(9):1383-93
7661155
J Pediatr. 2005 Apr;146(4):489-93
15812451
Pancreas. 2005 Mar;30(2):180-3
15714141
Aliment Pharmacol Ther. 1999 Jul;13(7):951-7
10383531
Curr Gastroenterol Rep. 2007 Apr;9(2):116-22
17418056
Lancet. 1999 Jul 17;354(9174):250; author reply 251
10421323
Am J Hosp Pharm. 1993 Feb;50(2):323-9
8480793
Gut. 1989 Oct;30(10):1344-7
2583563
Gastroenterology. 1983 Mar;84(3):476-82
6549746
Regul Pept. 2005 Jun 15;128(2):87-91
15780427
N Engl J Med. 1977 Oct 20;297(16):854-8
20572
Digestion. 1999;60 Suppl 1:97-103
10026441
Dig Dis Sci. 1994 May;39(5):988-92
8174440
J Hepatol. 1997 Aug;27(2):306-12
9288605
Am J Physiol Gastrointest Liver Physiol. 2000 Mar;278(3):G458-66
10712266
Gastroenterology. 1992 Feb;102(2):647-55
1732134
J Clin Gastroenterol. 2006 Sep;40(8):721-5
16940886
Gastroenterol Clin North Am. 1999 Sep;28(3):687-93
10503144
Pancreas. 2003 Jan;26(1):1-7
12499909
J Gastroenterol. 2006 Sep;41(9):901-8
17048055
Aliment Pharmacol Ther. 1998 Oct;12(10):1011-9
9798807
Clin Gastroenterol Hepatol. 2007 Apr;5(4):484-8
17445754
Dig Dis Sci. 1982 Jun;27(6):485-90
6282548
Am J Gastroenterol. 1975 May;63(5):381-8
1146795
Am J Gastroenterol. 1997 May;92(5):867-71
9149203
Acta Gastroenterol Belg. 1996 Jan-Mar;59(1):10-14
8686411
Lancet. 1996 Jun 8;347(9015):1620-1
8667884
Best Pract Res Clin Gastroenterol. 2001 Jun;15(3):477-86
11403540
Pancreas. 2007 Jul;35(1):1-15
17575539
Diabetologia. 1980 Sep;19(3):198-204
6997121
J Clin Gastroenterol. 2007 Mar;41(3):306-11
17426472
Pancreas. 1992;7(3):311-9
1594552
Gastroenterol Nurs. 2001 Mar-Apr;24(2):84-7
11847733
J Clin Gastroenterol. 2001 Apr;32(4):319-23
11276275
Gastroenterology. 1997 May;112(5):1624-34
9136842
Postgrad Med J. 1996 Mar;72 Suppl 2:S39-48; discussion S49-51
8869182
Aliment Pharmacol Ther. 2008 Feb 1;27(3):283-92
17973644
Br Med J. 1977 Feb 12;1(6058):418-9
13906
Eur J Gastroenterol Hepatol. 1996 Jul;8(7):699-703
8853261
Am J Gastroenterol. 1997 Nov;92(11):2032-5
9362186
J Pediatr Gastroenterol Nutr. 2006 Mar;42(3):256-61
16540792
Am J Physiol Gastrointest Liver Physiol. 2000 Nov;279(5):G1031-6
11053001
Gastroenterology. 1994 Jul;107(1):231-5
8020666
Gastroenterology. 1988 Jun;94(6):1315-25
3360258
Biochimie. 2000 Nov;82(11):987-95
11099795
Pancreas. 2006 Apr;32(3):258-63
16628080
Gastroenterology. 1999 Feb;116(2):431-7
9922325
Hepatogastroenterology. 1985 Aug;32(4):210-5
2414199
JOP. 2005 May 10;6(3):206-15
15883471
Aliment Pharmacol Ther. 2003 Feb;17(3):467-71
12562462
Int J Pancreatol. 2000 Feb;27(1):21-7
10811020
Aliment Pharmacol Ther. 1991 Apr;5(2):207-10
1888821
Gastroenterology. 1997 Jun;112(6):2048-55
9178698
Dig Dis Sci. 1983 Feb;28(2):97-102
6825540
N Engl J Med. 1977 Jun 9;296(23):1318-22
16213
Dig Dis Sci. 1982 Aug;27(8):716-22
7094792
Gut. 1989 Jun;30(6):866-72
2753411
JAMA. 1990 May 9;263(18):2459-61
2329633
Gut. 2006 Jul;55(7):1056-7
16766768
Curr Gastroenterol Rep. 2001 Apr;3(2):101-8
11276376
Gastroenterology. 1974 Nov;67(5):920-5
4609827
J Am Diet Assoc. 2006 Aug;106(8):1181-6
16863712
J Pediatr Gastroenterol Nutr. 2002 Jul;35(1):79-83
12142815
Dig Dis Sci. 1998 Jan;43(1):203-13
9508526
J Pediatr. 2006 Nov;149(5):658-662
17095338
Pancreas. 1987;2(4):368-77
3628234
Gastroenterology. 1986 Nov;91(5):1243-9
3758616
Gut. 1972 Feb;13(2):107-11
5045703
Surg Clin North Am. 1999 Aug;79(4):861-72, xi
10470332
J Clin Gastroenterol. 1998 Sep;27(2):101-7
9754770
Gastroenterology. 1984 Jan;86(1):1-7
6689652
Dig Dis Sci. 1994 May;39(5):993-8
8174441
J Nutr. 1994 Aug;124(8 Suppl):1321S-1326S
7914921
Diabetes Metab Res Rev. 2007 Jul;23(5):386-91
17103488
Dig Dis Sci. 1988 Mar;33(3):276-81
3342719
Am J Physiol. 1997 Aug;273(2 Pt 1):G553-8
9277437
Pancreas. 1997 Oct;15(3):226-35
9336785
Dig Dis Sci. 1993 Mar;38(3):482-9
8444080
Scand J Gastroenterol. 1992;27(2):108-10
1561522
Gastroenterology. 1987 Feb;92(2):449-58
2431952
Am J Gastroenterol. 2000 Aug;95(8):1932-8
10950038
Gastroenterology. 1989 Apr;96(4):1126-34
2494097
J Gastroenterol Hepatol. 2004 Sep;19(9):1005-9
15304117
Dig Dis Sci. 1984 Dec;29(12):1109-17
6499629
N Engl J Med. 1973 Apr 19;288(16):813-5
4693931
Pancreas. 1991 May;6(3):260-5
1713670
Gastroenterology. 1982 Sep;83(3):638-44
7095367
Clin Gastroenterol Hepatol. 2005 Jan;3(1):28-38
15645402
Ann Ital Chir. 2000 Jan-Feb;71(1):33-7
10829521
Aliment Pharmacol Ther. 2005 Apr 15;21(8):993-1000
15813835
J Clin Gastroenterol. 1994 Jan;18(1):32-5
8113582
Scand J Gastroenterol. 1995 Apr;30(4):392-8
7610357
Pancreas. 1994 Jan;9(1):137-8
8108368
N Engl J Med. 1977 Jun 9;296(23):1314-7
16212
Gastroenterology. 1979 Aug;77(2):285-9
447041
Am J Clin Nutr. 1985 Mar;41(3):517-25
2579539
Scand J Gastroenterol. 1986 Jan;21(1):104-8
3633631
Pancreas. 2006 Aug;33(2):156-62
16868481
Gastroenterol Clin Biol. 1988 Nov;12(11):787-92
3220231
N Engl J Med. 1997 May 1;336(18):1283-9
9113931
J Biol Chem. 1949 Jan;177(1):347-55
18107439
Gastroenterology. 1984 Jul;87(1):44-52
6202586
Gut. 1996 Oct;39(4):580-6
8944569
Gastroenterology. 1994 Nov;107(5):1481-7
7926511
Aliment Pharmacol Ther. 1994 Dec;8(6):603-7
7696449
Scand J Gastroenterol. 1996 Jan;31(1):90-4
8927947
Dig Dis Sci. 1986 Oct;31(10):1021-4
3757718
Am J Gastroenterol. 2001 Aug;96(8):2508-9
11513205
Metabolism. 2003 May;52(5):579-85
12759887
Am J Physiol. 1986 Oct;251(4 Pt 1):G475-80
2429560
Pharmacoepidemiol Drug Saf. 1999 Oct;8(6):377-84
15073899