title: Pancreatic enzyme supplementation for patients receiving enteral feeds.
abstract: BACKGROUND
  Pancreatic enzyme supplementation is an important part of management for a number of gastrointestinal conditions. For patients who are unable to swallow pancreatin capsules or granules, enteral feeding tubes can be used to administer the pancreatic enzyme. This presents challenges given the unique format of the pancreatic enzyme supplements, with common problems including tube blockage and loss of the enzyme's effect.
  
  
  RESULTS
  A novel technique is described for administration of pancreatic enzyme via feeding tubes. For gastrically placed tubes, this involves opening the pancreatin capsules and suspending the enzyme microspheres in thickened acidic fluid (such as the mildly thickened or "nectar-thick" fruit juice used for dysphagia) for delivery into the feeding tube. This technique minimizes tube blockage by preventing the enzyme from clumping in the tube. For jejunally placed tubes, enzyme microspheres can be crushed and activated with sodium bicarbonate before flushing into the tube, or the activated enzyme mixture can be added to enteral feeds.
  
  
  CONCLUSIONS
  Pancreatic enzyme supplementation can continue while patients receive enteral feeding. Using the described technique can help to avoid tube blockage and maintain optimal enzyme activity.
authors.affiliation: Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, Australia. Suzie.Ferrie@sswahs.nsw.gov.au
authors.forename: Suzie
authors.initials: S
authors.lastname: Ferrie
authors.forename: Christie
authors.initials: C
authors.lastname: Graham
authors.forename: Matthew
authors.initials: M
authors.lastname: Hoyle
mesh_terms: D003680:Deglutition Disorders; D019587:Dietary Supplements; D004750:Enteral Nutrition / Q000379:methods*; D010188:Exocrine Pancreatic Insufficiency / Q000628:therapy*; D006801:Humans; D010179:Pancreas / Q000201:enzymology*; D010194:Pancreatin / Q000008:administration & dosage*
chemical_list: D010194:Pancreatin