Lechenie pankreaticheskimi fermentami


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Treatment with pancreatic enzymes should be based on an understanding of normal physiology and pathophysiology of the exocrine function of the pancreas, as well as diseases that are the cause of exocrine pancreatic insufficiency, both structural and functional types. Administration of enzymes is indicated only in case of clinically significant pancreas dysfunction, but sensitive and specific tests for pancreatic function, unfortunately, are not available now. Therefore, it is considered that the treatment with pancreatic enzymes should be started on the basis of actual clinical data, for example, if the patient has diarrhea and weight loss and confirmed presence of the disease, leading to exocrine pancreatic insufficiency. Currently, enteric coated micropellets or mini-tablets with a diameter of 2 mm or less are clinically preferred. The initial dose is 20 000 to 40000 lipase units per meal, with further adjusting the dose as necessary. Dose can be increased and the treatment can be supplemented by taking a proton pump inhibitor. Until now, the application is not possible that drugs enteric coated (micropellets, microspheres and minitablets) one brand have the same or even higher efficiency as compared to other drugs brand. Nevertheless, we have a successful experience of using mini tablet, enteric-coated (trade name Ermital® (Ermytal®) in Russia**).

Full Text

Restricted Access

About the authors

Yoakhim Messner

Email: moej@medizin.uni-leipzig.de

References

  1. Maljaars P.W., Peters H.P., Mela D.J., Masclee A.A. Ileal brake: a sensible food target for appetite control A review. Physiol. Behav. 2008;95:271-81.
  2. Keim V., Klar E., Poll M., Schoenberg M.H. Postoperative care following pancreatic surgery: surveillance and treatment. Dtsch. Arztebl. Int. 2009;106:789-94.
  3. Rosendahl J., Witt H., Szmola R., Bhatia E., Ozsvari B., Landt O., Schulz H.U., Gress T.M., Pfützer R., Löhr M., Kovacs P., Blüher M., Stumvoll M., Choudhuri G., Hegyi P., te Morsche R.H., Drenth J.P., Truninger K., Macek M.Jr., Puhl G., Witt U., Schmidt H., Büning C., Ockenga J., Kage A., Groneberg D.A., Nickel R., Berg T., Wiedenmann B., Bödeker H., Keim V., Mössner J., Teich N., Sahin-Toth M. hymotrypsin C (CTRC) alterations that diminish activity or secretion are associated with chronic pancreatitis. Nat. Genet. 2008;40:78-82.
  4. Teich N., Mössner J. Hereditary pancreatitis. Best. Pract. Res. Clin. Gastroenterol. 2008; 22:115-30.
  5. Ammann R.W., Muellhaupt B., Meyenberger C., Heitz P.U. Alcoholic nonprogressive chronic pancreatitis: prospective long-term study of a large cohort with alcoholic acute pancreatitis (1976-1992). Pancreas. 1994;9:365-73.
  6. Keim V., Witt H., Bauer N., Bodeker H., Rosendahl J., Teich N., Mossner J. The course of genetically determined chronic pancreatitis. JOP. 2003;4:146-54.
  7. DiMagno E.P., Go V.L., Summerskill W.H. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N. Engl. J. Med. 1973;288:813-15.
  8. Siegmund E., Löhr J.M., Schuff-Werner P. The diagnostic validity of non-invasive pancreatic function tests - a meta-analysis. Z. Gastroenterol. 2004;42:1117-28.
  9. Kampanis P., Ford L., Berg J. Development and validation of an improved test for the measure ment of human faecal elastase-1. Ann. Clin. Biochem. 2009;46:33-7.
  10. Braden B. 13C breath tests for the assessment of exocrine pancreatic function. Pancreas. 2010;39:955-9.
  11. Lankisch P.G., Dröge M., Hofses S., König H., Lembcke B. Steatorrhoea: you cannot trust your eyes when it comes to diagnosis. Lancet. 1996;347:1620-21.
  12. Teich N., Orth M., Keim V., Mössner J. Diagnostik von Pankreaserkrankungen, Bestimmung von Lipase und alpha-Amylase meistens verzichtbar. Dtsch. Arztebl. 2002;99:2717-9.
  13. Moolsintong P., Burton F.R. Pancreatic function testing is best determined by the extended endoscopic collection technique. Pancreas. 2008;37:418-21.
  14. Bozkurt T., Braun U., Leferink S., Gilly G., Lux G. Comparison of pancreatic morphology and exocrine functional impairment in patients with chronic pancreatitis. Gut. 1994;35:1132-36.
  15. Pezzilli R. Chronic pancreatitis: maldigestion, intestinal ecology and intestinal inflammation. World J. Gastroenterol. 2009;15:1673-76.
  16. Layer P., Keller J., Lankisch P.G. Pancreatic enzyme replacement therapy. Curr. Gastroenterol. Reports. 2001;3:101-8.
  17. Löhr J.M., Hummel F.M., Pirilis K.T., Steinkamp G., Körner A., Henniges F. Properties of different pancreatin preparations used in pancreatic exocrine insufficiency. Eur. J. Gastroenterol. Hepatol. 2009;21:1024-31.
  18. Kühnelt P., Mundlos S., Adler G. Einfluss der Pelletgröße eines Pankreasenzympraparates auf die duodenale lipolytische Aktivitat. Z. Gastroenterol. 1991;29:417-21.
  19. Halm U., L Löser ser C., Löhr M., Katschinski M., Mösner J. A double blind, randomized, multicentre, crossover study to prove equivalence of pancreatin minimicrospheres versus microspheres in exocrine pancreatic insufficiency. Aliment. Pharm. Therap. 1999;13:951-57.
  20. Guarner L., Guarner F., Malagelada J.-R. Fate of oral enzymes in pancreatic insufficiency. Gut. 1993;34:708-12.
  21. Suzuki A., Mizumoto A., Sarr M.G., DiMagno E.P. Bacterial lipase and high-fat diets in canine exocrine pancreatic insufficiency: a new therapy of steatorrhea? Gastroenterology. 1997;112:2048-55.
  22. Kuhn R.J., Eyting S., Henniges F., Potthoff A. In vitro comparison of physical parameters, enzyme activity, acid resistance, and pH dissolution characteristics of enteric-coated pancreatic enzyme preparations: Implications for clinical variability and pharmacy substitution. Pediatr. Pharmacol. Ther. 2007;12:115-28.
  23. Dominguez-Munoz J.E., Iglesias-Garcia J., Iglesias-Rey M., Figueiras A., Vilarino-Insua M. Effect of the administration schedule on the therapeutic efficacy of oral pancreatic enzyme supplements in patients with exocrine pancreatic insufficiency: a randomized, three-way crossover study. Aliment. Pharmacol. Ther. 2005;21:993-1000.
  24. Caliari S., Benini L., Bonfante F., Brentegani M.T., Fioretta A., Vantini I. Pancreatic extracts are necessary for the absorption of elemental and polymeric enteral diets in severe pancreatic insufficiency. Scand. J. Gastroenterol. 1993;28:749-52.
  25. Mössner J., Secknus R., Meyer J., Niederau C., Adler G. Treatment of pain with pancreatic extracts in chronic pancreatitis (c.p.): results of a prospective placebo controlled multicenter trial. Digestion. 1992;53:54-66.
  26. Hausler M., Heimann G., Meilcke R., Biesterfeld S. Fibrosing colonopathy in an adult caused by over use of pancreatic enzyme supplements. Gut. 2000;47:598.
  27. Mayerle J., Hoffmeister A., Werner J., Witt H., Lerch M.M., Mössner J. Chronic pancreatitis -definition, etiology, investigation and treatment. Dtsch. Arztebl. Int. 2013;110:387-93.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies