scholarly journals Differentiated approach to replacement therapy in exocrine pancreatic insufficiency

2020 ◽  
Vol 47 (2) ◽  
pp. 37-49
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
A.Ye. Klochkov ◽  
G. M. Lukashevich ◽  
P. G. Fomenko
Keyword(s):  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Skin Irritation ◽  
Exocrine Pancreatic Insufficiency ◽  
Severe Exacerbation ◽  
Enzyme Preparations ◽  
Enzyme Replacement ◽  
Malabsorption Syndromes ◽  
Unpleasant Odor ◽  
Bladder Diseases

The article is an overview of current ideas about indications and features of various enzyme preparations (EP). The following requirements are applied for all EP: nontoxicity, resistance to hydrochloric acid and pepsin, good tolerance by patients, no significant side effects, optimal effect at pH≈6.0, rapid release of enzymatic activity in the small intestine at pH≈6.0, while maintaining this activity no less than 2 hours, high enzyme activity, compliance with the composition stated on the label, high serial homogeneity of the preparation, no unpleasant odor and taste. Considering the variety of pathogenetic mechanisms and nosological units that occur with maldigestion and malabsorption syndromes, the spectrum of indications for EP is rather wide: pancreatic, liver, gall bladder diseases, preparation for instrumental studies, etc. The authors present a modern algorithm (“steps”) of enzyme therapy. A differentiated approach to the choice of EP is developed depending on the pathology that the patient suffers from, EP composition, and features of its action. Attention is drawn to the possible reasons for the lack of effectiveness of replacement therapy, general contraindications to the prescription of EP (acute pancreatitis, severe exacerbation of chronic pancreatitis, hypersensitivity to the drug components) and their individual components (bile acids, nicotinamide, activated charcoal). Complications of enzyme replacement therapy are indicated, namely: pain in the oral cavity; skin irritation in the perianal region; abdominal discomfort; nausea; fibrosing colopathy; allergic reactions; sometimes hyperuricosuria; pancreatin shaping complexes with folic acid, disrupting its absorption.

scholarly journals Pancreatology: debunked myths

2020 ◽  
Vol 48 (3) ◽  
pp. 44-53
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva
Keyword(s):  
Chronic Pancreatitis ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Overweight And Obesity ◽  
Evidence Based ◽  
Enzyme Preparations ◽  
Enzyme Replacement ◽  
European Guidelines ◽  
Relieve Pain

Enzyme replacement therapy is not always effective enough upon exocrine pancreatic insufficiency. One of the main reasons is myths — doctors’ misconceptions about the indications and rules of replacement therapy. In particular, there is an outdated opinion about the effectiveness of tablet enzyme preparations used for the relief of pancreatic pain. However, a number of evidence-based studies have proved that enzyme preparations are not effective enough to relieve pain in chronic pancreatitis, and thus should not be used for this purpose. This statement is recorded in the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis, as well as in the recommendations of the American College of Gastroenterology. In addition, tablet preparations are characterized by asynchronism of the passage of the chyme and the tablet along the digestive tract. The second myth is that drugs without an acid-resistant coat start hydrolyzing the components of the chyme in the stomach, which ensures higher efficiency as compared to Creon. But in the absence of a coat, enzymes are inactivated in the acidic environment of the stomach and cannot have any effect at all. The third myth is that enzyme preparations always cause constipation. In fact, constipation occurs in no more than 10% of cases. They are usually associated with an overdose of the drug, concomitant pathology or insufficient compliance. The fourth myth is that prescribing the doses of enzyme preparations indicated in the European Guidelines causes addiction. It is crucial to know that such doses do not exceed 10% of the pancreas’s own capacities, therefore, they cannot significantly affect these capabilities, which is also demonstrated by evidence-based studies. The fifth myth is that patients gain weight because of enzyme preparations, and they should not be prescribed upon overweight and obesity. Numerous data firmly show that pancreatic insufficiency often occurs in such cases, and enzyme preparations are required. The sixth myth is that a drug with a different composition can be produced under the usual established product name. For example, NEO is added to the name to “mask” a drug with a new composition. Doctors should carefully monitor the composition of such drugs. The seventh myth is that a minimicrospherical preparation (Creon) is as effective as microspherical preparation. However, this statement turned out to be a myth as well. Minimicrospherical preparations are proved to be significantly more effective in clinical practice. Thus, the above-mentioned myths, like many others, are based on insufficient knowledge in the field of pancreatology.

scholarly journals Enzyme replacement therapy, life quality and expectancy of patients with chronic pancreatitis and exocrine pancreatic insufficiency

2018 ◽  
Vol 41 (3) ◽  
pp. 10-16
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
А. Y. Klochkov ◽  
G. М. Lukashevich ◽  
P. G. Fomenko ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Life Quality ◽  
Exocrine Pancreatic Insufficiency ◽  
Enzyme Preparations ◽  
Enzyme Replacement ◽  
Enteric Coated ◽  
Adequate Dosage

The article reviews the evidence-based studies devoted to the evaluation of the efficacy and safety of enzyme replacement therapy in patients with chronic pancreatitis with exocrine pancreatic insufficiency. Particular attention is paid to the effect of replacement therapy on the life quality and expectancy of patients. It has been proven that the correct prescription of enzyme preparations (minimicrosphere enteric-coated preparation, adequate dosage) improves the quality and prolongs the life of patients.

Chronic giardiasis: a rare cause of exocrine pancreatic insufficiency

2021 ◽  
Vol 14 (5) ◽  
pp. e242129
Author(s):  
Prateek Pophali ◽  
Maedeh Veyseh ◽  
Omar Fraij ◽  
Sahan Hapangama
Keyword(s):  
Clinical Practice ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Exocrine Pancreatic Insufficiency ◽  
Common Condition ◽  
Enzyme Replacement ◽  
Malabsorption Syndromes ◽  
Pancreatic Enzyme Replacement Therapy

Exocrine pancreatic insufficiency (EPI) is a major cause of maldigestion/malabsorption syndromes. It is routinely diagnosed in clinical practice with the use of faecal elastase 1 levels, and pancreatic enzyme replacement therapy continues to be the mainstay of treatment. Numerous primary pancreatic and extrapancreatic causes for EPI have been established. Chronic giardiasis is a common condition with symptoms similar to EPI; however, it has also been described as an infrequent cause of EPI. Much remains to be understood about the pathobiology of this association. Here, we present our experience of an intriguing case of severe pancreatic insufficiency in the setting of chronic giardiasis. The patient showed improvement in symptoms over weeks after completion of treatment for chronic giardiasis.

scholarly journals Evidence-based pancreatology 2018 (review of research results on diseases and exocrine pancreatic insufficiency)

2019 ◽  
Vol 43 (2) ◽  
pp. 4-14
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
A. Ye. Klochkov ◽  
G. M. Lukashevich ◽  
P. G. Fomenko ◽  
...  
Keyword(s):  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Bacterial Overgrowth ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Tumors ◽  
Research Results ◽  
Enzyme Replacement ◽  
Pancreatic Pathology

The article presents a detailed review of the research results in the field of pancreatology published in 2018. Certain parts of the review are devoted to the pathogenesis, diagnostics, course of pancreatitis, its treatment, as well as autoimmune, hereditary pancreatitis, pancreatic pathology in children, as well as treatment. In studying the pathogenesis of pancreatitis, attention is paid to genetic markers of pancreatitis along with a role of bacterial overgrowth syndrome in the small intestine, both in terms of worsening of the course of pancreatitis and the lack of effectiveness of enzyme replacement therapy. The study of the role of alcohol abuse and smoking in the pathogenesis of pancreatic pathology is still in progress. Diagnostics is going on. Endosonography remains the most informative method. A number of studies have been devoted to the studying of exocrine and endocrine pancreatic insufficiency both upon pancreatitis, pancreatic tumors, and in functional dyspepsia and HIV infection. Autoimmune pancreatitis is increasingly being diagnosed, a number of studies are devoted to its diagnostics and treatment. Pancreatic diseases in children develop mainly on the background of genetic predisposition, while functional pancreatic insufficiency occurs in adult patients. The study of the peculiarities of the effect of enzyme replacement therapy continues. The immediate and remote results of the surgical treatment of pancreatic pathology are assessed.

scholarly journals COMPARING THE ENZYME REPLACEMENT THERAPY COST IN POST PANCREATECTOMY PATIENTS DUE TO PANCREATIC TUMOR AND CHRONIC PANCREATITIS

2016 ◽  
Vol 53 (2) ◽  
pp. 94-97 ◽  
Author(s):  
Anna Victoria FRAGOSO ◽  
Martha Regina PEDROSO ◽  
Paulo HERMAN ◽  
André Luis MONTAGNINI
Keyword(s):  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Gastrointestinal Surgery ◽  
Exocrine Pancreatic Insufficiency ◽  
Intractable Pain ◽  
Enzyme Replacement ◽  
Significant Difference

ABSTRACT Background - Among late postoperative complications of pancreatectomy are the exocrine and endocrine pancreatic insufficiencies. The presence of exocrine pancreatic insufficiency imposes, as standard treatment, pancreatic enzyme replacement. Patients with chronic pancreatitis, with intractable pain or any complications with surgical treatment, are likely to present exocrine pancreatic insufficiency or have this condition worsened requiring adequate dose of pancreatic enzymes. Objective - The aim of this study is to compare the required dose of pancreatic enzyme and the enzyme replacement cost in post pancreatectomy patients with and without chronic pancreatitis. Methods - Observational cross-sectional study. In the first half of 2015 patients treated at the clinic of the Department of Gastrointestinal Surgery at Hospital das Clínicas, Universidade de São Paulo, Brazil, who underwent pancreatectomy for at least 6 months and in use of enzyme replacement therapy were included in this series. The study was approved by the Research Ethics Committee. The patients were divided into two groups according to the presence or absence of chronic pancreatitis prior to pancreatic surgery. For this study, P<0.05 was considered statistically significant. Results - The annual cost of the treatment was R$ 2150.5 ± 729.39; R$ 2118.18 ± 731.02 in patients without pancreatitis and R$ 2217.74 ± 736.30 in patients with pancreatitis. Conclusion - There was no statistically significant difference in the cost of treatment of enzyme replacement post pancreatectomy in patients with or without chronic pancreatitis prior to surgical indication.

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