Exocrine insufficiency in chronic pancreatitis; flexible dosing of pancreatic enzymes improves treatment outcome
Sikkens, E.C.M., Cahen, D.L., Wit, J. de, Looman, C.W.N., Kubben, F., Bruno, M.J.
Voorzitter(s): mw. prof.dr. M.M.E. Schneider, Utrecht & dr. W.G. Meijer, Hoorn
Locatie(s): Zaal 0.11
Categorie(ën):
Introduction: In exocrine insufficiency, pancreatic enzyme supplementation can prevent steatorrhea-related symptoms and malnutrition. The optimal dose varies, according to individual patient characteristics and dietary fat content. However, many patients use a fixed dose regimen. We prospectively evaluated if patient-education and flexible dosing improves treatment efficacy in exocrine insufficiency.
Methods: Between August 2010 and October 2012, chronic pancreatitis patients were included if they were treated with a fixed dose of 25,000 to 150,000 units of lipase per day. During the first 4 weeks of the trial, this fixed dose was continued (phase I). In week 5, patients were educated on flexible dosing, which was applied in the last 4 weeks of the trial (phase II). The faecal fat absorption (CFA) was measured at the end of each phase. The enzyme dose, steatorrhea-related symptoms, BMI, and presence of fat-soluble vitamin deficiencies were assessed at the end of both phases, and after 3 and 6 months. Steatorrhea-related symptoms were assessed with a scoring system, consisting of questions regarding stool frequency, consistency, stickiness, and abdominal cramps and/or flatulence. The scale ranged from 0-8, with higher scores indicating more severe symptoms.
Results: Ten patients were included (50% male; median age 53). With flexible dosing, the CFA went up from 87% to 90%. The mean enzyme dose increased from 3 to 10 capsules per day (p-value < 0.001) and the mean steatorrhea score improved from 5 to 3 (p-value 0.004). Both effects remained present after 3 and 6 months. The BMI did not change during the first 9 weeks of the study (23.5 and 23.7 respectively), but increased significantly after 3 and 6 months (24.5 and 25.0 respectively), compared to phase I (p-values 0.008 and < 0.001, respectively). Fat-soluble vitamin deficiencies, however, had not yet resolved after 6 months.
Conclusion: In exocrine insufficiency, patient-education and flexible enzyme dosing improved steatorrhea related complaints and bodyweight, and should therefore be routinely applied.
- Over Sikkens, E.C.M.
- Over Cahen, D.L.
- Over Wit, J. de
- Over Looman, C.W.N.
- Over Kubben, F.
- Over Bruno, M.J.