[Dose-dependent effect of pancreatin replacement upon the pancreatic function in the period after pancreatic surgery]

Disturbance of the exocrine function can persist for several weeks following pancreatic surgery. Active proteases in the duodenal lumen may help to recover exocrine function, but the effect can depend on dosage.

A placebo-controlled trial of enteric-coated pancreatin (Kreon 25,000 U lipase [A] and Kreon 10,000 U lipase [B]; 3 x 1 caps/day) was performed for 2 weeks following pancreatic surgery (resection or drainage operation in each group). A total of 60 patients were randomized, 20 to A and B pancreatin groups each, and 20 to the placebo group. We tested exocrine function via faecal elastase determinations, amylum tolerance test (ATT) and checks on the symptoms of maldigestion.

After medication for 10 days, in group A there was evidence of the beneficial effect of pancreatin suggested by 35% improvement in ATT, unchanged body weight and disappearance of maldigestion. In group B, positive influence of pancreatin was confirmed only in those patients who underwent drainage operation, with moderate improvement of the symptoms of maldigestion and an almost unchanged body weight. In the control group and in resected patients in group B, abnormal ATT and maldigestion remained, while average body weight decreased by 3.5 kg. In all groups, no significant change was noted in the elastase concentration.

The results suggest that dose-dependent enteric-coated pancreatin treatment after pancreatic surgery may lead to rapid improvement in the exocrine pancreatic function, probably by reducing the cholecystokinin response to food stimulation. This is an important indication for enteric-coated pancreatin medication.