The effect of enzyme substitution in patients with pancreatic insufficiency

Concentrations of pancreatic enzymes in the upper intestine during digestion of a meal were studied with and without different preparations of pancreatic extracts in 34 patients with severely decreased exocrine pancreatic function and in 17 patients with a partial gastrectomy (Billroth-II) and very low enzyme concentrations in the efferent loop. Granulated Pankreatin induced a dose-related increase in concentrations of amylase, lipase, and trypsin in the patients studied. The standard dose of 10 ml induced normalization of amylase and trypsin concentrations in a considerable number of patients, whereas the lipase concentration still was far below normal value. The increased concentrations of lipase resulted in a marked reduction of the fecal fat excretion. The induced increase in enzyme concentrations was for all enzymes significantly higher in the partially gastrectomized patients. Eight other pancreatic supplementary preparations were tested; only one of these was able to induce significant increases in enzyme concentrations.