Assessment of adequacy of pancreatic enzyme replacement with the multiple-phase carbon-14-triolein test

The carbon-14-triolein absorption test was used to investigate fat absorption and its response to pancreatic enzyme replacement therapy in 10 men with pancreatic steatorrhoea. Absorption was increased in all, from 1,14 +/- 1,2% of the dose per hour (group mean +/- SD) to 2,85 +/- 2,33% (P less than 0,01) by the simultaneous administration of 8 tablets of enteric-coated pancreatic enzymes (Nutrizym; Merck). In patients with normal or high gastric acid secretion, neutralization of gastric acid with 30 ml magnesium trisilicate had no effect on absorption while the addition of an extract of gastric secretions (Enzynorm; Noristan) to the therapy of the 1 achlorhydric patient improved absorption from 2,2% to 3,81%. The 14C fat test offers a rapid and more acceptable alternative method for determining individual response to pancreatic enzyme replacement therapy than the conventional 72-hour faecal fat excretion measurement. The enteric-coated pancreatin preparation used in this study appears to be optimally effective under conditions of normal gastric acid secretion.