[Substitution therapy in insufficient external pancreatic secretion]

Area of Science:

• Gastroenterology
• Endocrinology
• Nutritional Science

Context:

• Exocrine pancreatic insufficiency (EPI) impairs digestion and nutrient absorption.
• Chronic pancreatitis and pancreatic cancer surgery are common causes of EPI.
• Enzyme replacement therapy (ERT) is crucial for managing EPI symptoms.

Purpose:

• To assess and monitor adequate chymotrypsin levels in patients with EPI.
• To determine individual ERT dosage requirements for optimal outcomes.
• To evaluate the clinical efficacy of ERT in improving patient well-being.

Summary:

• Nineteen patients with EPI (17 chronic pancreatitis, 2 post-pancreatectomy) underwent fecal chymotrypsin monitoring.
• Individualized ERT dosage (1.8-7.2g pancreatin/day) achieved adequate substitution (>6U/g faeces).
• ERT led to symptom relief (pain, diarrhea), improved nutrition, arrested weight loss, and reduced insulin requirements in diabetics.

Impact:

• Demonstrates the effectiveness of personalized enzyme therapy for EPI.
• Highlights the importance of monitoring fecal chymotrypsin for treatment adequacy.
• Shows ERT improves quality of life and metabolic control in EPI patients.