Pancreatic enzyme therapy for pancreatic exocrine insufficiency

被引：111

作者：

Domínguez-Muñoz J.E. ^{[1
]}

机构：

[1] Department of Gastroenterology, University Hospital of Santiago de Compostela, E-15706-Santiago de Compostela, C/Choupana, s/n

来源：

Current Gastroenterology Reports | 2007年 / 9卷 / 2期

关键词：

Lipase; Chronic Pancreatitis; Pancreatic Enzyme; Steatorrhea; Pancreatic Exocrine Insufficiency;

D O I：

10.1007/s11894-007-0005-4

中图分类号：

学科分类号：

摘要：

Pancreatic exocrine insufficiency with steatorrhea is a major consequence of pancreatic diseases (eg, chronic pancreatitis, cystic fibrosis, severe acute necrotizing pancreatitis, pancreatic cancer), extrapancreatic diseases such as celiac disease and Crohn's disease, an gastrointestinal and pancreatic surgical resection. Recognition of this entity is highly relevant to avoid malnutrition-related morbidity and mortality. Therapy for pancreatic exocrine insufficiency is based on the oral administration of pancreatic enzymes aiming at providing the duodenal lumen with sufficient active lipase at the time of gastric emptying of nutrients. Administration of enzymes in the form of enteric-coated minimicrospheres avoids acid-mediated lipase inactivation and ensures gastric emptying of enzymes in parallel with nutrients. Nevertheless, such factors as acidic intestinal pH and bacterial overgrowth may prevent normalization of fat digestion even in compliant patients. The present article critically reviews current therapeutic approaches to pancreatic exocrine insufficiency. Copyright © 2007 by Current Medicine Group LLC.

引用

页码：116 / 122

页数：6

共 47 条

[1]

Layer P., Go V.L.W., DiMagno E.P., Fate of pancreatic enzymes during aboral small intestinal transit in humans, Am J Physiol, 251, (1986)

[2]

Holtmann G., Nelly D.G., Sternby B., DiMagno E.P., Survival of human pancreatic enzymes during small bowel transit: Effects of nutrients, bile acids and enzymes, Am J Physiol, 273, (1997)

[3]

DiMagno E.P., Malagelada J.R., Go V.L.W., Moertel C.G., Fate of orally ingested enzymes in pancreatic insufficiency: Comparison of two dosage schedules, N Engl J Med, 296, pp. 1318-1322, (1977)

[4]

DiMagno E.P., Go V.L.W., Summerskill W.H.J., Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency, N Engl J Med, 288, pp. 813-815, (1973)

[5]

Lankisch P.G., Lembcke B., Wemken G., Creutzfeldt W., Functional reserve capacity of the exocrine pancreas, Digestion, 35, pp. 175-181, (1986)

[6]

Carriere F., Renou C., Ransac S., Et al., Inhibition of gastrointestinal lipolysis by Orlistat during digestion of test meals in healthy volunteers, Am J Physiol, 281, (2001)

[7]

Carriere F., Renou C., Lopez V., Et al., The specific activities of human digestive tipases measured from in vivo and in vitro lipolysis of test meals, Gastroenterology, 119, pp. 949-960, (2000)

[8]

Carriere F., Grandval P., Renou C., Et al., Quantitative study of digestive enzyme secretion and gastrointestinal lipolysis in chronic pancreatitis, Clin Gastroenterol Hepatol, 3, pp. 28-38, (2005)

[9]

Carriere F., Grandval P., Gregory P.C., Et al., Does the pancreas really produce much more lipase than required for fat digestion?, JOP, 6, pp. 206-215, (2005)

[10]

Ihse I., Arnesjo B., Kugelberg C., Et al., Intestinal activities of trypsin, lipase, and phospholipase after a test meal. An evaluation of 474 examinations, Scand J Gastroenterol, 12, pp. 663-668, (1977)

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