Enzyme Substitution in Chronic Pancreatitis: Effects on Clinical and Functional Parameters and on the Hydrogen (H₂) Breath Test

Abstract

Ten patients with chronic pancreatitis (with abdominal pain and/or diarrhoea) were treated in a double-blind multiple cross-over trial with Pankreon granules 20 g per day or placebo during three periods of one month each. Pain and bowel habits were recorded. Faecal fat and breath hydrogen (H₂) excretion were analyzed during the last days of each treatment period. The pain score was initially low in all patients and was not affected by enzymes. The number of daily bowel movements was reduced from 3.16 to 2.32 (n.s.). Faecal fat excretion per 72hrs was reduced from 357 158 mmol free fatty acid to 226 98 mmol (p < 0.05). With placebo treatment H2 excretion (from 60 and 180min after a standard breakfast) was significantly increased compared with 19 healthy volunteers (p<0.05). It was not significantly reduced by enzymes. In 28 comparisons the H: output between 60 and 180 min was correlated to faecal fat. In eight patients the oro-coecal transit-time could be determined by the H₂ breath test. The transit-time did not differ from that of ten healthy volunteers and remained unchanged by enzymes. Carbohydrate maldigestion occurs parallel to fat maldigestion in chronic pancreatitis, and is not sufficiently reduced by 20 g of pancreatic enzymes.

Key Words:

• Carbohydrates
• pancreatitis
• chronic
• hydrogen breath test
• maldigestion
• steatorrhoea
• substitution therapy