Supplementation of pancreatic enzymes in chronic pancreatitis

When and in what doses should we prescribe oral supplementation of pancreatic enzymes in patients with chronic pancreatitis?

Miroslav Vujasinovic, MD, PhD: I think that it is a very important part of [the guidelines from United European Gastroenterology] because we are starting with higher doses than before. If we take into consideration that healthy pancreas is producing between 1 million and 2 million units per day, we know that these patients have a little bit more units of enzymes, so we are starting with 40,000 to 50,000 units. We said 40,000 to 50,000 because the drug is available on different European markets in different packages. We have 10,000, 25,000, and 40,000 units. Some countries have no possibility of using 40,000 so they are taking 2 capsules of 25,000. It is approximately 40,000 to 50,000 per main meal and 25,000 or half of the dose for a snack.

It is very important to emphasize that the patients should not reduce the intake of fat. Recently, we recommended patients to avoid fat, but now we changed the concept because we know from the dieticians’ point of view it is very important that the patient has normal food.

We try hard to educate the patients to understand the nature of their disease and why it is important for them to take pancreatic enzyme replacement therapy. Right now I recommend to my patients to increase the dose [of enzymes] if they are eating some fatty food, for example, 1 or 2 capsules more. And this is the start. After that, after approximately 2 to 3 months, we evaluate the effect of the therapy.