Ineffective oral supplementation of pancreatic enzymes

What should we do when oral supplementation of pancreatic enzymes is ineffective?

Miroslav Vujasinovic, MD, PhD: We double the dose. I always check the compliance of the patients. Unfortunately, there are some patients, especially those with alcoholic etiology, in whom compliancy is not very good, so we must take that into consideration. We also have education, just like I said [see: Supplementation of pancreatic enzymes in chronic pancreatitis], with dieticians.

If we know that the patient is taking the medicine appropriately, then we double the dose and check after approximately 3 months to see the effect. Then the dose is tripled.

We can also add a proton pump inhibitor but I think that acid suppression is not the most important thing in this context.

If a patient is cooperative, we have good success rates in doubling the dose.