How should we assess the effectiveness of oral supplementation of pancreatic enzymes?
Miroslav Vujasinovic, MD, PhD: The most important thing is not to repeat the fecal elastase test. If fecal elastase is very low, it will not improve, because the fecal elastase test is measuring only the human enzymes, not the artificial enzymes. So fecal elastase is not useful.
We have 3 main aims when treating this group of patients. When we meet the patients for the first time, most of them have weight loss, steatorrhea, diarrhea, and deficiencies in laboratory [test results]. We first want to stabilize the weight or gain weight if it is possible. Secondly, to normalize the stool because it impacts significantly the quality of life. And thirdly, to normalize all parameters in laboratory tests.
If we reach these aims, we are very happy. We are continuing with the same dose and we are talking about a lifelong therapy. If we are not satisfied, we are doubling or tripling the dose.