According to the theory of negative feedback regulation of pancreatic
enzyme secretion by
proteases, treatment with
pancreatic extracts has been proposed to lower
pain in
chronic pancreatitis by decreasing pancreatic duct pressure. We conducted a prospective placebo-controlled double blind multicenter study to investigate the effect of porcine
pancreatic extracts on
pain in
chronic pancreatitis. 47 patients with
pain (41 males, 6 females) due to
chronic pancreatitis documented by sonography, endoscopic retrograde cholangiopancreatography, and CT were included. Exclusion criteria were
steatorrhea above 30 g/day, gastric or pancreatic resections in the history, and serum
bilirubin above 1.5 mg/dl. Patients received
pancreatic extracts (
acid-protected microtablets;
Panzytrat -20,000; 5 x 2 capsules/day;
proteases/
capsule 1,000 Pharmacopoea europaea units) for 14 days followed by treatment with placebo for another 14 days or vice versa.
Pain (graded from 0 to 3) and concomitant use of
analgesics (N-butylscopolaminiumbromide and
tramadol) were recorded by diary. Physical examination and blood chemistry were done at day -1, 15 and 29. Quantitative stool fat was determined at days -2/-1, 13/14 and 27/28. 43 patients completed the studies.
Pain improved in most patients irrespective of whether they started with placebo or verum. There was no significant difference between both treatment arms. We conclude that
pancreatic extracts are not very efficient in lowering
pain.