Pancreatic
enzyme supplements (PES) are used in
chronic pancreatitis (CP) for correction of pancreatic exocrine insufficiency (PEI) as well as
pain and
malnutrition. The use of porcine pancreatic
enzymes for the correction of exocrine insufficiency is governed by the pathophysiology of the disease as well as pharmacologic properties of PES. Variability in bioequivalence of PES has been noted on in vitro and in vivo testing and has been attributed to the differences in enteric coating and the degree of micro-encapsulation. As a step towards standardizing pancreatic
enzyme preparations, the Food and Drug Administration now requires the manufacturers of PES to obtain approval of marketed formulations by April 2010. In patients with treatment failure, apart from evaluating
drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation. The choice of PES (enteric coated versus non-enteric coated) and the need for
acid suppression should be individualized. There is no current standard test for evaluating adequacy of
therapy in CP patients and studies have shown that optimization of
therapy based on symptoms may be inadequate. Goals of
therapy based on overall patient presentation and specific laboratory tests rather than mere correction of
steatorrhea are needed.