Factors influencing the effectivity of replacement
therapy with
Panpur and
Creon were controlled by in vivo and in vitro investigations. Both enteric coated preparations were equally
acid protected, they even seemed to be more effective in hyperacid than in anacid
chronic pancreatitis patients. Thus the uneven results of
Panpur treatment in pancreatic
steatorrhea cannot be explained by
acid inactivation of the
enzymes.
Creon dose-dependently ameliorated the
steatorrhea as well as
vitamin B12 absorption while crushed but not the intact
Panpur has only some insignificant effect. Good mixing of
pancreatin with the B12-intrinsic factor - R
protein complex and with the
protein containing meal seems to be important for digestion of
protein as well as fat. Unbound, overflowing
trypsin activity of
Panpur resulted in fast proteolytic inactivation of
lipase. This could be diminished by soybean
trypsin inhibitor which increased the in vivo effectiveness of the preparate. In summary
Creon fulfilled two important factors of replacement
therapy more successfully than
Panpur: good mixing with meals and stability of
lipase against proteolytic splitting, that is why it proved to be more effective for replacement
therapy of
pancreatic insufficiency.