The authors consider the different strategies in long term
enzyme replacement therapy in relation to the complex mechanics at the basis of pancreas exocrine insufficiency. This condition occurs in
chronic pancreatitis and is present in
Cystic Fibrosis, the most common potentially lethal inherited disorder of Caucasians. Pancreatic exocrine insufficiency occurs in the vast majority of
cystic fibrosis affected children and is now becoming a frequent pathology in adults for the better life expectancy and the recent acknowledgements in this disease. The principal aims of research in
enzyme replacement therapy have been directed at the formulation of products with high
enzyme concentration, to the prevention of gastric acid inactivation of
enzymes and to the better mixing of the preparations with meals. The authors consider all the different
enzyme preparations from
pancreatin powder to the 1st. generation of
enteric coated tablets and examine the advantages of administering H-2 receptor antagonists or
antacids and the possibility of stimulating
bicarbonate secretion as an adjunct to pancreatic
enzyme replacement therapy. Significant benefits in
pancreatic insufficiency therapy have derived from the introduction of enteric coated
microspheres which ensure a consistent level of
enzymes to reach the duodenum mixed with the meal and which are resistant to gastric acid inactivation as well.