Pancreatic
steatorrhea and pancreatic diabetes are the dominant symptoms of patients in the decompensated stage of
chronic pancreatitis (CP). In this stage, the nutritional state is greatly disturbed and
hypoglycemia and labile
infection are involved. Pancreatic
enzyme replacement therapy is the principal treatment method for pancreatic
steatorrhea. Before initiating this
therapy,
dietary fat intake must be determined and pancreatic
lipase and
bicarbonate secretion function must be evaluated. Upper small intestinal pH is regulated by gastric acid secretion, and abnormal gastric emptying changes lipolysis. In addition, precipitation of
bile acids in the upper small intestine and ileal brakes due to undigested
fats and
carbohydrates must be considered. Porcine
pancreatin, bacterial
lipase, and
acid-resistant fungal
lipase are used as
enzymes for replacement
therapy. Conventional, entero-coating, and enteric-coated
microsphere preparations of porcine
pancreatin are available for treatment and are formulated to protect against gastric acids, to dissolve
enzymes at optimum pH, and to be emptied simultaneously with food from the stomach. Gastric acid secretion suppressants, such as H2 blockers or a
proton pump inhibitor, can also be used concomitantly with
pancreatin preparations. In consideration of both strengths and weaknesses of these preparations, types and dosages of
enzyme replacement therapy should be carefully prescribed, and fecal
fats should be examined repeatedly by a simple and rapid method during treatment. Attention should also be paid to changes in
body weight and nutritional indices (e.g., nutritional parameters, fat-soluble
vitamins). The relationship between
carbohydrate maldigestion/malabsorption in CP patients and treatment of pancreatic diabetes are topics for future research.