Fibrosing colonopathy

Question

Dear expert team,
I would like to know, if there are any differences between preparations concerning the fibrosing colonopathy. Before I used to have Kreon®, however had to switch to Pangrol® due to the costs.
Is there probably a stronger tendency to fibrosing colonopathy when taking Pangrol®?
Many thanks for your answer.

Answer

Dear questioner,
as you turn to the CF-expert team we assume, that you are suffering from CF and we will answer your question under this assumption.
You want to know, if there is a relationship between certain preparations of pancreatic enzymes and the occurrence of fibrosing colonopathy. In the early 90ties, the intake of higher dosages of lipase units had been correlated with the occurrence of fibrosing colonopathy. There were observations, that there was no association with Kreon® 25.000 however indeed with other preparations for an increased risk of the occurrence of fibrosing colonopathy. Further clinical and scientific investigations revealed, however, that the worldwide cases with strictures of the colon occurred while taking pancreatic enzyme preparations with a very high lipase content and not while taking certain preparations. The fibrosing colonopathy has become more rare since the upper limit of the dosage has been introduced.
Kreon® and Pangrol® contain the same amount of lipase units and can in general be used alternatively in the adjusted dosage from CF patients. The preparations differ in the amount of amylase and protease. This however, has no influence on the impaired digestion of fat of CF patients.
A second difference is the size of the small pellets that are in the capsules.
Pangrol® 25.000 are gastric acid resistant capsules filled with minitablets. These minitablets are cylindric and 2mm x 2.4 mm to 3.3 mm in size. They are therefore larger than the pellets in Kreon®, can however also be mixed with puree. Pangrol® 40.000 are capsules filled with pellets of different size. Kreon® contains mini-micropellets with an average diameter of about 1.2mm, therefore smaller than those in Pangrol®. Due to the different sizes of the pellets, some patients have a better effect with Kreon®, this is however not the rule.
I hope to have helped you with my remarks and stay with my best regards,
Yours,
Dr. Christina Smaczny

22.12.2014