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Composition and effects of Creon (Pancreatine)

Does Creon (Pancreatine) only help the digestion of fat or also when the pancreas does not produce enough enzymes to digest proteins (azotorrhea)?

I clarify the question: if you can explain us how it runs, according to the pH level and what about the possible interest of adding some vegetal enzymes like papain or bromelain.

Thank you
The pancreatic enzyme supplements (like Creon) consist of a combination of porcine pancreatic enzymes: lipase, amylase and protease.
In addition to their essential role in the fat absorption by lipase, pancreatic preparations are also involved in protein digestion, through their protease, in addition to the original action of gastric and biliary proteases and intestinal peptidases.
The improvement of the coefficient of nitrogen absorption observed in studies assessing efficacy of Creon versus placebo confirms the involvement of pancreatic enzymes in the process of protein digestion.
The gastro-protected microgranules protect the enzymes from gastric acid pH, and release these enzymes in the duodenum where the alkaline pH supports their action. However, the duodenal pH is on average lower in cystic fibrosis patients due to the poor bicarbonate secretion, which may decrease the efficacy of pancreatic enzymes.
For a maximum efficacy of pancreatic enzymes, good conditions of use are essential, especially for young children: Do not crush or chew the microgranules, provide them at the beginning of the meal, with acid food, do not expose them to heat, do not use after the expiration date.
If symptoms of malabsorption appear despite treatment, the coefficient of fat absorption can be used to verify the good control of pancreatic insufficiency.
The role of vegetal enzymes (papain, bromelain ... proposed as dietary supplements) for the digestion of proteins has never been studied by clinical trials and is not supported by scientific data.
A high stool fat rate leads to re-evaluate the prescription of pancreatic enzyms, re-evaluate the diet with the dietician, and sometimes add a treatment reducing gastric acidity.
Best regards
Dr Michèle Gérardin