Creon

Question

How should one start a treatment with pancreatic enzymes ? What parameters to use? Do you only need to take it when you eat fat or also with other foods (vegetables/fruits) so that they are also absorbed better?

Answer

The amount of pancreatic enzymes needed differs between patients. The need is influenced by the fat content in the food, the amount one eats and the degree of fat malabsorption the patient has. The more fat in food or liquids, the more pancreatic enzymes are needed. The dose needs to be adjusted according to the stool pattern and the weight gain of the patient. The dose is mostly calculated on the basis of lipase content. A usual ‘starting dose’ in infants is 3300 units of lipase per milk feed of 120ml. Depending on the improvement in the stools and the weight evolution, the dose is further adjusted. Especially in children with poor weight gain, it is necessary to repeatedly take a dietary history and measure stool fat analysis. If too much fat is lost in the stools, the dose of pancreatic enzymes should be increased. The usual maximal dose is 10.000 units of lipase per kg/day. Beyond that dose one can considered treatment with an ‘acid production inhibitor’ to decrease the acidity in the small intestine and improve the efficacy of the pancreatic enzymes.
If food really does not contain any fat or protein (like some vegetables, water, pure sugar, coca-cola..) it is not necessary to take pancreatic enzymes. But of course, patients with CF just need food with a high fat and protein content. For children with severe malabsorption, it is often advised to take pancreatic enzymes even with fruits and vegetables.
Prof. K. De Boeck

01.12.2011