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Pancreatic enzymes

Question
Hello,
My 7 month old has CF and since he is two months he takes "pancreatic enzymes" at the beginning of each meal... I wonder what are its effects? How do this drug work? Disadvantages? Its risks? Its duration of effectiveness? Under what conditions this medicine is it most effective with enteral nutrition during the night? How to use it with food diversification I started some days ago? Should we give it before each meal even without milk?
Thank you.
Answer
Hello,
Your baby is treated with pancreatic enzymes since the age of two months, when probably the diagnosis of pancreatic insufficiency was done. In Cystic Fibrosis, the abnormal composition of pancreatic secretions is responsible in more than 85% of children for an exocrine pancreatic insufficiency, leading to fat malabsorption. Your child receives pancreatic enzymes to correct this deficiency.
Porcine pancreatic extracts are used; the microgranules are gastroprotected, preventing their destruction by stomach acidity. The pancreatic enzymes are then released into the duodenum and allow the intestinal absorption of fat. Thus, they correct the malabsorption of fats and fat-soluble vitamins, and participate in a good nutritional status.
The tolerance of pancreatic extracts is very good. In infants, it is advisable to check inside the cheeks after feeding, because the microgranules may induce small ulcers in case of prolonged contact. Very rare cases of fibrosing colopathy have been reported in older patients taking high doses of pancreatic extracts. The current European recommendations are therefore to not exceed 10 000 U lipase per kg body weight per day. Finally, although the potential risk of viral transmission by porcin extracts can not be totally excluded, no cases of viral transmission by pancreatic extracts have been reported.
The pancreatic enzymes should be taken at the beginning of any meal containing fat (milk and dairy products, meat, oil, etc ...). If your child eats very slowly, you can give half at the beginning and half at the middle of the meal. If a nocturnal nutrition by tube is performed, the required amount of pancreatic enzymes depends on the product administered. Usually, the microgranules are given in the mouth at the beginning of the nocturnal tube feeding, and if possible at the middle and end of it. Effectiveness will be appreciated on the aspect of stools, the absence of abdominal pain, and the weight gain. Concerning the diversification, it is necessary to adjust the dose of pancreatic enzymes according to the quantity of fat in the meal. Therapeutic education sessions can be provided to help you for this adjustment; you can talk about it with the CF dietician or your doctor.
Sincerely
Dr. Michele Gérardin

Sinaasappel et al in the Journal of Cystic Fibrosis 2002, 1:51-75:”Nutrition in patients with Cystic Fibrosis: a European Consensus.”


19.07.2012