Pancreatic enzyme replacement therapy

Kasos enzymes – lipase, amylase, and protease, e.g., trypsin, chymotrypsin, – help digest fats, carbohydrates, and proteins. Their insufficiency can cause malabsorption. Patients need to be informed about effective replacement therapy with enzymes (e.g. “Pangrol”).
• To solve the malabsorption problem, the dose of enzymes must be adjusted according to what is eaten.
– Enzymes should be taken with all food products containing fats, proteins, or starchy carbohydrates, e.g., meals and snacks. When eating sweet food products that do not contain fats and proteins, enzyme replacement therapy is not necessary.
– Enzymes should be strictly taken just before eating or at the beginning of a meal.
• Enzymes are sensitive to high temperatures, so they should not be mixed with hot food and drinks.
• Enzymes are sensitive to stomach acid (pH < 4). A capsule with microspheres or the microspheres of a broken capsule should be swallowed without chewing, as stomach acid denatures the enzymes.
• H2 antagonists are prescribed to reduce stomach secretion and improve the effect of enzyme replacement therapy (e.g. “Raniberl”).
• The side effects of high-strength preparations are associated with the development of colonic strictures in children under 13 years old. The dose should not exceed 15,000-20,000 units of lipase / kg body weight / per day. Drink enough fluids, monitor if the symptoms of the disease have not worsened.

Source | Dietary Treatment in General Practice | Dietitian Doctor Jūratė Dobrovolskienė