The pancreas is the unsung hero of your digestive system. Nestled safely behind your stomach and in front of your spine, your pancreas secretes more than 1.5 quarts of fluid into your small bowel each day. Digestive enzymes that break down dietary proteins, fats and carbohydrates account for much of the pancreatic fluid. With chronic pancreatitis, inflammation and scarring reduce digestive enzyme production to critically low levels, necessitating enzyme replacement therapy. Doctors determine the effectiveness of treatment by the assessing physical signs and symptoms of your disease and biochemical indicators of your nutritional status.
Stabilization of Body Weight
Incomplete food digestion associated with chronic pancreatitis commonly leads to malnourishment and weight loss due to loss of nutrients, especially fats, in your stool. Effective pancreatic enzyme replacement therapy ideally resolves malnourishment as you regain the ability to digest and absorb the food you eat. Increased absorption of calorie-rich nutrients stabilizes your body weight and halts unintentional weight loss. If you are underweight, effective enzyme replacement therapy combined with a high-calorie nutrition plan may help you increase your body weight.
Fewer Bowel Movements
With chronic pancreatitis, insufficient production of fat-digesting enzymes leads to abnormally high levels of fat in your stool. Physiologist Lauralee Sherwood, Ph.D., reports in the text "Human Physiology: From Cells to Systems" that roughly 60 to 70 percent of ingested fat is lost in the stool with pancreatic enzyme deficiencies. Excretion of excessive fat in the stool, or steatorrhea, leads to diarrhea and increased stool volume. With effective pancreatic enzyme replacement therapy, fat digestion and absorption resume in your small bowel and, as a result, stool fat levels fall to normal or near normal levels. The reduced level of fat in your stool leads to fewer bowel movements and decreased stool volume.
Normal Stool Characteristics
Undigested fat imparts stool with abnormal characteristics, including an oily or greasy appearance, the tendency to float in water, and an unusually offensive odor. Oily fluid may also leak from your anus between bowel movements. Correction of impaired fat digestion with pancreatic enzyme replacement therapy reduces the amount of fat in your stool and partially or completely corrects these stool abnormalities, depending on the effectiveness of your therapy. Your doctor may order a laboratory test to measure the amount of fat in your stool to assess your response to treatment.
Reduced Abdominal Pain
Chronic pancreatitis is characterized by seepage of digestive enzymes into the pancreatic tissue and its related cell destruction. This self-digestion of the pancreas and the associated inflammation proves intensely painful for most people. Alleviating pancreatic pain is a focal point of chronic pancreatitis management, along with correction of digestive and nutritional abnormalities. Enzyme supplements reduce abdominal pain in some chronic pancreatitis patients by reducing enzyme production, thereby averting self-digestion of the pancreatic tissue. Pain may persist, however, despite effective correction of impaired fat digestion. If enzyme therapy fails to relieve the pain of chronic pancreatitis, your doctor may prescribe pain medication or recommend surgery to alleviate your discomfort.
Normal Nutrition Markers
In a March 2010 article published in the "Journal of the Pancreas," Dr. Enrique Domínguez-Muñoz and colleagues reported that malnutrition often persists despite the alleviation of fatty diarrhea and weight loss with pancreatic enzyme replacement therapy. Your doctor may order blood tests to check the levels of various proteins that indicate your nutritional status, including your pre-albumin, albumin, retinol-binding protein and transferrin. With effective pancreatic enzyme replacement therapy, the levels of these blood proteins will normalize as your nutritional status improves.
Tip
Enzyme replacement therapy for chronic pancreatitis often requires a series of adjustments to optimize treatment. Working closely with your healthcare team and communicating candidly about any symptoms and problems you may experience during therapy will help your doctor make timely and appropriate adjustments to your management plan.
References
- "Modern Nutrition in Health and Disease"; Maurice Edward Shils, M.D., Sc. D., et al.; 2005
- National Institute of Diabetes and Digestive and Kidney Diseases: Pancreatitis
- "The Merck Manual for Healthcare Professionals"; Chronic Pancreatitis; Steven D. Freedman, M.D., Ph.D.; August 2007
- "Human Physiology: From Cells to Systems"; Lauralee Sherwood, Ph.D.; 2009
- "Harrison’s Principles of Internal Medicine, 16th Edition"; Dennis L. Kasper, M.D., et al., Editors; 2004
- "American Family Physician"; Chronic Pancreatitis; Rajasree J. Nair, M.D., et al.; December 2007
- "Journal of the Pancreas"; Oral Pancreatic Enzyme Substitution Therapy in Chronic Pancreatitis: Is Clinical Response an Appropriate Marker for Evaluation of Therapeutic Efficacy?; J. Enrique Domínguez-Muñoz, M.D., Ph.D., et al.; March 2010
- "Clinical Gastroenterology and Hepatology"; Chronic Pancreatitis and Persistent Steatorrhea: What Is the Correct Dose of Enzymes?; J. Enrique Domínguez-Muñoz, M.D., Ph.D.; March 2011
- "Clinical and Experimental Gastroenterology"; Enzyme Replacement Therapy for Pancreatic Insufficiency: Present and Future; Aaron Fieker, D.O., et al.; May 2011
