Su1140 Exocrine Insufficiency in Chronic Pancreatitis; Flexible Dosing of Pancreatic Enzymes Improves Treatment Outcome

Abstract

In exocrine insufficiency, pancreatic enzyme supplementation can prevent malnutrition and steatorrhea-related symptoms. Although the optimal dose varies according to dietary fat content and individual patient characteristics, many patients are prescribed a fixed dose. We prospectively evaluated if patient-education on flexible dosing improves treatment efficacy in exocrine insufficiency due to chronic pancreatitis. Between August 2010 and October 2012, exocrine insufficient patients using a fixed enzyme dose of 1 to 6 capsules per day were included. In the first 4 weeks of the trial (phase I), patients continued this dose. In week 5, patients were educated in flexible dosing (depending on the fat intake and presence of steatorrhea, patients varied the amount of capsules up to a maximum of 16 per day), which was applied in the last 4 weeks of the trial (phase II). During the study, patients were treated with Panzytrat25000 containing 25,000 units of lipase. The faecal fat absorption (CFA) was measured at the end of phase I and II. The enzyme dose, steatorrhea-related symptoms, and BMI were assessed at the end of phases I and II, and after 3 and 6 months. Symptoms of steatorrhea were assessed with a scoring system, consisting of questions regarding stool frequency, consistency, stickiness, and abdominal cramps and/or flatulence. The scale ranged from 0-8, with higher scores indicating more severe symptoms. Ten patients were included (50%male; median age of 53).With flexible dosing, the median CFA improved from 87% to 90% (p value 0.23, Table 1). The mean enzyme dose increased from 3 to 10 capsules per day and steatorrhea-related symptoms improved. Both effects were significant and persistent in the longer term. BMI did not change during the first 9 weeks, but significantly improved thereafter. In exocrine insufficiency, patient-education on flexible dosing increased the daily enzyme dosage and improved treatment efficacy. Therefore, it should be routinely applied in enzyme supplementation therapy. Table 1. Treatment outcomes during the fixed and flexible treatment phases, and after 3 and 6 months follow-up