Question

Assessment of adequacy of pancreatic enzyme supplementation

Answer 1

More than 90% of people who have CF take pancreatic enzyme replacements. Enzymes should be taken just before meals and snacks. For older children and adults, the capsules should be taken with liquid and swallowed whole.

Answer 2

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Digestive enzymes are able to break down proteins and carbohydrates and lipids, and their supplementation may play a role in the management of digestive disorders, from lactose intolerance to cystic fibrosis. To date, several formulations of digestive enzymes are available on the market, being different each other in terms of enzyme type, source and origin, and dosage.

Methods:

This review, performed through a non-systematic search of the available literature, will provide an overview of the current knowledge of digestive enzyme supplementation in gastrointestinal disorders, discussion of the use of pancreatic enzymes, lactase (β-galactosidase) and conjugated bile acids, and also exploring the future perspective of digestive enzyme supplementation.

Results:

Currently, the animal-derived enzymes represent an established standard of care, however the growing study of plant-based and microbe-derived enzymes offers great promise in the advancement of digestive enzyme therapy.

Conclusion:

New frontiers of enzyme replacement are being evaluated also in the treatment of diseases not specifically related to enzyme deficiency, whereas the combination of different enzymes might constitute an intriguing therapeutic option in the future.

Keywords: Bile acids, celiac disease, enzyme supplementation, gastrointestinal disease, lactose intolerance, pancreatic insufficiency.

INTRODUCTION

Digestive enzymes are produced and secreted by the gastrointestinal system to degrade fats, proteins, and carbohydrates, to accomplish the digestion and, afterwards, the absorption of nutrients. Their supplementation, when indicated, may provide a reliable help as an adjuvant treatment of several disorders characterized by an impairment of digestive functions. To date, various formulations of enzyme supplementation are available on the market, and they are currently used in clinical practice for the management of several digestive diseases, especially those involving organs designated to the production of digestive enzymes, including the exocrine pancreas (which produces pancreatic enzymes) and the small intestinal brush border (which produces lactase).
Pancreatic enzyme supplementation is the therapy of choice for the management of exocrine pancreatic insufficiency (EPI) in chronic pancreatitis, pancreatic cancer, cystic fibrosis (CF) or diabetes [1-6].
Another relevant application of enzyme supplementation in the clinical practice is the management of lactose intolerance. It is estimated that 75 percent of individuals worldwide experience hypolactasia, or some decrease of lactase activity, especially during adulthood