Pancreatic Replacement Therapy - Managing Pancreatic Insufficiency

Introduction

Pancreatic replacement therapy helps digest protein, fat, and carbohydrates in food. Diseases that affect the pancreas, such as pancreas cancer, pancreatitis (inflammation of the pancreas), surgeries, and cystic fibrosis, block the release of the number of digestive enzymes produced by the pancreas. Pancreatic replacement therapy helps manage the symptoms of indigestion, such as diarrhea and weight loss. The therapy contains capsules of enzymes that aid in digestion. They help cope with chemotherapy and surgery. Managing problems with diet and digestion can make a big difference in how a person feels. This article describes the role of pancreatic enzymes and the importance of pancreatic replacement therapy.

What Is Pancreas?

The pancreas is a gland surrounded by the liver, small intestine, spleen, and gallbladder. They help in blood sugar regulation and digestion. Pancreas is both an exocrine and endocrine gland. The exocrine part of the pancreas contains ducts that secrete pancreatic enzymes that lead to a pancreatic duct. The pancreatic duct carries pancreatic enzymes and secretions called pancreatic juice. The endocrine part secretes hormones that are ductless. The endocrine part produces insulin that helps regulate blood glucose levels. Besides the pancreas, the endocrine system includes the hypothalamus, adrenal glands, testes, ovaries, pineal gland, thymus, pituitary gland, thyroid, and parathyroid gland.

Doctors will prescribe pancreatic enzyme replacement therapy (PERT) for people with pancreatic insufficiency. PERT medications include digestive enzymes that include lipase, which breaks down fats, amylase for carbohydrates, and protease, which helps with protein digestion.

What Are Pancreatic Enzymes and Their Functions?

Pancreas is a double-function organ that has both exocrine and endocrine functions. The daily secretion of pancreatic juice is 1200 to 1500 mL. It is a transparent and colorless fluid that is isotonic with plasma. The pancreatic juice contains pancreatic alpha-amylase and pancreatic lipase.

The pancreatic enzymes are lipase which breaks down fats and proteins. The pancreatic lipase hydrolyzes neutral fats to glycerol esters and fatty acids. Another pancreatic lipase that is activated by bile salts catalyzes the hydrolysis of cholesterol esters, triglycerides, and phospholipids.

• The pancreatic proteolytic enzymes are powerful protein enzymes in the pancreatic juice and are secreted as inactive proenzymes. Trypsin is the most potent proteolytic enzyme in pancreatic juice. It hydrolyses the proteins into small polypeptides. The chymotrypsin digests the protein into small polypeptides. The deoxyribonuclease splits the nucleic acids into nucleotides. Trypsin inhibitor is secreted by acinar cells and at pancreatic enzymes protects the pancreas from autodigestion.

• The two gastrointestinal hormones cholecystokinin (pancreozymin) and secretin, on liberation into the portal circulation, reach the pancreatic tissue to stimulate the secretion of pancreatic juice.

• The small intestine helps in the digestion of fats, carbohydrates, and proteins. The intestinal contents are mixed with intestinal juice. Erepsin is a mixture of several mixtures of peptidases, nuclease, and related enzymes. The small intestine contains intestinal juice that contains disaccharides.

What Are Exocrine Pancreatic Insufficiency?

In exocrine pancreatic insufficiency, the pancreas does not produce digestive enzymes. This leads to malnutrition and weight loss. The pancreas is damaged to the point where the proteins, fats, and carbohydrates are not digested properly. During exocrine pancreatic insufficiency, there is not enough digestive enzyme in the pancreas. Hence, the food passes through the intestine in an undigested state so the body does not get nutrients from the food. The significant cause in children is cystic fibrosis. In cystic fibrosis, there is a build-up of mucus in the lungs. This mucus collects in the pancreas, preventing digestive enzymes from reaching the small intestine. The main cause of pancreatic insufficiency are:

• Diabetes.

• Pancreatic cancer.

• Celiac disease (disease of the digestive system caused by a protein called gluten).

The symptoms of exocrine pancreatic insufficiency include:

• Diarrhea.

• Fatty stools.

• Abdominal pain.

• Constipation.

• Weight loss.

What Is Pancreatic Replacement Therapy?

• Pancreatic enzyme replacement therapy replaces the enzymes of the pancreas.These medications help in nutrient absorption and digestion.

• In this therapy, medications are taken by the patient to replace the enzymes of the pancreas. Pancrelipase is a mixture of protease, lipase, and amylase, which is a mixture of digestive juices from the pancreas.

• They help break down protein, fat, and carbohydrates. People with pancreatic exocrine insufficiency take this medication during mealtime and snacks. These capsules contain replacement enzymes that make up for enzyme insufficiency.

• The factors that contribute to the dosage of capsules are a person's body weight, the fat content of the meals, and the level of pancreatic function. The capsules are consumed along with the food. Taking them with cold drinks or swallowing them with food at a normal temperature is crucial. Hot drinks can make the enzyme less effective because high temperatures damage the capsules.

How to Consume the Medications of Pancreatic Replacement Therapy (PERT)?

The following instructions should be followed while taking the medications:

• The medications are always taken along with the meal, and the first capsule is taken along with the first bite of the snack or meal.

• The medications are taken with meals because the digestive enzymes work best when taken with a meal. These digestive juices break down complex food like fats, proteins, and carbohydrates.

• Taking too much of these enzymes can lead to nausea and abdominal cramps. So it is always good to take them along with the food.

• Wait until the first bite of food to take the first dose. If the dose is missed, never double the dose. Never take the extra dose of medication with the meal or snack if it was missed the earlier day.

• Missing a dose is not harmful, but the person may experience symptoms like diarrhea, bloating, and flatulence.

• Swallowing the capsule as a whole should be followed by chewing because the capsules are crushed, which releases the enzymes in the mouth or stomach, where the acid will destroy them.

Conclusion

Pancreatic enzyme insufficiency leads to insufficiency of digestive enzymes in the body, where the patient has to take pancreatic enzyme replacement medications. The lack of enzymes is due to damage in the pancreas or blockage in the duct of the pancreas. The PERT capsule contains lipases, amylases, and proteases that are crucial for digestion. It helps in better digestion and reduces the symptoms of constipation, diarrhea, and abdominal pain.