EFFECTS OF PANCREATIC DIGESTIVE ENZYMES, SODIUM-BICARBONATE, AND A PROTON PUMP INHIBITOR ON STEATORRHEA CAUSED BY PANCREATIC DISEASES

Forty-five patients with pancreatic steatorrhoea (27 with calcified pa ncreatitis, 13 with non-calcified pancreatitis, two with pancreaticodu odenectomy, one with total pancreatectomy, and two with pancreatic can cer) were divided into four groups and given the following medication for 2 to 4 weeks: 4 to 6 g/day of sodium bicarbonate (group I); 9 g/da y of high-lipase pancreatin (lipase, 56 600 U/g, Federation Internatio nale Pharmaceutique (FIP); group II); 12 to 24 tablets or 9.0 g of com mercial pancreatic enzyme preparations (group III); or 50 mg of omepra zole (group IV). Faecal fat excretion was evaluated before and after d rug administration. Faecal fat excretion was reduced by 2.9 g (range, 1.7 to 5.0 g) in group I; 8.8 g (range, 2.9 to 39.9 g) in group II; 10 .8 g (range, 2.3 to 21.8 g) in group III; and 4.3 g (range, 3.6 to 5.6 g) in group IV. The pancreatic digestive enzyme preparation was more effective than sodium bicarbonate and agents that raise the pH of the upper small intestine (such as proton-pump inhibitors) in reducing fae cal fat excretion. The results indicate that all of the preparations u sed are effective against mild pancreatic steatorrhoea. If the conditi on is more advanced, however, a massive dosage of pancreatic digestive enzyme and possibly the combined use of an agent to raise the pH of t he upper small intestine are likely to be effective,