EFFICACY OF ENZYME SUPPLEMENTATION AFTER SURGERY FOR CHRONIC-PANCREATITIS

Although surgical procedures that improve pancreatic drainage alleviat e abdominal pain in the vast majority of patients with chronic pancrea titis, postoperative absorption and nutritional status are less predic table. The present study was designed to determine the efficacy of pan creatic enzyme supplementation in maintaining postoperative digestion and nutrition in patients who had received the local resection-longitu dinal pancreaticojejunostomy (LR-LPJ) procedure for chronic pancreatit is. We evaluated nutritional status and intestinal absorption in 11 pa tients who had undergone LR-LPJ. The efficacy of postoperative pancrea tic enzyme supplementation was studied by measurements of intestinal a bsorption and nutritional status at baseline, after 4 weeks of individ ualized daily dosage of pancreatin (Creon), and after an additional 4 weeks of randomization to receive another 4 weeks of pancreatin or pla cebo. All patients demonstrated abnormal digestion of fat, protein, an d total energy at baseline 3 weeks after surgery, Pancreatin supplemen tation significantly improved the coefficients of absorption of dietar y fat and total energy over the next 4 weeks. Between 4 and 8 weeks, p ancreatin significantly improved protein absorption and nitrogen balan ce, whereas placebo substitution worsened the absorption of dietary fa t and total energy. Nutritional status was not significantly altered o ver the 8-week study period, although four patients receiving pancreat in gained more than 3.6 kg body weight. The data suggest that long-ter m postoperative pancreatic enzyme supplementation is both efficacious and necessary in chronic pancreatitis patients after LR-LPJ.