GASTRIC TRANSIT AND PHARMACODYNAMICS OF A 2-MILLIMETER ENTERIC-COATEDPANCREATIN MICROSPHERE PREPARATION IN PATIENTS WITH CHRONIC-PANCREATITIS

It has been suggested that enteric-coated pancreatin microsphere (ECPM ) preparations with sphere sizes larger than 1.7 mm pass through the s tomach at a slower rate than a meal and therefore may be less efficaci ous in restoring pancreatic enzyme activity than preparations with sma ller sphere sizes. The aim of this study was to investigate the gastri c transit profile of a 2-mm ECPM preparation in relation to that of a solid meal and to simultaneously measure enzyme activities in eight pa tients with pancreatic exocrine insufficiency due to chronic pancreati tis. Gastric transit was assessed by double-isotope scintigraphy. A pa ncake was labeled with Tc-99m. A 2-mm ECPM preparation was labeled wit h Er-171. Intraluminal pancreatic enzyme activities were assessed duri ng a 6-hr period with the cholesteryl[[C-14]octanoate breath test (for carboxyl ester lipase activity) and the N-benzoyl-L-tyrosyl-p-aminobe nzoic acid/p-aminosalicylic acid (NBT-PABA/PAS) test (for chymotrypsin activity). The ECPM preparation passed through the stomach more rapid ly (median 24 min) than the pancake (median 52 min, P < 0.05). During ECPM therapy, mean cumulative (CO2)-C-14 outputs rose significantly fr om 30% to 70% (P < 0.05), but remained below outcomes in healthy volun teers. Mean cumulative plasma PABA concentrations rose significantly f rom 46% to 87% (P < 0.05) and were not significantly different from ou tcomes in healthy volunteers. In chronic pancreatitis, a 2-mm ECPM pre paration does not pass through the stomach more slowly than a solid me al, but in fact faster. Digestion of ester lipids and proteins showed an improvement to subnormal and normal levels, respectively.