INFLUENCE OF HIGH-DOSE PANCREATIC-ENZYME TREATMENT ON PANCREATIC FUNCTION IN HEALTHY-VOLUNTEERS

Conclusions. Adaptive changes in exocrine and endocrine pancreatic fun ction, as well as changes in pancreas size and morphology, were not ob served after 4 wk of offal pancreatic enzyme application. These findin gs suggest that the normal pancreas does not significantly adapt-eithe r morphologically or functionally-to a 4-wk oral application of high-d ose pancreatic enzymes. Background. The control of exocrine pancreatic enzyme secretion is not completely understood. Although it has been e stablished that exocrine pancreatic secretion is mainly regulated in t he short-term by the amount of pancreatic enzymes in the proximal smal l intestine, it is not known whether long-term application of pancreat ic enzymes causes changes in exocrine pancreatic secretion in humans. Methods. Twelve healthy male volunteers (median age 27 yr) participate d in a prospective, randomized, placebo-controlled, double-blind study . Six were placed in the treatment group and six in the placebo group. Over a 4-wk period, the six subjects in the treatment group took 18 c apsules of Panzytrat (20,000 units of lipase, 18,000 units of amylase, and 1000 units cf protease per capsule) daily. Before (wk 0), 4 wk fo llowing pancreatic enzyme application and 2 wk afterward, a secretin-c erulein test was carried out in all subjects to study exocrine pancrea tic function (trypsin, chymotrypsin, bicarbonate content, and total pa ncreatic fluid secretion in the duodenum). One day following the secre tin-cerulein test, a standard test meal was given to all subjects to a nalyze endocrine pancreatic function. Additionally, before starting th e treatment, once per week during treatment and 2 wk afterward, an ult rasound examination of the pancreas was carried out to see whether the re was any change in pancreas size and morphology. Results. Trypsin co ntent in the duodenal aspirates following simultaneous stimulation wit h secretin and cerulein after 4 wk of high-dose pancreatic enzyme appl ication was 92% in the treatment group and 82% in the placebo group co mpared with the wk 0 test results (10O%). Two weeks after enzyme appli cation, the secretin/cerulein-stimulated trypsin content was 88% in th e treatment group and 107% in the placebo group. None of these changes was statistically significant. The same results were seen for chymotr ypsin content, amylase, and bicarbonate content as well as for total p ancreatic fluid secretion. Additionally; no change in the endocrine pa ncreatic function could be observed after 4 wk of pancreatic enzyme tr eatment. Pancreas ultrasonography revealed no alteration in pancreas s ize or parenchymal structure during the 4 wk of treatment and the foll owing 2 wk.