Enteric-coated pancreatic enzyme supplementation. A dose-response study

Nine patients with pancreatic steatorrhoea were investigated to assess the effect of increasing dosages of the enteric-coated preparation, Pancrease, on fat absorption. Baseline studies of gastric acid output, 72-h faecal fat excretion and 14C triolein breath test were performed. The latter was repeated on alternative days using 2, 4 and 8 capsules of an enteric-coated enzyme preparation (Pancrease). Twenty healthy subjects served as controls for the 14C triolein breath test. Stool fat excretion showed that all but one of the patients had severe steatorrhoea (mean 191 ± 15 mmol/day). The mean baseline 14C triolein breath test was 1.14 ± 0.95%/h and significantly lower (P < 0.001) than the lower limit in controls (3.5%). A significant linear correlation (r = 0.67, P < 0.05) was shown between the breath test and stool excretion. The mean percentage improvement in fat absorption as measured by 14C triolein breath test after 2, 4 and 8 capsules of Pancrease was 226 ± 221%, 317 ± 237% and 336 ± 223%, respectively. Fat absorption was significantly improved by all three regimens. The 4- and 8-capsule schedule was significantly better than the 2-capsule one, but the 8-capsule dose was not better than the 4. The improvement in fat absorption in more than half the patients was insufficient to achieve a normal breath test. The efficacy of the response to increasing dosages of Pancrease did not correlate with gastric acid output. Our results suggest that 4 capsules are as effective as 8 in improving the absorption of 25 g fat, which is the usual fat content of a normal diet.