Pancreatic enzymes are capable of breaking down proteins, carbohydrates and lipids. Their supplementation may play a role in treating digestive disorders, from lactose intolerance to cystic fibrosis. In this context, currently, there are several formulations of enzyme supplementation available in the market being used in clinical practice. These are used for the management of several digestive diseases, especially those involving organs intended for the production of digestive enzymes, such as the exocrine pancreas (which produces enzymes) and the brush edge of the small intestine (which produces lactase).
What are they?
Digestive enzymes are produced and secreted by the gastrointestinal system to degrade fats, proteins and carbohydrates. Thus, it performs digestion and, later, the absorption of nutrients. Therefore, when indicated, they may contribute to the treatment of several disorders characterized by a impairment of digestive functions.
Thus, pancreatic enzymes can be divided into three groups according to their respective functions: proteolytic enzymes (mainly trypsinogen and chymotrytryinogen and their active forms trypsin and chymotrypsin), amylolytic enzymes (pancreatic amylose) and lipolytic enzymes (mainly lipase).
Pancreatic enzyme supplementation is the therapy of choice for the management of exocrinal pancreatic insufficiency (EIP) in chronic pancreatitis, pancreatic cancer, cystic fibrosis (CF) or diabetes. Another relevant application of enzyme supplementation in clinical practice is the management of lactose intolerance. It is estimated that 75 percent of individuals worldwide experience hypolactasia, or some decrease in lactase activity, especially during adulthood.
Industry and Trade in Pancreatic Enzymes
Currently, enzymes derived from animals, mainly swine or bovine sources, represent an established standard of treatment. However, the growing study of enzymes derived from plants and microorganisms, such as Aspergillus oryzae
and Rhizopus arrhizus
offer great promise in advancing digestive enzyme therapy.
In addition, two commercially available formulations are available: without and with enteric coating. The latter preparation was developed to facilitate the passage of enzymes ingested through the hostile acid medium of the stomach and duodenum, since the efficacy of exogenous enzyme supplementation is decreased by low pH, besides the lipase being irreversibly denatured when exposed to pH ≤4.
The required daily dose of pancreatic enzymes is variable. This is related to the etiology and severity of pancreatic insufficiency and clinical characteristics of the patient, such as age and body weight. With regard to cystic fibrosis, genotype and intestinal factors that affect its absorption. Pancreatic enzyme preparations are dosed by lipase content. However, much evidence suggests that a minimum dose of 25,000-50,000 U of lipase per meal is usually required to reduce statherotomy to <15 g of fat per day in adults. When dealing with cystic fibrosis, 500–3,000 U lipase is recommended per meal <and 6,000 or 10,000 U lipase – kg / day in children. Children over 4 years of age tend to eat less fat per kilogram than children under 4 years of age who require less dosage of enzymes (500 vs. 1000 U lipase / kg / meal, respectively).
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Article Pancreatic Enzymes: Ianiro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G. Digestive Enzyme Supplementation in Gastrointestinal Diseases.
Curr Drug Metab. 2016;17(2):187-93. doi: 10.2174/138920021702160114150137. PMID: 26806042; PMCID: PMC4923703.