Major pancreatic resection can cause pancreatic enzyme insufficiency with fat malabsorption, resulting in symptoms of abdominal pain, steatorrhoea and weight loss which can be extremely debilitating. The most important factors influencing subsequent development of steatorrhoea are the extent and type of surgical resection and the underlying disease process. The resultant steatorrhoea can be marked and difficult to control. There have been relatively few randomised controlled studies which have addressed this particular problem in patients who have had pancreatectomy. The use of effective doses of pancreatic enzyme supplements is essential in those patients who are symptomatic. When stabilised on therapeutically effective doses of pancreatic enzyme supplements, however, over 30% of patients still have evidence of significant levels of steatorrhoea. These results emphasise that the complete eradication of steatorrhoea is still not feasible at the present time, even using the best currently available agents, highlighting the need for further effective therapies.

1.
DiMagno EP, Go VLW, Summerskill WHJ: Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 1973;288:813–815.
[PubMed]
2.
Bruno MJ, Haverkort EB, Tytgat GN, van Leeuwen DJ: Maldigestion associated with exocrine pancreatic insufficiency: Implications of gastrointestinal physiology and properties of enzyme preparations for a cause related and patient tailored treatment. Gastroenterology 1995;90:1383–1393.
3.
Layer P, Holtmann G: Pancreatic enzymes in chronic pancreatitis. Int J Pancreatol 1994;15:1–11.
[PubMed]
4.
Guanner L, Rodriguez R, Guarner F, Malagelada J-R: Fate of oral enzymes in pancreatic insufficiency. Gut 1993;34:708–712.
[PubMed]
5.
Layer P, Go VLW, DiMagno EP: Fate of pancreatic enzymes during arboral small intestine transit in humans. Am J Physiol 1986;251:G75–480.
[PubMed]
6.
Thiruvengadam R, DiMagno EP: Inactivation of human lipase by proteases. Am J Physiol 1988;255:G476–G481.
[PubMed]
7.
DiMagno EP, Malagelada JR, Go VLW, Moertel CG: Fate of orally ingested enzymes in pancreatic insufficiency: Comparison of two dosage schedules. N Engl J Med 1997;296:1318–1322.
8.
Layer P, van der Ohe MR, Holst JJ, Jansen JBMJ, Grandt D, Holtmann G, Goebell H: Altered post-prandial motility in chronic pancreatitis: role of malabsorption. Gastroenterology 1997;112:1624–1634.
[PubMed]
9.
Spiller RC, Trotman IF, Higgins BE, Ghatei MA, Grimble GK, Lee YC, Bloom SR, Misiewicz JJ, Silk DB: The ileal brake – inhibition of jejunal motility after ileal fat perfusion in man. Gut 1984;25:365–374.
[PubMed]
10.
Susuki A, Mizumoto A, Sarr MG, Dimagno EP: Does gastric emptying or small intestinal transit of nutrients affect intestinal absorption of nutrients in canine pancreatic exocrine insufficiency? Gastroenterology 1997;112:A484.
11.
Paris JC: A multicentre double blind placebo controlled study of the effect of a pancreatic enzyme formulation (Panzytrat® 25,000) on impaired lipid digestion in adults with chronic pancreatitis. Drug Invest 1993;5:229–233.
12.
Freiss H, Bohm J, Muller MW, Glasbrenner B, Riepl RL, Malfertheiner P, Buchler MW: Maldigestion after total gastrectomy is associated with pancreatic insufficiency. Am J gastroenterol 1996;91:341–347.
[PubMed]
13.
Evans JD, Wilson PG, Carver C, Bramhall SR, Buckels JAC, Mayer AD, McMaster P, Neoptolemos JP: Outcome of surgery for chronic pancreatitis. Br J Surg 1997;84:624–629.
[PubMed]
14.
Lankisch PG, Lohrhappe A, Oho J, Creutzfeldt W: Natural course in chronic pancreatitis: Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion 1993;54:148–155.
[PubMed]
15.
Neoptolemos JP, Russell RCG, Bramhall SR, Theis B: Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. Br J Surg 1997;84:1370–1376.
[PubMed]
16.
VanHoozen CM, Peeke PG, Taubeneck M, Frey CF, Halsted CH: Efficacy of enzyme supplementation after surgery for chronic pancreatitis. Pancreas 1997;14:174–180.
[PubMed]
17.
Wittingen J, Frey CF: Islet concentration in the head, body, tail and uncinate process of the pancreas. Ann Surg 1974;179:412–414.
[PubMed]
18.
Morrow CE, Cohen J, Sutherland DER, Najoran JS: Chronic pancreatitis: Long term results of pancreatic duct drainage, pancreatic resection and near total pancreatectomy and islet autotransplantation. Surgery 1984;96:608– 616.
19.
Traverso LW, Longmire WP Jr: Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 1978;146:959–962.
[PubMed]
20.
Morel P, Mathey P, Corboud H, Huber O, Egeli RA, Rohner A: Pylorus preserving duodenopancreatectomy: Long term complications and comparison with the Whipple procedure. World J Surg 1990;14:642–647.
[PubMed]
21.
Beger HG, Buchler MW, Bittner R: The duodenum preserving resection of the head of the pancreas (DPRHP) in patients with chronic pancreatitis and inflammatory mass in the head: An alternative surgical technique to the Whipple operation. Acta Chir Scand 1990;156:309–315.
[PubMed]
22.
Beger HG, Büchler M, Bittner RR, Oettinger W, Roscher R: Duodenum preserving resection of the head of the pancreas in severe chronic pancreatitis: Early and late results. Ann Surg 1989;209:273–278.
[PubMed]
23.
Neoptolemos JP, Bramhall SR, Russell RCG, Johnson CD, Williamson RCN, Benjamin IS, Alderson D, Kleibueker JH: Double-blind, cross-over study comparing the efficacy and tolerance of Creon® 25,000 versus Creon® in patients following total or partial pancreatectomy (abstract). Digestion 1997;58(suppl 2):54.
24.
Bozkurt T, Maroske D, Adler G: Exocrine pancreatic function after recovery from necrotising pancreatitis. Hepatogastroenterology 1995;42:55–58.
[PubMed]
25.
Yagi M, Shimizu K, Hashimoto T, Izumi R, Nagakawa T, Miwa K, Miyazaki I: Pancreatic exocrine insufficiency after pancreatic surgery – detected by tubeless testing. J Clin Biochem Nutr 1994;16:205–209.
26.
Bruno MJ, Haverkort EB, Tijssen GP, Tytgat GNJ, van Leeuwen DJ: Placebo controlled trial of enteric-coated pancreatic microsphere treatment in patients with unresectable cancer of the pancreatic head region. Gut 1998;42:92–96.
[PubMed]
27.
Abrams CK, Hamosh M, Dutta SK, Hubbard VS, Hamosh P: Role of nonpancreatic lipolytic activity in exocrine pancreatic insufficiency. Gastroenterology 1987;92:125–129.
[PubMed]
28.
Balasubramanian K, Zentler Munro PL, Batten JC, Northfield TC: Increased intragastric acid resistant lipase activity and lipolysis in pancreatic steatorrhoea due to cystic fibrosis. Pancreas 1992;7:305–310.
[PubMed]
29.
Schneider MU, Demling L, Jones SA, Barker PJ, Domschke S, Heptner G, Domschke W: NMR spectrophotometry – a new method for total stool fat quantification in chronic pancreatitis. Dig Dis Sci 1987;32:494–499.
[PubMed]
30.
Lankisch PG: Exocrine pancreatic function tests. Gut 1982;23:777–798.
[PubMed]
31.
Löser C, Möllgaard A, Fölsch UR: Faecal elastase 1: A novel highly sensitive and specific tubeless pancreatic function test. Gut 1996;39:580–586.
[PubMed]
32.
Ventrucci M, Cipolla A, Ubalducci GM, Roda A, Roda E: 13C-labelled cholesteryl octanoate breath test for assessing pancreatic exocrine insufficiency. Gut 1998;42:81–87.
[PubMed]
33.
Layer P, vd Ohe M, Gröger G, Dicke D, Goebell H: Luminal availability and digestive efficacy of substituted enzymes in pancreatic insufficiency. Pancreas 1992;7:745.
34.
Saunders JHB, Cargill JM, Wormsley KG: Gastric secretion of acid in patients with pancreatic disease. Digestion 1978;17:365–369.
[PubMed]
35.
Meyer JH, Elashoff J, Porter-Fink V, Dressman J, Amidon GL: Human postprandial gastric emptying of 1–3 mm spheres. Gastroenterology 1988;94:1315–1325.
[PubMed]
36.
Lankisch PG, Lembcke B, Göke B, Creutzfelt W: Therapy of pancreatogenic steatorrhoea: Does acid protection of pancreatic enzymes offer any advantage? Z Gastroenterol 1986;24:753–757.
[PubMed]
37.
Stead RJ, Skypala I, Hodson ME: Treatment of steatorrhoea in cystic fibrosis: A comparison of enteric coated microspheres of pancreatic versus non-enteric coated pancreatin and adjuvant cimetidine. Aliment Pharmacol Ther 1988;2:471–481.
[PubMed]
38.
Zentler Munro PL, Assoufi BA, Balasubramanian K, Cronell S, Benoliel D, Northfield TC, Hodson ME: Therapeutic potential and clinical efficacy of acid resistant fungal lipase in the treatment of pancreatic steatorrhoea due to cystic fibrosis. Pancreas 1992;7:311–319.
[PubMed]
39.
Susuki A, Mizumoto A, Sarr MG, DiMagno EP: Bacterial lipase and high fat diets in canine exocrine pancreatic insufficiency: A new therapy of steatorrhoea? Gastroenterology 1997;112:2048–2055.
[PubMed]
40.
Vecht J, Maclee A, Gielkens H, Heyerman H, Lahers C: Does escalation of pancreatic enzymes decrease malabsorption and abdominal symptoms in patients with pancreatic insufficiency? Gastroenterology 1997;112:A494.
41.
Bruno MJ, Borm JJJ, Hoek FJ, Delzenne B, Hofmann AF, de Goeij JJM, van Royen EA, van Gulik TM, de Wit LTh, Gouma DJ, van Leeuwen DJ, Tytgat GNJ: Comparative effects of enteric coated pancreatic microsphere therapy after conventional and pylorus preserving pancreatoduodenectomy. Br J Surg 1997;84:952–956.
[PubMed]
42.
Gan KH, Heizerman HGM, Gevs WP, Bakker W, Lamers CBHW: Comparison of a high lipase pancreatic enzyme extract with a regular pancreatic preparation in adult cystic fibrosis patients. Aliment Pharm Ther 1994;8:603–607.
[PubMed]
43.
Delhaye M, Meuris S, Gohimont AC, Buedts K, Cremer M: Comparative evaluation of a high lipase pancreatic enzyme preparation and a standard pancreatic supplement for treating exocrine pancreatic insufficiency in chronic pancreatitis. Eur J Gastroenterol Hepatol 1996;8:699–703.
[PubMed]
You do not currently have access to this content.