Gastric acid suppression and treatment of severe exocrine pancreatic insufficiency

Adding either H2-receptor antagonists (cimetidine or ranitidine) or proton pump inhibitors to an adequate amount of lipolytic activity improves fat malabsorption in most cases and abolishes steatorrhoea in up to 40% of children and adults with cystic fibrosis and in adults with chronic pancreatitis....

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Bibliographic Details
Published in:Baillière's best practice & research. Clinical gastroenterology 2001-06, Vol.15 (3), p.477-486
Main Author: DiMagno, Eugene P.
Format: Article
Language:English
Subjects:
Anti-Ulcer Agents - therapeutic use
chronic pancreatitis
cystic fibrosis
exocrine pancreatic insufficiency
Exocrine Pancreatic Insufficiency - drug therapy
Gastric Acid - physiology
H2-receptor inhibitors
Humans
lipase
lipolytic activity
malabsorption
Pancreas - drug effects
Pancreas - pathology
pancreatic enzymes
proton pump inhibitors
steatorrhoea
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Summary:Adding either H2-receptor antagonists (cimetidine or ranitidine) or proton pump inhibitors to an adequate amount of lipolytic activity improves fat malabsorption in most cases and abolishes steatorrhoea in up to 40% of children and adults with cystic fibrosis and in adults with chronic pancreatitis. Acid suppression improves fat absorption because the resultant increase in pH within the upper gastrointestinal tract improves the survival of lipolytic activity, reduces duodenal volume flow and prevents the precipitation of bile acids. These effects increase the concentration of intraduodenal lipolytic activity and promote the aggregation of bile acids and the micellar solubilization of lipid. The amount of lipase that should be recommended is controversial, but we interpret our studies as indicating that at least 90000 United States Pharmacopeia (USP) units should be ingested with meals. This amount of lipolytic activity taken with an agent that suppresses gastric acid secretion improves fat absorption in most patients and may even abolish steatorrhoea.
ISSN:1521-6918
1532-1916
DOI:10.1053/bega.2001.0195