From the Guidelines
Atrophic pancreas is a condition that requires prompt treatment to manage symptoms and prevent further complications, and the most effective treatment approach involves pancreatic enzyme replacement therapy (PERT) and nutritional support. Atrophic pancreas is a condition where the pancreas shrinks in size and loses its normal function due to progressive damage to its tissue. This occurs when pancreatic cells are destroyed and replaced by fibrous tissue, leading to decreased production of digestive enzymes and hormones like insulin.
Treatment Approach
The treatment primarily focuses on managing symptoms and addressing underlying causes.
- PERT is the cornerstone of treatment, using medications like Creon, Zenpep, or Pancreaze taken with meals (typically starting at 500 lipase units/kg/meal for adults) 1.
- Insulin therapy is necessary if diabetes develops due to insufficient insulin production.
- Nutritional support is essential, including a low-fat diet (25-50g daily), small frequent meals, and fat-soluble vitamin supplements (A, D, E, K) 1.
- Pain management may involve analgesics ranging from acetaminophen to opioids in severe cases, and sometimes nerve blocks.
- Lifestyle modifications are crucial, including complete alcohol abstinence and smoking cessation.
Monitoring and Adjustments
Regular monitoring of nutritional status, blood glucose levels, and digestive function helps adjust treatment as needed 1.
- The treatment approach must be individualized based on the severity of pancreatic atrophy, underlying cause, and specific symptoms experienced by the patient.
- The use of enteric-coated microspheres may be more effective than enteric-coated tablets, and the addition of proton pump inhibitors may improve the effectiveness of PERT 1.
- For patients of all ages, powder enzymes can be used to help digest enteral tube feedings, and enzymes given in this situation should not be mixed with the feed; they should be administered as bolus doses through the enteral feeding tube 1.
From the FDA Drug Label
INDICATIONS AND USAGE CREON is indicated for the treatment of exocrine pancreatic insufficiency in adult and pediatric patients. (1)
The term atrophic pancreas is not directly mentioned in the provided drug label. However, exocrine pancreatic insufficiency can be related to an atrophic pancreas, as it refers to the condition where the pancreas is not producing enough digestive enzymes.
- An atrophic pancreas refers to a condition where the pancreas has shrunk in size or has reduced function.
- The treatment for exocrine pancreatic insufficiency, which can be associated with an atrophic pancreas, is pancrelipase (PO), as indicated in the drug label 2.
From the Research
Definition of Atrophic Pancreas
- An atrophic pancreas refers to a condition where the pancreas undergoes a decline in its size and function, often due to aging or certain diseases such as chronic pancreatitis, cystic fibrosis, or pancreatic cancer 3.
- This decline can lead to impaired pancreatic exocrine function, resulting in malnutrition and maldigestion 3.
Treatment of Atrophic Pancreas
- Pancreatic enzyme replacement therapy (PERT) is the mainstay of treatment for pancreatic insufficiency, including atrophic pancreas 4, 5, 6, 7.
- PERT involves the administration of pancreatic enzymes to replace the deficient enzymes in the pancreas, improving nutrient absorption and reducing symptoms such as steatorrhea and abdominal pain 4, 5, 6.
- The recommended dosage of PERT varies, but typically starts with 25,000 to 40,000 units of lipase per meal, with adjustments made based on individual response and symptoms 4, 5.
- Treatment should be taken in divided doses throughout meals, and patients who do not respond to initial dosages should be evaluated for alternative etiologies and optimized PERT 5.
- High-dose or enteric-coated enzymes may be more effective than low-dose or non-coated enzymes, and administration during food and acid suppression may also improve treatment outcomes 6.