From the Guidelines
Patients with high-risk clinical conditions, such as chronic pancreatitis, relapsing acute pancreatitis, pancreatic ductal adenocarcinoma, cystic fibrosis, and previous pancreatic surgery, should consider taking enzyme supplements. These conditions are associated with exocrine pancreatic insufficiency (EPI), a condition where the pancreas does not produce enough digestive enzymes, leading to malabsorption of nutrients and potentially severe health consequences 1.
Key Conditions for Enzyme Supplement Consideration
- Chronic pancreatitis
- Relapsing acute pancreatitis
- Pancreatic ductal adenocarcinoma
- Cystic fibrosis
- Previous pancreatic surgery
- Moderate-risk clinical conditions, such as duodenal diseases, including celiac and Crohn’s disease; previous intestinal surgery; longstanding diabetes mellitus; and hyper-secretory states 1
Diagnosis and Treatment
The diagnosis of EPI can be suspected based on clinical features such as steatorrhea with or without diarrhea, weight loss, bloating, excessive flatulence, fat-soluble vitamin deficiencies, and protein-calorie malnutrition 1. The fecal elastase test is the most appropriate initial test for diagnosing EPI, and a level <100 mg/g of stool provides good evidence of EPI 1. Once EPI is diagnosed, treatment with pancreatic enzyme replacement therapy (PERT) is required to prevent complications related to fat malabsorption and malnutrition 1.
PERT Administration
PERT should be taken during meals, with an initial treatment of at least 40,000 USP units of lipase during each meal in adults and one-half of that with snacks 1. The dosage can be adjusted based on meal size and fat content. Routine supplementation and monitoring of fat-soluble vitamin levels are also recommended, along with dietary modifications such as a low-moderate fat diet with frequent smaller meals 1.
From the Research
Enzyme Supplements: Who Should Consider Taking Them
- Individuals with digestive disorders, such as lactose intolerance, cystic fibrosis, and exocrine pancreatic insufficiency, may benefit from enzyme supplements 2, 3.
- Those with gastrointestinal diseases, including celiac disease, may require enzyme supplementation to manage symptoms 4, 5, 6.
- Patients with malabsorption and lactose intolerance may also benefit from enzyme supplements, particularly those derived from microbial species or plant-based sources 3.
- People with poor digestion, including those with conditions such as irritable bowel syndrome, may find enzyme supplements helpful in breaking down proteins, carbohydrates, and lipids 2, 3.
Specific Conditions That May Benefit from Enzyme Supplements
- Celiac disease: patients with non-responsive celiac disease may benefit from pancreatic enzyme supplements, although the evidence is limited and variable 4, 5, 6.
- Exocrine pancreatic insufficiency: enzyme supplementation is a standard treatment for this condition, and may be beneficial for patients with cystic fibrosis and other pancreatic disorders 2, 3.
- Lactose intolerance: lactase (β-galactosidase) supplements may help individuals with lactose intolerance to digest lactose-containing products 2, 3.