From the Guidelines
Diarrhea associated with pancreatitis can be treated with pancreatic enzyme replacement therapy (PERT).
Treatment Options
- Pancreatic enzyme replacement therapy (PERT) is the mainstay of treatment for diarrhea associated with pancreatitis, as it helps to replace the deficient pancreatic enzymes and improve nutrient absorption 1.
- Dietary modifications such as a low-moderate fat diet with frequent smaller meals and avoiding very-low-fat diets can also help to manage diarrhea associated with pancreatitis 1, 2.
- Probiotics may be considered as a potential therapeutic intervention, as decreased levels of health-enhancing gut bacteria such as Bifidobacteria have been found in patients with chronic pancreatitis 3.
- Antibiotics may be required to treat small intestinal bacterial overgrowth (SIBO), which can complicate chronic pancreatitis and contribute to diarrhea 3.
Key Considerations
- PERT formulations are all derived from porcine sources and are equally effective at equivalent doses, but may require H2 or proton pump inhibitor therapy with non–enteric-coated preparations 1.
- Dosage of PERT should be adjusted based on the meal size and fat content, 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.
- Monitoring of fat-soluble vitamin levels and nutritional status is important to ensure successful treatment with PERT 1, 2.
From the Research
Treatment Options for Diarrhea Associated with Pancreatitis
- Diarrhea induced by exocrine pancreatic insufficiency in relation to chronic pancreatitis can be managed with diet and pancreatic enzyme replacement therapy 4
- Pancreatic enzyme replacement therapy is the principal treatment method for pancreatic steatorrhea, and it should be carefully prescribed considering the strengths and weaknesses of different preparations 5
- Treatment options for diarrhea associated with pancreatitis include: + Pancreatic replacement therapy to combat maldigestion and malabsorption 6 + High-calorie, high-protein, and low-fat diet to minimize symptoms and promote weight retention or gain 6 + Pancreatic enzyme replacement therapy (PERT) with lipase > 40,000 U per meal, and enteric-coating may be preferred to conventional enzymes 7 + Administration of enzymes with meals is proven to be the most effective regimen, and response to PERT should be measured by the improvement of patients' symptoms, nutritional status, and fecal fat or (13) C-mixed triglyceride breath test 7
- In some cases, loperamide treatment for diarrhea may be associated with acute pancreatitis, and alternative treatment options should be considered 8