Principles of enzyme replacement therapy of exocrine pancreatic insufficiency

This paper deals with the basic principles of enzyme replacement therapy of exocrine pancreatic insufficiency. Different variants of exocrine pancreatic insufficiency are considered in conjunction with clinical criteria for the assessment of the results of therapy of malabsorption syndrome developing as a result of reduced activity of pancreatic enzymes in the duodenum cavity. The indications for the choice of the optimal pharmaceutical form and dosage regimen of panreatin-containing medications are proposed. The results of modern evidence-based clinical studies are presented to substantiate the necessity of using high doses of enzymatic preparations with lipase activity of up to 25,000 U. The evaluation of their effect on food intake demonstrated high effectiveness and good tolerance of these medicines. It is concluded that preference in the treatment of exocrine pancreatic insufficiency should be given to the use of micropelleted formulations having double protection and of the pancreatin-containing capsules.