Gastroenterology

Answer 4 Administration of non-enteric-coated pancreatic enzyme replacement tablets with meals and snacks with concurrent dosing with a histamine2 blocker. Non-enteric-coated pancreatic enzyme replacement with concurrent histamine2-blocker dosing will deliver active enzymes to the proximal small bowel and help reduce the malabsorption and steatorrhea that this patient is experiencing. Enteric-coated enzyme preparations can also be effective, but they are more expensive and, when administered with calcium-containing antacids, can worsen steatorrhea by complexing with fatty acids, thus making absorption more difficult. Institution of a low-fat diet can worsen malnutrition; a normal allowance of fat intake (up to 40 g/day) can result in greater patient compliance. Octreotide is often an effective agent for treating the pain of chronic pancreatitis, but it does not enhance food absorption. Placement of pancreatic duct stents also may aid in the treatment of pain in patients with dilated pancreatic ducts, but the stents do not improve digestive capacity. Click here to return to the questions

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