Enzyme Preparations of the Pancreas without Enteric Coating: Whether they are Used Today?

Abstract

Introduction. For the treatment of exocrine pancreatic insufficiency (EPI) it is recommended enzyme replacement therapy with high-dose enteric-coated preparations. In this regard, the question arises about the rationale of clinical application of the older low-dose non enteric-coated enzyme preparations (as a reference drug served Mezim® forte). Results. A number of anatomical and physiological characteristics and active use of suppressants of gastric secretion — proton pump inhibitors, antacids (sodium bicarbonate) — allows significantly to increase the «survival» of pancreatic enzymes that do not contain enteric coating in gastric juice and their delivery to the duodenum. This formulation is used for the relief of pain in case of chronic pancreatitis (enteric-coated preparations are uneffective). It was proposed to use a combination of two dosage forms — enteric-coated and non enteric-coated — for more effective therapy EPI. In functional diseases of the gastrointestinal tract (irritable bowel syndrome with functional disorders of the pancreas, functional dyspepsia) non enteric-coated enzyme preparations speeds recovery of patients. In inflammatory bowel disease (ulcerative colitis, Crohn’s disease) and chronic obstructive pulmonary disease, this formulation increases the duration of remission, and in case of inflammatory bowel disease — also the quality of life during remission. Non enteric-coated enzyme preparations are used in a number of other diseases associated with maldigestion/malabsorption. Additionally, they are used for the gradual cessation of therapy by high-dose enzyme preparations. They also find application for the correction of EPI during snacks and some gaps in the diet. Financial sales figures indicate a high demand for low-dose non enteric-coated enzyme preparations (Mezim® forte). Conclusions. Low-dose non enteric-coated enzyme preparations are still widely used in current clinical practice.

Keywords

• enzyme preparations
• exocrine pancreatic insufficiency, Mezim® forte