Re : Re : Amounts of enzymes

[Guest guest]

Hi Shirley,

I'll try to answer your question. People are prescribed enzymes if

their doctor judges that the exocrine function (digestive) of their

pancreas is more or less seriously compromised. The digestive

enzymes normally produced by the pancreas may no longer be being

produced. This can lead to malabsorption, again, of greater or

lesser severity. The patient may experience diarrhoea and/ or

steatorrhoea. The latter is fatty diarrhoea, to put it simply! It

may be pale and sometimes very offensive as well! Lower abdominal

pain and cramps may also be experienced with malabsorption, as well

as the more typical pancreatic pain (from an inflamed pancreas, in

many cases) which is more often felt higher up in the abdomen,

and/or going through to the back and/or, sometimes, more on one side

than the other.

Of course, many patients may experience both types of pain, as I did

myself, if the pancreatitis becomes chronic, severe, extensive etc.

Some years ago I was having alternating severe upper-abdominal pain

from the pancreas itself, as well as the lower pain associated with

malabsorption. (My case was further complicated by the fact that I

have coeliac disease which also causes malabsorption and symptoms

often similar to those of CP.)

Many CP patients find that taking the enzymes with food does make a

difference (in my case a huge difference) to the malabsorption

symptoms. I saw a great improvement pretty quickly when I started

taking them. In addition, the pancreas is " rested " , to use

layperson's words, because it is no longer " trying " to produce the

enzymes itself. This in turn can also help the actual pancreatic

pain. In my case, this has also happened so I am better on both

counts as a result of taking enzymes. I'm not symptom-free, by any

means, and still get bad days, but my symptoms have improved.

I ought to add that my CP is very advanced and the doctors think I

produce no enzymes any more, or hardly any. They have indicated that

I may well be near complete burn-out.

If you have had pancreatitis diagnosed, it's a good idea to talk to

your gastroenterologist about enzymes. He or she may or may not

think they are appropriate for you.

My gastro originally prescribed 2 x Creon 20,000 per meal when he

first made the diagnosis following a CT scan, although he said I

could increase that if necessary. At the same time he referred me to

a specialist pancreatologist who greatly increased the prescribed

dose when I went to his clinic a couple of months later. He said I

should try up to 4x Creon 40,000. You may have read Sue's post. She

has the same specialist and takes up to 9 x Creon 40,000. I saw an

improvement even with the lower doses but do best on the higher

doses coupled with a diet low in fat.

The article I refer to in this month's Journal of the Pancreas

discusses different ideas about the amount of Creon (or other enzyme

preparation...there are several) which should be prescribed.

I know I've explained things in a very simplistic way. The medical

explanation of exactly how enzymes " rest " the pancreas is technical

and I don't want to even try to reproduce it here! I have read it a

couple of times but I don't feel competent to reproduce it without

going back and rereading the whole thing! Someone else may feel able

to do so though.

Hope this is a bit helpful. Good luck in your discussions with your

docs!

Fliss (UK)