Re: how to ask Dr about Enzymes? to lyn

January 17, 2004

lyn,

I've coped below a quote from the Hopkins University

Gastroenterology website. This is just a small portion of the

information that the PAI has been given permission by

Hopkins University to include in our " Files " section here on our

own website. The University has given us permission to access

and use their information for us to use in explaining chronic

pancreatitis to the general public. In this instance, the " general

public " appears to be your GI, who places too much importance

on high pancreatic enzyme levels as a diagnostic indicator of

chronic pancreatitis.

Please read the first paragraph carefully, and ask your doctor to

do the same. Perhaps if he sees that one of the leading

gastroenterology medical centers in the country doesn't place

much emphasis on enzyme levels to determine CP, he may

change his way of thinking about this.

You're welcome to go to the " Files " section on the left hand side

of our yahoogroups PAI main page. Click on files, and then click

on the heading for Hopkins and several pages of research

material will come up. You can copy any of that which interests

you and take it to your doctor.

I've had CP for almost three years now, and my amylase and

lipase levels DO NOT elevate during an episode of pain, not

even during an acute attack. When I was hospitalized with an

acute attack in October, they were tested and came in lower than

normal. When I had my first attack three years ago, they were

considerably high, but not now since my pancreas is

non-functional. Your loss of 1/3rd of your pancreas could also

have created an environment that produced lower than normal,

or normal enzymes levels.

As far as asking him to prescribe enzyme supplement, I would

just do so. Say that it was discussed previously by another

physician, and you would like to try them to see if they would help

with your digestive problems. Many people take them that have

all types of different digestive problems, not just people with

chronic pancreatitis. They are not harmful in any way, so he

shouldn't have any objections. As I mentioned, there are several

brands and generic versions available, and some work better for

some people than others. It took me several months to find the

right brand that was most effective for me. I have tried Viokase,

Creon, Ultrase, Pancrelipase and Lipram each, for over a month

at a time, and ultimately chose Ultrase as being the most

effective for my individual needs. I tell you this so that you know

that if one doesn't work for you as it's supposed to, that another

brand may do better. Once you get the right brand and the right

dosage, digestion should not be a source of discomfort again,

unless you are having an acute attack. The enzymes are not

recommended for use during an acute attack. The key is to keep

trying them until you get the relief that you need, and then

remember to take them whenever you eat.

I hope this article helps you, and that you can learn some more

from the files on the webpage.

From Hopkins University Gastroenterology website:

*********************

Biochemical Measurements

Isoamylase, lipase, trypsin, and elastase levels may be low,

normal, or elevated in patients with chronic pancreatitis. In early

or mild cases of chronic pancreatitis, it is difficult to make a

definitive diagnosis based on serum enzyme levels alone.

The secretin stimulation test is the most sensitive test to

diagnose early pancreatic disease in patients who have

developed malabsorption problems.

The bentiromide test is inexpensive, convenient, and easily

available for diagnosis of advanced disease. This test, however,

has a low sensitivity for diagnosing early or mild chronic

pancreatitis. Essentially a urine test, it requires normal renal

function, adequate diuresis, and proper absorption in the

intestines. Para-aminobenzoic acid (PABA) is the result of the

synthetic tripeptide bentiromide, cleaved by pancreatic

chymotrypsin, in the duodenum and excreted in the urine (Figure

10A). Patients consistently excrete less PABA with chronic

pancreatitis because of impaired chymotrypsin secretion by the

pancreas (Figure 10B).

Figure 10. Bentiromide test; A, para-aminobenzoic acid (PABA)

excreted in urine; B, chronic pancreatitis — little or no PABA in

the urine.

The quantitative measurement of fecal fat is diagnostic in

determining malabsorption. In this test, a known quantity of

dietary fat is consumed. Normally 7% or less of the ingested fat

is detectable in the stool. In chronic pancreatitis, a two-stage test

is more sensitive and specific. The test uses fecal collection with

and without the use of pancreatic enzyme replacement to

differentiate steatorrhea secondary to chronic pancreatitis from

other causes. Steatorrhea due to chronic pancreatitis arises

when 90% of pancreatic exocrine function has been lost.

Plasma cholecystokinin (CCK) may be elevated in chronic

pancreatitis patients compared with those with normal

pancreatic function.

Tests of pancreatic exocrine function may directly measure

enzyme or bicarbonate secretions, or indirectly demonstrate

malabsorption of a compound that requires pancreatic digestion

for normal absorption. None of the methods targeted at exocrine

function are absolutely accurate in terms of assessing exocrine

secretion. In addition, none of these secretion assays appears

to be able to differentiate chronic pancreatitis from carcinoma of

the pancreas.

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