Pancreatic Enzymes in Health and Disease

This book reviews the special role of pancreatic enzymes in normal digestion and gives practical advice for pancreatic enzyme treatment in pancreatic disorders. Pancreatic enzymes play a decisive role in the digestion of fat, protein and carbohydrates. However, they experience a nonparallel decrease during their aboral transit. This physiological role has implications for enzyme treatment in the diseased pancreas. There is no doubt that pancreatic enzymes are necessary for pancreatic enzyme substitution in exocrine pancreatic insufficiency. However, such a treatment may be ineffective under special conditions. Recent investigations have shown that the efficacy of pancreatic enzyme substitution depends on the size of the enzymes required for simultaneous transport with food and on their protection against gastric acid inactivation and inactivation by protolytic enzymes. Other investigations have shown that, because of a negative feedback mechanism, pancreatic enzymes may ameliorate pancreatic pain. This evidence indicates that the main symptoms of chronic pancreatitis - pain, exocrine and endocrine pancreatic insufficiency - may thus be combated by pancreatic enzyme treatment.This book of proceedings on internal medicine, gastroenterology and metabolic diseases is intended for clinicians and practitioners.