How to manage the "fatty stool" in chronic pancreatitis?
The pancreas is the main digestive enzyme factory in the human digestive system. Failure of the pancreas to produce adequate amounts of enzymes will lead to failure of digestion. This failure is manifest most commonly as fatty stools or oily stools as fat digestion is done mostly from enzymes secreted by the pancreas
Patients with severe pancreatic malfunction cannot properly digest complex foods or absorb digestive breakdown products. Nevertheless, clinically significant protein and fat deficiencies do not occur until over 90 percent of pancreatic function is lost. Steatorrhea (fat malabsorption) usually occurs prior to protein deficiencies since lipolytic activity decreases faster than proteolysis.
The clinical manifestations of fat malabsorption include loose, greasy, foul smelling stools that are difficult to flush. Steatorrhea seems to be less in Indian patients, probably as the fat intake in Indian diet is low.
Treatment of pancreatic exocrine insufficiency with pancreatic enzyme supplementation in chronic pancreatitis is dependent on the size and nature of the meal (fat content), the residual function of the pancreas (which may be progressively lost), and the goals of therapy (elimination of steatorrhea, reduction in the abdominal symptoms of maldigestion (bloating, diarrhea), or improvement in nutrition, depending on the size and condition of the patient).
Treatment depends upon the severity of disease. It may involve dietary modifications alone or with the addition of pancreatic digestive enzyme supplementation.
Modifying your diets
The most suggested approach in patients with steatorrhea is to restrict fat intake. Generally intake of 20 grams per day or less is sufficient. Patients who continue to suffer from steatorrhea following fat restriction require medical therapy. This amount of fat is contained in about 30 - 35 almonds or peanuts.
Fat enzyme "Lipase" supplementation
After the appropriate dose of pancreatic enzymes is determined (often one to three capsules 25 000 IU for a meal or one to two capsules 10 000 IU for a snack) by trial and error (This requires a lot of co operation from the patient's side), we instruct the patient on how to take the pancreatic enzymes. Enzymes should be taken with the first bite of a meal. The whole dose can be split into 2 parts and taken at the beginning and at the end of the meal.
Using medium chain triglycerides
Patients with severe pancreatic malfunction cannot properly digest complex foods or absorb digestive breakdown products. Nevertheless, clinically significant protein and fat deficiencies do not occur until over 90 percent of pancreatic function is lost. Steatorrhea (fat malabsorption) usually occurs prior to protein deficiencies since lipolytic activity decreases faster than proteolysis.
The clinical manifestations of fat malabsorption include loose, greasy, foul smelling stools that are difficult to flush. Steatorrhea seems to be less in Indian patients, probably as the fat intake in Indian diet is low.
Treatment of pancreatic exocrine insufficiency with pancreatic enzyme supplementation in chronic pancreatitis is dependent on the size and nature of the meal (fat content), the residual function of the pancreas (which may be progressively lost), and the goals of therapy (elimination of steatorrhea, reduction in the abdominal symptoms of maldigestion (bloating, diarrhea), or improvement in nutrition, depending on the size and condition of the patient).
Treatment depends upon the severity of disease. It may involve dietary modifications alone or with the addition of pancreatic digestive enzyme supplementation.
Modifying your diets
The most suggested approach in patients with steatorrhea is to restrict fat intake. Generally intake of 20 grams per day or less is sufficient. Patients who continue to suffer from steatorrhea following fat restriction require medical therapy. This amount of fat is contained in about 30 - 35 almonds or peanuts.
Fat enzyme "Lipase" supplementation
This was the most difficult challenge of all in our clinical practice. Use of Creon was prohibitively expensive to most of our patients with chronic pancreatitis.
| Creon provides good control of steatorrhea, but the aim of treatment should be weight gain rather that decrease in steatorrhea. |
It is difficult or even impossible to replace all the pancreatic enzymes by external supplementation. It will be equivalent to 28 capsules of Creon for the entire day. But we need to replace only about 10% of the enzyme requirements. Patients with chronic pancreatitis typically have some residual pancreatic function, thus supplementation rather than complete replacement is usually sufficient. The dosing of pancreatic enzyme supplements is based on relief of the target symptoms.
After the appropriate dose of pancreatic enzymes is determined (often one to three capsules 25 000 IU for a meal or one to two capsules 10 000 IU for a snack) by trial and error (This requires a lot of co operation from the patient's side), we instruct the patient on how to take the pancreatic enzymes. Enzymes should be taken with the first bite of a meal. The whole dose can be split into 2 parts and taken at the beginning and at the end of the meal.
Using medium chain triglycerides
Medium chain triglycerides (MCTs) provide an alternate fat source in patients with weight loss and a poor response to diet and pancreatic enzyme therapy. MCTs are readily degraded by gastric and pancreatic lipase, and do not require the presence of bile. MCTs are directly absorbed by the intestinal mucosa and stimulate the pancreas minimally. Coconut oil is an excellent source of MCT in our country and will be very useful in these rare clinical circumstances.
Comments
Post a Comment