Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency in the 21st century

Table 1 Reasons for a poor response to supplemental enzyme therapy

Inactivation of the enzymes in the stomach by acid and/or proteases

Inadequate mixing of the enzymes and nutrients during delivery to the small intestine such that a proportion of the meal is not exposed to appropriate concentrations of enzymes

Separation of enteric-coated microspheres from meal contents in the stomach

Low duodenal and small bowel pH fail to provide optimal conditions for lipase and bile salts to provide optimal digestion of the ingested nutrients

Delayed dissolution of enteric-coated enzyme microspheres in the small intestine

Incorrect or incomplete diagnosis