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World J Gastroenterol. Sep 7, 2014; 20(33): 11467-11485
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11467
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11467
Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency in the 21st century
Tony Trang, Johanna Chan, David Y Graham, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, United States
Author contributions: Trang T, Chan J and Graham DY have been involved equally and have read and approved the final manuscript; Trang T, Chan J and Graham DY meet the criteria for authorship established by the International Committee of Medical Journal Editors and verify the validity of the results reported.
Supported by The Office of Research and Development Medical Research Service Department of Veterans Affairs, Public Health Service grants No. DK067366 and No. DK56338 which funds the Texas Medical Center Digestive Diseases Center
Correspondence to: David Y Graham, MD, Professor, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX 77030, United States. dgraham@bcm.edu
Telephone: +1-713-7950232 Fax: +1-713-7901040
Received: June 26, 2014
Revised: July 21, 2014
Accepted: July 29, 2014
Published online: September 7, 2014
Processing time: 72 Days and 23.9 Hours
Revised: July 21, 2014
Accepted: July 29, 2014
Published online: September 7, 2014
Processing time: 72 Days and 23.9 Hours
Core Tip
Core tip: In the last two decades, a number of studies comparing pancreatic enzymes and placebo have confirmed that pancreatic enzymes are superior to placebo for treatment of pancreatic malabsorption. While many patients achieved a satisfactory clinical response, individualization is often needed. Studies conclusively show that dose escalation is not a reliable method of obtaining further improvements and instead results in increased costs. Here, we describe alternate strategies for obtaining a satisfactory clinical response including changing to, or adding, a different product, adding non-enteric coated enzymes, use of antisecretory drugs and/or antacids, and changing the timing of enzyme administration.