An Enteric-Coated High-Buffered Pancrelipase Reduces Steatorrhea in Patients with Cystic Fibrosis: A Prospective, Randomized Study

Enteric-coated (EC) high-buffered (2.5 mEq [2.5 mmol] bicarbonate per capsule) pancrelipase microsphere enzymes were compared to EC-nonbuffered pancreatic enzymes for efficacy in reducing steatorrhea in patients with cystic fibrosis. Prospective, randomized, controlled trial using a crossover design with each subject as his/her own control. Eighteen subjects with cystic fibrosis, who had pancreatic insufficiency and required large enzyme doses, were studied over two consecutive 7-day treatment periods. Each 7-day period consisted of 3 days at home followed by 4 days in a general clinical research center for careful control of diets, enzyme lipase doses (given at approximately 50% of the subject’s usual lipase dose), and carmine red-labeled stool collections for 72-hour fecal fat balance studies. Fecal fat excretion. Differences in fat excretion, when each subject received EC–high-buffered pancrelipase vs EC-nonbuffered enzymes, were compared using linear modeling. Mean fat excretion decreased significantly in each subject during periods when given EC–high-buffered pancrelipase compared with periods when given EC-nonbuffered enzymes (fat excretion 18.2% vs 24.9% or fat absorption 81.8% vs 75.1%, respectively; P=0.01). Thirteen of 18 subjects (72%) excreted less fat when receiving EC–high-buffered pancrelipase whereas 10 (56%) decreased fat excretion by more than 5%, and five subjects did not respond. EC–high-buffered pancrelipase decreased fat excretion, symbolizing improved fat absorption, when compared with EC-nonbuffered pancreatic enzymes given at equivalent, reduced (approximately 50% of usual) lipase doses in nourished subjects with cystic fibrosis and mild pulmonary disease.