The exocrine pancreas

This seminar text reviews various forms of enzyme supplementation used clinically in digestive and absorption disorders. Enzyme supplementation plays an integral role in the management of various digestive disorders, particularly with regard to exocrine pancreatic insufficiency. However, application of enzymes may also be beneficial for other conditions associated with poor digestion including lactose intolerante and coeliac disease. Historically, porcine and bovine pancreatic enzymes have been the preferred form of supplementation for exocrine pancreatic insufficiency. Use of microbe-derived lipase has shown promise with studies indicating benefit similar to pancreatic enzymes, but at a lower dosage concentration and with a broader pH range. Safety and efficacy of enzymes derived from microbial species in the treatment of conditions such as malabsorption and lactose intolerance is promising. Plantbased enzymes, such as bromelain from pineapple, serve as effective digestive aids in the breakdown of proteins. Synergistic effects have been observed using a combination of animal-based enzymes and microbe-derived enzymes or bromelain. Pancreatic enzyme activity depends on different pathways including local duodenal mechanism and central parasympathetic (acetylcholinergic) signalling. Local and central mechanisms use cholecystokinin as signal. Cholecystokinin is considered an anorexigenic compound and is produced by duodenal gut lining cells. Once pancreatic enzymes are activated, they degrdadate fats, proteins and carbohydrates in absorbable microsubstances. Insufficiency of the exocrine pancreas could therefore produce malabsorbtion syndrome, nutritional deficiency (vitamin A, vitamin D and vitamin E), steatorrhea and multiple organ disorder. The use of pancreatic enzyme supplementation has been proven to be effective in several disorders including colitis ulcerosa, morbos Crohn, systemic diseases, irritable bowel syndrome (IBS), chronic and acute pancreatitis and pancreas cancer.