Effectiveness and safety of small vs. large doses of enteric coated pancreatic enzymes in reducing steatorrhea in children with cystic fibrosis: A prospective randomized study

Authors

  • Dr. Mary Sue Brady RD, DMSc,

    Corresponding author
    1. Department of Pediatric Nutrition and Dietetics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
    • James Whitcomb Riley Hospital for Children, 702 Barnhill Drive, Indianapolis, IN 46202-5200
    Search for more papers by this author
  • Karyl Rickard RD, PhD,

    1. Department of Pediatric Nutrition and Dietetics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
    Search for more papers by this author
  • Pao-Lo Yu PhD,

    1. Department of Medical Genetics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
    Search for more papers by this author
  • Howard Eigen MD

    1. Department of Pulmonology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
    Search for more papers by this author

Abstract

Among cystic fibrosis (CF) centers, usual doses of enteric coated (EC) pancreatic enzymes vary from one to six capsules per meal based upon arbitrary criteria for stool and growth patterns. Large doses of non-EC enzymes are associated with increased serum urate (SU) and urinary uric acid (UUA) but data are unavailable for EC enzymes. This study compared the effectiveness and safety of a relatively large dose (patient's usual dose) versus a small dose (¼ usual dose) of EC enzymes in nine nourished children with CF, regarding decreasing fecal fat and stool nitrogen losses and maintaining normal SU and UUA concentrations. A crossover study design randomly assigned large or small doses to two consecutive 7 day treatment periods within each child. Large doses of EC enzymes reduced steatorrhea and increased SU and UUA. SU was normal with both treatments and UUA was normal, i.e., 17 of 18 values were between the 10th and 95th percentiles for healthy children eating a normal diet. When fat excretion was greater than 10% with small doses of EC enzymes, large doses resulted in reduced fat excretion and normal UUA. These data suggest that large doses of EC enzymes reduce steatorrhea and are safe in patients who have malabsorbtion with small doses. Pediatr Pulmonol 1991; 10:79–85.

Ancillary