Effect of oral pancreatic enzyme administration on digestive function in healthy subjects: Comparison between two enzyme preparations

Background: Intraduodenal proteases exert a negative feedback on pancreatic secretion. Aim: To investigate the effect of two pancreatic enzyme preparations (enteric-coated tablets, and capsules with enteric-coated microtablets) on postprandial pancreatic and bile acid secretion, gastroduodenal motility and release of gastrin and pancreatic polypeptide in healthy humans. Methods: Twenty healthy males were studied on two different days one week apart. After an overnight fast a nine-lumen motility tube was positioned with the distal tip at the Treitz angle. On each study day, 30 min after an interdigestive migrating motor complex-phase III, a semi-liquid test meal was given either alone (n = 20) or with enzymes (3 tablets (n = 10) or 2 capsules with microtablets (n = 10); 40000 U lipase and 2000 proteases) in a randomized order, and the study continued over 2 h, Motility was continuously recorded with four ports in the antrum and three in the duodenum, using a low-compliance pneumohydraulic perfusion system. Secretion of human-specific pancreatic elastase and bile acids was measured by a standard duodenal intubation perfusion technique. Plasma concentrations of gastrin and pancreatic polypeptide were measured by specific radioimmunoassays. Results: Postprandial pancreatic secretion was significantly reduced by administration of microtablets (median 82 mg/2 h vs. 70 mg/2 h, P < 0.02) but not by tablets (median 59 mg/2 h vs, 58 mg/2 h, N,S.). No changes were observed in bile acid secretion, antroduodenal motility or release of gastrin and pancreatic polypeptide. Conclusions: Oral administration of pancreatic enzymes at normal therapeutic doses significantly inhibits postprandial pancreatic secretion in healthy humans, when capsules with enteric-coated microtablets are given, Exogenous pancreatic enzymes have no significant effect on bile acid secretion, gastroduodenal motility and hormone release.