In the decompensated stage of chronic pancreatitis, exocrine pancreatic insufficiency drives digestive malabsorption, persistent steatorrhea, and progressive weight loss. When the initial enzyme replacement strategy has not achieved adequate fat absorption and steatorrhea control, a defined next-line protocol is indicated.
Chronic pancreatitis in the decompensated stage, presenting with exocrine pancreatic insufficiency, steatorrhea, and weight loss. At this stage, treatment is required for digestive malabsorption and the nutritional consequences of decreased pancreatic exocrine function.
The prior protocol — pancreatic enzyme replacement therapy with pancrelipase, combined with adequate nutrition and fat-soluble vitamin supplementation — did not achieve the target goals: improvement in fat absorption and fecal fat content, reduction of steatorrhea, and reversal of weight loss. This protocol is the structured next step following that insufficient response.
DOI: 10.1007/s00535-022-01911-6
In the decompensated stage, treatment is required for digestive malabsorption, nutritional disorders, and diabetes mellitus caused by decreased pancreatic endocrine and exocrine function.
Patients with exocrine pancreatic insufficiency should receive pancreatic enzyme replacement therapy and adequate nutrition without fat restriction.
If the therapeutic effect of pancreatic enzyme replacement therapy is inadequate in patients with pancreatic exocrine insufficiency, an H2-receptor antagonist or proton pump inhibitor can be used.
Treatment with a proton pump inhibitor or H2-receptor antagonist has been shown to be effective when combined with a pancreatic digestive enzyme agent, whether enteric-coated or not, in patients with steatorrhea.
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