Enzyme Suppletion in Exocrine Pancreatic Dysfunction (SAPES)

• Fecal Fat percentage [ Time Frame: week 1, 5 and 9 ]
  difference in efficacy measured by the fecal fat content during treatment with pancreatic enzymes in a self-dosage regimen after extensive patient-education in comparison to the standard treatment for patients with EPI due to chronic pancreatitis
  
  

• enzyme dose [ Time Frame: On a weekly base during 9 weeks ]
  Change in enzyme dose
  
  
• Improvement of steatorrhea-related complaints [ Time Frame: On a weekly base during 9 weeks ]
  Improvement of complaints (e.g. steatorrhoea, abdominal cramps, abdominal pain).
  
  
• Change in dietary habits [ Time Frame: Week 1, 5 and 9 ]
  Change in dietary habits by means of a food diary
  
  
• Patient satisfaction [ Time Frame: Week 4 and 9 ]
  Patient satisfaction by means of a SF36 questionnaire
  
  
• Quality of life [ Time Frame: week 4 and 9 ]
  Quality of life by means of a SF36 questionnaire
  
  
• Evaluation of the nutritional status [ Time Frame: week 5 and 9 ]
  Evaluation of the nutritional status in the blood and calculating the Body Mass Index (BMI)
  
  

This is a prospective, open, comparative study with a linear design with two sequential phases (observatory, then patient-monitored).

The research population consists of patients who are treated with pancreatic enzymes (< 6 capsules p/d containing 25,000 units of lipase) for exocrine insufficiency caused by chronic pancreatitis.

After inclusion, patients will discontinue taking pancreatic enzymes during one week (wash-out period). The last four days of this week, a fecal fat balance test will be performed to quantify the fecal fat loss without enzyme correction. If the fecal fat excretion is less than 15%, this is considered normal and therefore the patient will be excluded from the study. Subsequently, the next three weeks of the trial the patient will restart using the same dose of pancreatic enzymes the way it was prescribed before inclusion. The last four days of the fourth week, a fecal fat balance test will be repeated to quantify the fecal fat loss with enzyme correction. After this test the intervention takes place, consisting of a standardised education of the patient by a dietician. In the second phase of four weeks, patients are stimulated to use this information to self-dose the amount of pancreatic enzymes according to the fat content of their diet. In the last week of the study a fecal fat balance test will be repeated.

The primary endpoint is the fecal fat excretion. Secondary endpoints are the change in enzyme dose after intervention, improvement of complaints (e.g. steatorrhoea related complaints, abdominal cramps, abdominal pain), change in dietary habits, patient satisfaction, quality of life, evaluation of the nutritional status, and the occurrence of side effects.

Because the maximum amount of 16 capsules of pancreatic enzymes a day according to the standard guidelines will not be exceeded in this trial, no risks are foreseen. The anticipated benefit of the study is that patients will be treated more effectively for their EPI. The burden of this trial for patients is the repeated fecal fat balance test.