Medical Q&As

Pancreatic enzymes - role?

I am interested in the use of pancreatic enzymes on a patient who has had chemotherapy for advanced pancreatic cancer with secondaries in the liver, now refractory. The initial reason for use of the enzymes was to improve digestion, absorption and possibly reduce pain.

Presumably the person you refer to requires these enzymes because the pancreas is no longer capable of producing adequate amounts of pancreatic juice due to the combined effects of the cancer and the chemotherapy. There are many different types of pancreatic enzyme and they are all produced in the exocrine glands of the pancreas. In contrast, the hormone insulin is produced in the endocrine cells of the pancreas. The principal types of pancreatic enzyme are the proteases, lipase and amylase. Proteases digest protein and there are two principal types, trypsin and chymotrypsin. Pancreatic lipase breaks down triglyceride, which is the major form of dietary fat. Trigylceride cannot be absorbed through the gut wall and has to be broken down first by lipase into its constituent fat molecules. Amylase is the enzyme that breaks down carbohydrate or starch. This enzyme is also present in saliva. These various enzymes are crucial to the process of digestion and if they were absent for whatever reason the affected person would develop malabsorption because the various foodstuffs would continue through the gut in undigested form and be expelled with the faeces. The term malabsorption simply means that the nutrients are not being absorbed from the gut. In the past it was suggested that pancreatic enzymes might reduce pain but recent evidence suggests that such is not the case. In summary the pancreatic enzymes that are being used for treating this person are simply a substitute for the enzymes that the personís pancreas is no longer producing.