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.