# Is There Need for Pancreatic Enzyme Replacement Therapy in Patients with Exocrine Pancreatic Insufficiency When Using High-Caloric Liquid Diets? Orientating Studies on Praecaecal Digestibility in Pigs with Experimentally Induced Pancreatic Exocrine Insufficiency and Ileocaecal Fistula

## TL;DR

This study shows that pancreatic enzyme replacement therapy is needed for patients with pancreatic insufficiency even when using high-calorie drinks to prevent poor digestion.

## Contribution

Demonstrates the necessity of PERT in PEI patients using high-caloric liquid diets through a novel pig model with ileocaecal fistula.

## Key findings

- Pancreatic insufficiency significantly reduces fat and protein digestion rates in high-caloric diets.
- PERT normalizes digestion rates to levels seen in healthy controls.
- One high-caloric drink showed high fat digestion without PERT, suggesting formulation optimization is important.

## Abstract

In patients with pancreatic exocrine insufficiency (PEI), focus is primarily placed on fat digestion. Using high-caloric drinks (HCD) is often recommended to avoid malnutrition, but knowledge is limited whether pancreatic enzyme replacement therapy (PERT) is needed. In this study the animal model of pancreatic duct-ligated (PL) and ileocaecal-fistulated minipig was used to determine the praecaecal disappearance rates (pcDR) of the fat and protein of four HCD in controls and PL-pigs with or without PERT. In controls pcDR were high (95.5–96.6% for fat; 70.2–78.6% for protein) while in PL-pigs receiving no PERT the pcDR were significantly lower (fat DR: 47.4–54.3%; protein 22.4–33.5%) despite a high fat pcDR value (84.0%) of one diet. PERT resulted in a normalisation of pcDR of fat and protein with values not differing from controls. This study demonstrates the massive impact of PEI on pcDR, even in HCD typically considered highly digestible. Using PERT is highly recommended in PEI patients using HCD to avoid maldigestion and associated digestive tract symptoms. Optimisation of formulations and galenic preparations of the HCD seems to be necessary as well, as the high fat pcDR of one drink showed that even without PERT high values can be reached.