***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The relative efficacy of three commercial pancreatic enzyme supplements in improving fat absorption was studied using the [14C]triolein breath test in 12 patients with chronic pancreatitis . Two of the supplements were enteric coated . The one nonenteric coated product was studied twice : with and without ranitidine coadministration . Doses complied with the manufacturers recommendations . Baseline studies included pentagastrinstimulated gastric acids , 72-hr fecal fat excretion , and [14C]triolein absorption while not on supplementation . Acid outputs were variable ( BAO : 0.3–4.1 meq/hr ; MAO : 3.5–34.6 meq/hr ) . Three patients had mild steatorrhea ( i.e. , < 10 g/day ) and the remaining severe fat malabsorption ( 56.9±41.5 g/day ) .  Although fat absorption was significantly improved by all three supplements , the nonenteric coated preparation was most effective ( P < 0.001 ) . However , laboratory analysis demonstrated that lipase content was four times greater , ie , 17,000 IU/4 tablets . Pretreatment with ranitidine failed to further improve the absorption in patients given nonenteric supplements but was effective in those found to have high or normal acid outputs ( P<0.001 ) . Our results suggest that the recommended dosage of enteric coated preparations is insufficient for adult patients with severe chronic pancreatitis . Secondly , the marked variability of acid secretion in such patients possibly accounts for the variability of results obtained by others on the usefulness of coadministration of antacids and H2 antagonists . Routine measurement of gastric acid secretion status may help optimize the choice and form of pancreatic enzyme supplementation Pancreatic enzyme replacement may fail to achieve a beneficial effect because of enzyme inactivation by gastric acid . In this controlled r and omized study , 8 hospitalized patients with severe exocrine pancreatic insufficiency and considerable steatorrhoea ( greater than 15 g faecal fat/day ) were treated with a conventional pancreatic enzyme preparation ( Pankreon 700 ; 3 X 3 dragees daily ) , with ( 300 mg ) and without cimetidine before meals , and with a new pH-sensitive enzyme preparation ( Kreon ; 3 X 6 capsules daily ) comprising acid-protected granules . Both conventional enzyme replacement plus cimetidine , and acid-protected pancreatin were significantly ( p less than 0.05 ) more effective than conventional enzyme therapy alone . Since both regimens are equally potent in overcoming gastric acid-induced enzyme inactivation , it is concluded that therapy with acid-protected pancreatin may simplify and improve treatment of exocrine pancreatic insufficiency in the presence of gastric hyper- or normo-acidity In a double-blind study on 19 patients with the diagnosis of chronic pancreatitis , the effects of treatment with a granulated pancreatic enzyme preparation ( Pankreon ) were compared with those of placebo administration . One week of treatment with each preparation was preceded by one week without any medication . The patients kept daidy records of their symptoms , plotting the severity of pain on an analog scale . Weekly assessment s of the mean pain level were also made by an examiner question ing the patients . Recordings of body weights and pancreas and liver laboratory tests were done weekly . Fifteen of 19 patients noted less pain during the week of treatment with pancreatic enzymes as compared to that of placebo treatment ( P<0.05 ) . The average reduction of pain , as calculated for all patients , was 30 % as evaluated by both patients ( P<0.01 ) and the examiner ( P<0.05 ) . No differences were found in other parameters examined . A possible explanation of the findings could be an effect on the intraductal pressure by intraluminal trypsin Pancreatic enzymes ( PE ) are prepared as pH-sensitive enteric coated microspheres [ Pancrease , Alipase in France ( P ) ] , to prevent gastric inactivation of orally administered enzymes . The efficacy and tolerability of P were compared to those of Eurobiol ( E ) ( PE lacking enteric coating ) in patients with exocrine pancreatic insufficiency ( PI ) via an open crossover study conducted at 16 centers in France . Pancreatic insufficiency was diagnosed in patients with signs of chronic pancreatitis who showed steatorrhea ( fecal fat excretion greater than 8.0 g/24 h ) . The dosage of P was 9 capsules/d and that of E , 3 vials/d . Stools were collected for 3 consecutive days at each of the following periods : after 10 d without any PE , and after 21 d of P and E administration . Results were analyzed statistically by the method of Hills and Armitage . Chronic pancreatitis was alcohol-induced in 33 of 35 patients ( 94 % ) who entered the study . The group that received P before E ( n = 20 ) was comparable to the group that received E before P ( n = 15 ) in patient and disease characteristics . Eight of 35 patients failed to complete the study for the following reasons : adverse reactions 2 cases , lost to followup 4 cases , dropped out of study 2 cases . The degree of steatorrhea was similar after P and E. However , symptomatic improvement was noted far more frequently with P than with E. Moreover , patients preferred P to E because of drug taste ( p less than 10(-4 ] and ease of drug administration ( p less than 10(-3 ) . Drug safety was comparable in the two groups of patients Background : Oral pancreatic enzyme supplements should be properly administered in order to ensure an adequate gastric mixing with the food and simultameous gastric emptying with the chyme Objectives : Creon 10 Minimicrospheres is an enteric-coated , delayed-release pancrelipase preparation design ed to deliver active pancreatic enzymes to the small intestine . The primary objective of this study was to compare the effect of Creon 10 with placebo in the control of steatorrhea in chronic pancreatitis patients . Secondary objectives included evaluation of stool parameters and global improvement of symptoms scales . Methods : The study was a r and omized , double-blind , placebo-controlled , 2-week trial . After a placebo run-in ( " washout " ) phase , the effect on coefficient of fat absorption ( % ) , daily fat excretion before and after treatment , and stool frequency and consistency were assessed . Results : In Creon 10-treated subjects , the change in mean coefficient of fat absorption ( % ) from run-in to double-blind phase was significantly higher compared with placebo-treated subjects ( + 36.7 vs. + 12.1 , P = 0.0185 ) . Stool consistency improved significantly more with Creon 10 than with placebo ( P = 0.0102 ) result ing in more subjects with formed stool ; stool frequency decreased significantly more with Creon 10 than with placebo ( P = 0.0015 ) from 10.8 during placebo run-in to 5.2 stools per day during double-blind treatment ; and daily mean fat excretion in stool decreased significantly more ( −56.5 vs. −11.4 g/d , P = 0.0181 ) in Creon 10-treated subjects compared with placebo-treated subjects . Global disease symptom scores showed greater improvement for both physicians and subjects in the Creon 10 group relative to those receiving placebo . Between treatment difference reached statistical significance for Creon 10 ( P = 0.0435 ) for physician score and showed a trend ( P = 0.0634 ) favoring Creon for subject score . Conclusions : This r and omized , placebo-controlled trial found that Creon 10 treatment controlled steatorrhea , as reflected in reduced fat excretion , decreased stool frequency and improved stool consistency  . Creon 10 treatment was safe and well tolerated To provide a rational basis for pancreatic enzyme replacement therapy , we evaluated , in six patients with advanced pancreatic insufficiency , the effects of various treatment regimens on fecal fat and nitrogen balance and on duodenal recovery of ingested pancreatic enzymes after a solid test meal . The combination of cimetidine ( an H2-receptor antagonist ) and pancreatin , each given by mouth , produced significantly higher postpr and ial duodenal recoveries and concentrations of trypsin and lipase ( P less than 0.05 ) . Steatorrhea was reduced in all patients and abolished in four of the six . In the dosages used , neither enteric-coated enzymes nor supplemental neutralizing antacids were more effective than pancreatin alone in decreasing steatorrhea or improving duodenal enzyme delivery .  Cimetidine may be a useful adjunct to oral pancreatic extract therapy in some patients with severe pancreatic insufficiency who fail to respond to pancreatic enzyme replacement alone BACKGROUND This study was aim ed to investigate the effect of long-term treatment with high-protease pancreatic extract on the recurrent abdominal pain of patients with chronic pancreatitis . METHODS Twenty-six patients with a firm diagnosis of chronic pancreatitis and a pattern of recurrent pain were recruited and r and omly assigned to treatment with pancreatic extract ( Pancrex-Duo capsules , each containing 34,375 USP units of protease in enteric-coated microspheres ) or placebo , at a dose of four capsules four times daily , for 4 months . At the end of the first period patients were switched to the other medication for the next 4 months . Four patients did not complete the study because of unbearable recurring pain or inadequate compliance with treatment . The other 22 patients daily recorded the presence , intensity , and duration of pain and the consumption of analgesics , for 8 months . RESULTS No difference was found when intraindividual records during placebo and extract treatment periods were compared . Conversely , in the second 4 months of follow-up , regardless of the treatment given in the first period , there was a significant reduction in the cumulative pain score ( median , 95 ; range , 0 - 1005 , versus 134 ; 0 - 972 ; p < 0.05 ) , in the number of days ( 8 ; 0 - 132 , versus 13 ; 0 - 126 ; p < 0.02 ) and hours ( 54 ; 0 - 680 , versus 80 ; 0 - 602 ; p < 0.05 ) of pain , and in the analgesic consumption score ( 0 ; 0 - 22 , versus 12 ; 0 - 44 ; p = 0.02 ) . CONCLUSIONS Chronic supplementation with pancreatic extract is not beneficial in the management of recurrent pain in patients with chronic pancreatitis Background Chronic pancreatitis often culminates in maldigestion and diabetes . Clinical management is complex as the correction of maldigestion often disturbs diabetic control . Study In the following study , we examined the effects of a potent new commercial pancreatic enzyme on food absorption and blood glucose control .  Enzymes were manufactured in enteric-coated mini-microsphere form ( 0.7–1.6 mm ) , design ed to prevent gastric acid degradation and facilitate co-migration with food , and given in quantities calculated to cover normal digestion requirements ( four capsules with meals , two with snacks ; content/capsule : lipase 10,000 USP units , protease 37,500 units , amylase 33,200 units ) . Forty patients with chronic pancreatitis were screened during a run-in nonenzyme-supplemented phase ; only those with stool fat excretion rates over 10 g/d ( n = 29 ) were advanced to a 14-day parallel r and omized placebo versus enzyme supplement group comparison . Results Of these , 62 % were diabetic ( 50 % insulin-dependent ) and 52 % were malnourished ( body mass index less than 20 kg/m2 ) . After enzyme supplementation , stool fat and nitrogen excretion decreased , whereas fat absorption increased from 54.0 ± 9.7 % to 80.8 ± 3.8 % per day ( p = 0.002 ) and protein from 80.5 ± 3.4 % to 86.8 ± 2.2 % per day ( p = 0.004 ) . Changing treatment from active enzyme supplementation to placebo ( and vice versa ) result ed in major problems with glucose control ; blood glucose levels became abnormal in 28 of 29 patients , one patient required hospitalization for symptomatic hypoglycemia ( 0.9 mmol/L ) during placebo treatment , and one developed diabetic ketoacidosis after recommencing active enzyme supplementation . Conclusions In conclusion , high-dose pancreatin mini-microspheres improved , but did not normalize , fat absorption , possibly because of the residual influence of diabetes and malnutrition on absorptive function . In view of the brittle nature of blood glucose control in malnourished insulin-dependent patients , enzyme adjustment should be carefully supervised in-hospital According to the theory of negative feedback regulation of pancreatic enzyme secretion by proteases , treatment with pancreatic extracts has been proposed to lower pain in chronic pancreatitis by decreasing pancreatic duct pressure . We conducted a prospect i ve placebo-controlled double blind multicenter study to investigate the effect of porcine pancreatic extracts on pain in chronic pancreatitis .  47 patients with pain ( 41 males , 6 females ) due to chronic pancreatitis documented by sonography 
    Output:
    
We found no significant benefit in reducing faecal fat with any particular schedule of enzyme preparation or type of enzyme .
Another small study did not show any significant benefit of timing the administration of enzyme preparations in relation to meals on faecal fat .
The role of pancreatic enzymes for abdominal pain , weight loss , steatorrhoea , analgesic use and quality of life in patients with chronic pancreatitis remains equivocal .