***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 
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    Input: 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 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 , endoscopic retro grade cholangiopancreatography , and CT were included . Exclusion criteria were steatorrhea above 30 g/day , gastric or pancreatic resections in the history , and serum bilirubin above 1.5 mg/dl . Patients received pancreatic extracts ( acid-protected microtablets ; Panzytrat -20,000 ; 5 x 2 capsules/day ; proteases/capsule 1,000 Pharmacopoea europaea units ) for 14 days followed by treatment with placebo for another 14 days or vice versa . Pain ( grade d from 0 to 3 ) and concomitant use of analgesics  ( N-butylscopolaminiumbromide and tramadol ) were recorded by diary . Physical examination and blood chemistry were done at day -1 , 15 and 29 . Quantitative stool fat was determined at days -2/-1 , 13/14 and 27/28 . 43 patients completed the studies . Pain improved in most patients irrespective of whether they started with placebo or verum . There was no significant difference between both treatment arms . We conclude that pancreatic extracts are not very efficient in lowering pain The symptomatic effect of pancreatic enzyme substitution therapy was examined in a 4-week double-blind crossover study . Twenty patients , 11 with and 9 without steatorrhoea , were examined .  Pancreatic steatorrhoea was reduced from a median of 24 g/day to 10 g/day by the enzyme therapy ( P less than 0.01 ) . No significant pain reduction was found in either of the two groups , although there was a tendency to reduction in pain and analgetic consumption in the patients with steatorrhoea when treated with pancreatic enzymes . It is concluded that pancreatic steatorrhoea is still the only indication for pancreatic enzyme therapy 
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Conclusion .