Pediatric Pancreatic Enzyme Therapy

The pancreas is a gland located near the gallbladder that secretes many enzymes, such as amylase, lipase, trypsin, chymotrypsin, carboxypeptidase and bile (from the liver). Pancreatic enzymes are needed to digest fats, proteins, carbohydrates and acids. Children who do not produce enough pancreatic enzymes may not grow properly and can suffer severe nutritional deficiencies. Cystic fibrosis and celiac disease are conditions that may be helped by pediatric pancreatic enzyme therapy.

Cystic Fibrosis

• Pancreatic insufficiency is common in cystic fibrosis, a genetic chronic disease characterized by frequent lung infections, digestive problems and salty skin. It is diagnosed in early childhood. Cystic fibrosis causes the body to produce abnormally thick and sticky mucus that inhibits the breakdown of fats, starches and proteins in the intestines. The resulting malabsorption of nutrients impairs health and normal growth. Supplementation of pancreatic enzymes can prevent and treat malnutrition. According to guidelines developed by Australian doctors and published in the April 1999 Journal of Paediatrics and Child Health, "Pancreatic enzyme replacement therapy (PERT) is a major factor associated with achieving optimum growth and nutritional status in cystic fibrosis (CF) patients with pancreatic insufficiency and consequent malabsorption."

Celiac Disease

• Childhood nutritional deficiencies caused by intolerance to dietary gluten may be helped by pancreatic enzymes, according to the University of Maryland Medical Center (UMMC). Treatment for celiac disease consists of eliminating dietary gluten found in wheat, barley and rye. Damage done to the intestines by gluten can take time to heal. In a 1995 study cited by UMMC, children who were given pancreatic enzymes had better weight gain than control groups in the first month of therapy.

Side Effects

• Pancreatic enzymes are generally safe, although they should not be administered to children under 12 without guidance from a health care professional. Common side effects include nausea and gastric upset.
  In a University of Michigan case study of an infant under one year with cystic fibrosis, doctors determined that pancreatic enzyme therapy was responsible for intracranial pressure that caused the baby's irritability and bulging soft spot. Symptoms resolved when enzyme therapy was stopped. Pancreatic enzymes were restarted, without incident, when the child was older and the need for them was more apparent. Previously, doctors thought such symptoms were due to vitamin A deficiency and not to the enzyme treatment itself.