New methods for assessment of enzyme activity: do they help to optimize enzyme treatment?

Several factors related to the patient and the pancreatin formulation influence the efficacy of enzyme supplementation. Up to now, only few tests exist to judge the efficacy of enzyme replacement therapy in pancreatic insufficiency. Tube tests and fecal fat excretion studies are cumbersome, time-consuming and unpleasant. Recently, several breath tests for the detection of pancreatic insufficiency have been developed. The cholesteryl octanoate breath test differentiated between healthy controls and patients with pancreatic insufficiency already after a 30-min collection period. Using this test, it was demonstrated that a pancreatin preparation containing small microspheres (1.0-1.2 mm) induces high duodenal lipolytic activity parallel to gastric emptying of food. In contrast, the gastric emptying of large microspheres (1.8-2.0 mm) is significantly delayed. The cholesteryl octanoate breath test detects pancreatic insufficiency within 30-60 min and offers the possibility of monitoring the in vivo release of pancreatin preparations.