Digestive Diseases and Sciences

, Volume 37, Issue 9, pp 1441–1446 | Cite as

Use of famotidine in severe exocrine pancreatic insufficiency with persistent maldigestion on enzymatic replacement therapy

A long-term study in cystic fibrosis
  • Antonio Carroccio
  • Francesca Pardo
  • Giuseppe Montalto
  • Luciana Iapichino
  • Maurizio Soresi
  • Maurizio R. Averna
  • Giuseppe Iacono
  • Alberto Notarbartolo
Original Articles

Abstract

In patients with pancreatic exocrine insufficiency, the use of pancreatic enzyme does not abolish steatorrhea in some cases. We carried out a long-term prospective study in an attempt to clarify the effectiveness of the associated use of famotidine to enzymatic supplementation on fat absorption and nutritional parameters of patients with pancreatic insufficiency due to cystic fibrosis. We studied 10 patients, mean age 12.5 years, with persistent steatorrhea on enzymatic supplementation. A double-blind crossover design was used and famotidine (1 mg/kg/day) or placebo was given as adjuvant to enzymatic preparations for either of two six-month periods. A statistically significative reduction in fecal wet weight (P<0.0001), an improvement in the coefficient of fat absorption (P<0.01) and in the steatocrit values (P<0.028) were found on famotidine. Moreover, the weight and the height increases were greater after famotidine than after placebo period (respectively, P<0.012 and P<0.01); also the serum calcium and triglycerides levels were higher after the period on famotidine (respectively, P<0.0025 and P<0.025). No adverse effects of famotidine were noted. These data suggest that famotidine is a useful adjuvant to pancreatic enzyme therapy in patients with severe pancreatic insufficiency and persistent maldigestion on large doses of pancreatic supplements; in fact, famotidine improves not only fat absorption but the nutritional status of the patients.

Key Words

famotidine cystic fibrosis maldigestion growth pancreatic enzymes 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Di Magno EP, Go VLW, Summerskill WHJ: Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 288:813–815, 1973Google Scholar
  2. 2.
    Di Magno EP, Malagelada JR, Go VLW, Moertell CG: Fate of orally ingested enzymes in pancreatic insufficiency. Comparison of two dosage schedules. N Engl J Med 296:1318–1322, 1977Google Scholar
  3. 3.
    Regan PT, Malagelada JR, Di Magno EP, Glanzman SL, Go VLW: Comparative effects of antacids, Cimetidine and enteric coating on the therapeutic response to oral enzymes in severe pancreatic insufficiency. N Engl J Med 297:854–858, 1977Google Scholar
  4. 4.
    Chase HP, Long MA, Lavin MH: Cystic fibrosis and malnutrition. J Pediatr 95:337–347, 1979Google Scholar
  5. 5.
    Meyer JH: The ins and outs of oral pancreatic enzymes. N Engl J Med 296:1347–1348, 1977Google Scholar
  6. 6.
    Nassif EG, Younoszai MK, Weinberger MM, Nassif CM: Comparative effects, of antacids, enteric coating and bile salts on the efficacy of oral pancreatic enzyme therapy in cystic fibrosis. J Pediatr 98:320–323, 1981Google Scholar
  7. 7.
    Braggion C, Borgo G, Faggionato P, Mastella G: Influence of antacid and formulation on effectiveness of pancreatic enzyme supplementation in cystic fibrosis. Arch Dis Child 62:349–356, 1987Google Scholar
  8. 8.
    Carroccio A, Pardo F, Montalto G, Iapichino L, Iacono G, Collura M, Notarbartolo A: Effectiveness of enteric coated preparations on nutritional parameters in cystic fibrosis. Digestion 41:201–205, 1988Google Scholar
  9. 9.
    Montalto G, Carroccio A, Iacono G, Soresi M, Notarbartolo A: Steatocrit test in monitoring malabsorption in cystic fibrosis. Int J Pancreatol 3(2):265, 1988Google Scholar
  10. 10.
    Cox KL, Isenberg JN, Osher AB, Dooley RR: The effect of cimetidine on maldigestion in cystic fibrosis. J Pediatr 94:488–492, 1979Google Scholar
  11. 11.
    Zentler-Munro PL, Fine DR, Batten JC, Northfield TC: Effect of cimetidine on enzyme inactivation, bile acid precipitation and lipid solubilisation in pancreatic steatorrhea due to cystic fibrosis. Gut 26:892–901, 1985Google Scholar
  12. 12.
    Zentler-Munro PL, Fitzpatrick WJF, Batten JC, Northfield TC: Effect of intrajejunal acidity on aqueous phase bile acid and lipid concentration in pancreatic steatorrhea due to cystic fibrosis. Gut 25:500–507, 1984Google Scholar
  13. 13.
    Boyle BJ, Long WB, Balestrieri WF, Widzer SJ, Huang N: Effect of cimetidine and pancreatic enzymes on serum and fecal bile acids and fat absorption in cystic fibrosis. Gastroenterology 78:950–953, 1980Google Scholar
  14. 14.
    Chalmers DM, Brown RC, Miller MG, Clarke PCN, Kelleher J, Littlewood JM, Losowky MS: The influence of long-term cimetidine as an adjuvant to pancreatic enzyme therapy in cystic fibrosis. Acta Paediatr Scand 74:114–117, 1985Google Scholar
  15. 15.
    Mastella G: Nutritional problems in maldigestion and malabsorption in childhood.In Enzyme Development and Postnatal Feeding. HR Muller (ed). Vavey, 1975, pp 115–138Google Scholar
  16. 16.
    Shwachman H, Kulchezycki LL: Long-term study of 105 patients with cystic fibrosis. AMA J Dis Child 96:6, 1958Google Scholar
  17. 17.
    Crispin N, Norman AP: The systematic evaluation of the chest radiography in cystic fibrosis. Pediatr Radiol 2:101–105, 1974Google Scholar
  18. 18.
    Van de Kamer JH, Ten Bokkel Huinin KH, Wayers HA: A rapid method for the determination of fat in feces. J Biol Chem 177:347–355, 1949Google Scholar
  19. 19.
    Phuapradit P, Narang A, Mendonca P, Harris DA, Baum JD: The steatocrit: A simple method for estimating stool fat content, in newborn infants. Arch Dis Child 56:725–727, 1981Google Scholar
  20. 20.
    Durie PR, Bell L, Linton W, Corey ML, Forstner GG: Effect of cimetidine and sodium bicarbonate on pancreatic replacement therapy in cystic fibrosis. Gut 21:778–786, 1980Google Scholar
  21. 21.
    Colombo C, Maiavacca R, Ronchi M, Consalvo E, Amoretti M, Giunta A: The steatocrit: A simple method for monitoring fat malabsorption in patients with cystic fibrosis. J Pediatr Gastroenterol Nutr 6:926–930, 1987Google Scholar
  22. 22.
    Iacono G, Carroccio A, Montalto G, Cavataio F, Bragion E, Iapichino L, Balsamo V, Notarbartolo A: Usefulness of steatocrit test in monitoring malabsorption in cystic fibrosis. Ital J Gastroenterol 5:295–298, 1988Google Scholar
  23. 23.
    Ryan RR: Clinical pharmacology of famotidine: Summary of data from the United States. Ital J Gastroenterol 16:171–174, 1984Google Scholar
  24. 24.
    Shepherd RW, Cooksley WGE, Cooke WDD: Improved growth and clinical nutritional and respiratory changes in response to nutritional therapy in cystic fibrosis. J Pediatr 97:351–357, 1980Google Scholar
  25. 25.
    Muller P, Dammann HG, Schmidt-Gayk H, Lichtwald K, Staiger C, Simon B: Famotidine (MK-208): duration of action, 24-hour intragastric acidity, antipyrine kinetics, and basal hormone levels in men. Gastroenterology 86:1190, 1984 (abstract)Google Scholar
  26. 26.
    Hayakawa A: Effect of famotidine on serum gastric prolactin, the gonadotropic hormone (LH, FSH), and sex hormones (estradiol, testosterone). Ital J Gastroenterol 16:174–176, 1984Google Scholar

Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • Antonio Carroccio
    • 1
  • Francesca Pardo
    • 1
  • Giuseppe Montalto
    • 1
  • Luciana Iapichino
    • 1
  • Maurizio Soresi
    • 1
  • Maurizio R. Averna
    • 1
  • Giuseppe Iacono
    • 1
  • Alberto Notarbartolo
    • 1
  1. 1.Cattedra di Patologia Medica IIUniversitá di Palermo, and Serv. Fibrosi Cistica, Osped. di CristinaPalermoItaly

Personalised recommendations