Monitoring of Enzyme Substitution Using the Cholesteryl Octanoate Breath Test

The efficiency of enzyme replacement therapy in pancreatic insufficiency is usually judged on the grounds of clinical improvement and the effect on steatorrhea: treatment is thought to be successful if steatorrhea is abolished or, at least, reduced. In the majority of patients, the amount of enzyme necessary to alleviate steatorrhea can be reduced if lipase is protected against acidic inactivation either by blocking H2 secretion of the stomach or by protecting enzymes by pH-sensitive enteric coating. However, steatorrhea is frequently not abolished and a differential treatment may be necessary in each patient.