In order to properly digest and absorb nutrients, enzymes that are released from the pancreas need to mix with food ingested at meals. These pancreatic enzymes help break food down so that it can be absorbed in the small intestine. After a partial or total gastrectomy, some patients may experience malabsorption of some nutrients – especially fats. This is often due to the increased transit time of food through the GI system.
The stomach serves as a holding tank and slowly lets food into the small bowel as it is broken down into small pieces. Without a stomach, food quickly passes from the esophagus through to the small intestine. This quick movement of food into the small intestine can prevent sufficient mixing of food with digestive enzymes. In addition there is no filtering of food so larger than normal food particles can empty into the small bowel making enzyme breakdown of food even more difficult. After a gastrectomy, there may be a decreased amount of digestive enzymes released from the pancreas. This combined with the rapid transit of food through the system described above can cause a maldigestion and malabsorption of fats and other nutrients. Symptoms of fat malabsorption include the following: foul smelling oily stools, (steatorrhea), oil droplets floating in the toilet bowl after bowel movements, and abdominal discomfort, gas and bloating.
Pancreatic enzyme replacement may be necessary to improve absorption of nutrients especially fats and fat soluble vitamins such as vitamin D. Pancreatic enzymes taken at meals and snacks can often improve digestion and absorption of these nutrients. There are a number of over-the-counter pancreatic enzyme products; however, to ensure safety and effectiveness, prescription pancreatic enzymes are preferred. Pancreatic enzymes currently available by prescription in the U.S. include Pancreaze, Zenpep and Creon.