Does mixing pancreatic enzyme microspheres (Pancrease) with food damage the enteric coating?

Supplemental pancreatic enzymes are required for the treatment of malabsorption associated with cystic fibrosis. It is a general practice for enzymes to be sprinkled on, or administered in, food given to infants or children who require pancreatic enzyme replacement. We tested the effect of in vitro incubation of enteric-coated pancreatic enzyme microspheres with infant foods on total recoverable enzyme activity and on the enteric coating. Incubation of enzyme beads with foods with pH greater than 5 (i.e., chicken pH 6.5, veal pH 6.3, and green beans pH 5.6) was without significant effect on either parameter. There was a statistically significant, albeit minor, reduction in maximum enzyme activity recovered following incubation with applesauce (pH 3.5). In addition, the thickness of the enteric coating was significantly reduced. Whether changes in the enzyme beads results in improved or diminished efficiency of therapy remains to be determined. Lipase, unprotected by enteric coating, was rapidly inactivated in applesauce, emphasizing the need to instruct parents about which foods to avoid when administering pancreatic enzymes without enteric coating.