For digestive problems, enzymes are most often prescribed to help normalize the functioning of the stomach and pancreas. Today, pharmaceutical companies produce many drugs that help improve the functioning of the digestive system. Among them, the most popular are Festal and Pancreatin, the action of each medicine is aimed at eliminating negative manifestations, namely discomfort and severe heaviness in the stomach, normalizing the absorption of nutrients and microelements. In order to understand which is better, Festal or Pancreatin, you will need to conduct a comparative analysis and identify the advantages and disadvantages of each drug.
Pharmacological action, pharmacodynamics and pharmacokinetics
According to the annotation, Festal has choleretic, lipolytic and proteolytic effects.
This enzyme preparation helps normalize the functioning of the pancreas and compensates for its secretory insufficiency.
Protease, lipase and amylase contained in the drug stimulate digestive and metabolic processes, and also facilitate the breakdown of carbohydrates and protein compounds, improving their absorption into the blood from the intestines.
Hemicellulase reduces gas formation and helps eliminate bloating.
Bile components emulsify fats and also facilitate the absorption of fat-soluble vitamins (A, E, B, K).
Possibilities of enzyme therapy in the treatment of biliary and pancreatic insufficiency
Professor Drapkina O.M.: : - We are moving on to the next section, gastroenterology, and once again I ask, dear colleagues, to comply with the regulations. Professor Shatikhin Andrey Ionovich, “Possibilities of enzyme therapy in the treatment of biliary and pancreatic insufficiency.”
Professor Shatikhin A.I.: — Gastroenterologists know well that, according to modern concepts, chronic pancreatitis is a group of diseases of the pancreas of various etiologies, characterized by pain and progressive functional failure of the organ.
What will we talk about today? We will talk about the treatment of functional pancreas insufficiency. Gradual fibrosis, exogenous pancreatic insufficiency - all this can lead to diabetes mellitus.
Pancreatic fibrosis with the development of functional pancreatic insufficiency in chronic pancreatitis is the outcome of a wide range of exogenous influences and endogenous factors. In chronic pancreatitis, both the secretory and endocrine parts of the pancreas are affected, which in the later stages leads to the development of diabetes mellitus.
What etiological factors should attract the attention of practicing gastroenterologists when diagnosing chronic pancreatitis? The most common causes are alcohol abuse up to 90%, the presence of diseases of the biliary system, and aging. In connection with the above, biliary pancreatitis and alcoholic pancreatitis are often distinguished. Hereditary or involutive pancreatitis is also possible.
Clinical symptoms of chronic pancreatitis. Its main manifestations are:
- constant pain in the upper abdomen after eating;
- constant decrease in exocrine pancreatic function; dyspeptic disorders;
- jaundice up to 33% in patients of a transient nature, associated with edema, enlargement of the head of the pancreas and compression of the common bile duct;
- formation of pseudocysts due to ruptures of the pancreatic ducts.
A rare manifestation of chronic pancreatitis may be portal hypertension due to inflammatory compression of the vena portae (portal vein) and v. lienalis (splenic vein).
Pancreas research methods:
- these are, of course, complaints, an absolutely deep, clear, meticulous history of the disease;
- laboratory tests of pancreatic enzymes in blood and urine;
- plain radiography to detect calcifications in an oblique projection, which often happens in people who abuse alcohol;
- Ultrasound examination: size, contour irregularities, ducts, pseudocysts, lesions, parenchyma compactions on the gray scale of the screen. I must warn you that now a diagnosis is often made only on the basis of an ultrasound examination, as if exaggerating the significance of an ultrasound examination. This is not true;
- ERCP (endoscopic retrograde cholangiopancreatography) is a change in the pancreatic ducts and its branches, identifying the so-called “chain of lakes” symptom;
- computed tomography (CT) with contrast, signs of chronic pancreatitis in this case: the absence of accumulation of the contrast agent is revealed - this is a zone of necrosis;
- angiography;
- and what is often carried out in practice by doctors and is of great importance for determining exocrine function is stool macroscopy: stool has a gray tint, has a shiny color, is greasy, sticky due to steatorrhea, and is poorly washed off the toilet; and stool microscopy - amilorrhea, creatorrhoea and steatorrhea due to the large amount of neutral fat in the stool of large droplets with a diameter of up to 8 microns. Study of elastase in feces.
General principles of treatment of chronic pancreatitis:
- refusal to drink alcohol, including beer;
- diet: fifth, 5p table (pancreatic) low in fat and with a lot of protein;
- pain relief: these are antispasmodics and non-narcotic analgesics: papaverine, no-spa, metamizole, paracetamol;
- Narcotic analgesics may be prescribed for severe pain, in particular promedol;
- tramadol – orally;
- antacids - very good for inactivating HCl, which stimulate pancreatic secretion;
- aluminum hydroxide 15 minutes before meals and an hour after meals;
- anticholinergics (m-anticholinergics);
- antidepressants;
- octreotide, in particular sandostatin, as an inhibitor of pancreatic secretion, reduces the number of pseudocysts;
- Proton pump blockers are a big thing now. This is a whole group of drugs, which are prescribed to these patients 1-2 times a day, 20 mg;
- beta blockers (anaprilin);
- lateral pancreatojejunostomy and distal pancreatectomy are surgical interventions;
- percutaneous denervation of the plexus solaris by administration of alcohol.
Now we come to the drugs that are the topic of today’s message in the treatment of exocrine pancreas function:
- these are drugs containing lipase, amylase, protease in different concentrations;
- tablet preparations: mezim, panzinorm, pancreoflat, pancitrate (capsules with microtablets);
- encapsulated preparations: micrazim, enteric capsules with microgranules, the now famous Creon - enteric capsules with minimicrospheres with various doses of lipase from 10 thousand ED to 40 thousand ED; preparations containing, in addition to lipase, amylase, protease, components of bile from cattle, often from pigs, and in enteric tablets.
Enzyme preparations:
- facilitate the digestion of proteins, fats and carbohydrates;
- stimulate the secretion of their own enzymes of the pancreas, stomach, small intestine and bile secretion;
- stimulate choleretic action;
- stimulate emulsification of fats;
- stimulates lipase activity;
- stimulates the absorption of fats and fat-soluble vitamins.
Creon and chronic pancreatitis. About Creon, it must be said that this is a relatively new drug, and here the doctor’s curiosity and passion for a new, perhaps better drug are triggered. I have absolutely nothing against Creon, but Creon also does not make a difference in the treatment of exocrine function. Why Creon? Why is it preferred? Since it has a high lipase content? This tendency is generally accepted among all gastroenterologists: if there is a lot, it means better.
In recent years, due to the appearance of Creon, the problem of chronic pancreatitis with pancreatic insufficiency has been very actively discussed, and, consequently, other enzymes and indications for them are forgotten.
There is overdiagnosis of chronic pancreatitis. I already stopped at this when I talked about ultrasound examination. But overeating is where the search for enzyme preparations takes place. In practice, there is an overdiagnosis of chronic pancreatitis with true pancreatic insufficiency. This is deep pancreatic insufficiency, which is quite rare. In this case, chronic pancreatitis is diagnosed, I emphasize once again, using only echography. It should be noted that true pancreatic insufficiency is rare and requires, first of all, clinical and laboratory confirmation (scatology and elastase test).
The most common cause of digestive disorders is overeating due to diseases of the biliary tract and liver or relative deficiency of pancreatin due to hyperacidity.
Why should doctors be interested in bile enzymes? Today the situation is changing due to the non-infectious epidemic of diabetes mellitus, which is accompanied by diseases of the biliary tract and biliary insufficiency.
The problem of biliary insufficiency is currently not relevant in clinical practice, while in patients with biliary tract diseases with diabetes mellitus, metabolic syndrome and alcoholism, it is very relevant. This leads to renewed interest in choleretics, in particular festal, which can correct the symptoms of biliary insufficiency.
Let's remember the mechanisms of action of bile and bile acids. There is an opinion among doctors that tableted enzymes are ineffective, since they are destroyed by the action of HCl, while they forget that although there are tablets, they are enteric drugs, please, your festal.
Doctors do not sufficiently understand, or have forgotten, the mechanisms of action of bile, bile acids and lipase, which does not allow them to deeply understand the mechanisms of action of some enzymes.
Bile is a secretion secreted by hepatocytes; in the human intestine plays an important role in the physicochemical processing, digestion and absorption of fat.
From a physiological point of view, bile acids are the main component of bile, associated with the processes of digestion and absorption of fat.
Bile acids activate pancreatic lipase; in the presence of a bile component, the pH optimum for lipase action shifts from 8 to 6, that is, the level that corresponds to the duodenum.
Bile acids (cholic and chenodeoxycholic) transport lipids in an aqueous environment and are capable of dissolving lipids by forming a micellar solution - a lipid complex of bile, which is transferred to the intestine.
Bile acids are involved in the emulsification of fat as part of the emulsifying system, where saturated monoglyceride, unsaturated fatty acid and bile acid are fat emulsion stabilizers.
After fat is broken down by lipase, the breakdown products – monoglycerides and fatty acids – form a micellar solution. Thanks to bile acids, micelles that are stable in an aqueous environment are formed containing fat breakdown products, cholesterol and phospholipids, which are transferred from emulsified particles to the absorption surface of the intestinal epithelium.
This is where fat absorption begins. Lipases catalyze the hydrolytic breakdown of triglycerides into fatty acids and glycerol, which are absorbed in the digestive tract as energy, and I emphasize, plastic material. This is something that is difficult to digest without, so lipase, by catalyzing hydrolytic cleavage, provides us with energy and plastic materials.
About the results of the positive use of festal containing bile components. Festal is especially popular among doctors and consumers as an enzyme containing bile components, in particular bile acids. In case of pancreatic disease, festal compensates for the insufficiency of its exocrine function. Festal ensures success in treating biliary dyskinesia, hypomotor hypokinesia of the gallbladder, and enhances intestinal motility. Has a beneficial effect on the function of the entire gastrointestinal tract; good tolerance is noted; relieves dyspeptic symptoms. This is the data of Okhlobystin A.V. and academician Ivashkin V.T. from their book “Rational Pharmacotherapy of Digestive Diseases.”
It also postulates that drugs containing bile and bile acids, in particular festal, can serve as a means of replacement therapy for endogenous bile acid deficiency.
About the results of the positive use of festal containing bile components. Thus, in patients with biliary pancreatitis, involuting chronic pancreatitis, especially in those with alcoholic pancreatitis, a significant progressive decrease in the total content of bile conjugates was noted in the duodenal bile, which can lead to a decrease in the absorption of cholesterol in the intestine and affect the exocrine function of the pancreas. In patients with no severe exogenous pancreatic insufficiency and only dyspeptic complaints, the use of drugs such as Festal is justified, as they contain a bile extract that promotes the emulsification of fats and increases lipase activity.
So, about the results of the positive use of festal containing bile components. This is where I cited the data of L.V. Vinokurova. from the book “Effective Pharmacotherapy-Gastroenterology” for this year.
Yakovenko E.P. et al. says that it is advisable to combine Odeston with multienzyme preparations containing bile components, namely festal.
In multicenter studies assessing the proteolytic activity of a number of enzyme preparations, taking into account the own hydrolytic activity of duodenal contents in patients, it was proven that festal has the greatest specific (true) proteolytic activity. It is the drug of choice for reducing pain and creating functional rest of the pancreas.
The minimum amount of bile acids ensures the activation of lipase, but does not cause diarrhea, but only a slight loosening of the stool. The choleretic effect is indicated for biliary chronic pancreatitis, in patients after cholecystectomy, mainly with constipation. This is the data of Professor Gubergrits N.B. from Donetsk.
I can’t help but tell you about the opposite opinion; this opinion belongs to I.V. Mayev. and his employees, Pharmateka, No. 12, 2011. In Russia, they continue to recommend pancreatin tablets from various manufacturers, which is especially sad when they sometimes prescribe not only pure pancreatin, but also drugs with bile components. There is absolutely not a single word to prove that this cannot be done, it cannot be used, supposedly, containing bile acids.
The drug is prescribed 2-3 tablets during meals; Do not chew the tablets, take them with a small amount of liquid. The duration of treatment is determined individually.
Treatment of chronic pancreatitis is carried out under the control of: the clinical condition of patients; clinical and laboratory data, that is, scatological data are improved; scatological research; elastase content in feces.
Criteria for the effectiveness of therapy for exogenous deficiency in chronic pancreatitis. Signs of effectiveness are: increase in body weight; normalization of stool; reduction of flatulence; positive dynamics of the results of scatological research, namely a decrease in grains of neutral fat, that is, a decrease or disappearance of steatorrhea, creatorrhoea and amilorrhea; normalization of elastase test indicators; normalization of vitamin deficiency.
Contraindications to the use of Festal: acute pancreatitis and exacerbation of chronic pancreatitis; acute cholecystitis; acute hepatitis. Thank you for your attention!
What does Festal help with?
The main indications for taking an enzyme preparation is a decrease in the activity of the pancreas and hepatolienal system, which is accompanied by symptoms of dyspepsia, increased gas formation, and impaired digestion of food.
Festal is prescribed for:
- Toxic, medicinal and alcoholic hepatitis, liver cirrhosis.
- Chronic pancreatitis.
- Malabsorption syndrome.
- Dysbacteriosis.
- Gastritis, duodenitis, enteritis, colitis.
- Other pathological conditions of the gastrointestinal tract, accompanied by impaired digestion and absorption of food.
Description of means
The main purpose of Festal and Pancreatin is to normalize the functioning of the gastrointestinal tract.
Thanks to the presence of pancreatic enzymes, it is possible to significantly simplify the breakdown of proteins directly into amino acids, starch into monosaccharides with dextrins, lipids into glycerol, and fatty acids. At the same time, their absorption is normalized and the digestive process is corrected.
Since the mechanism of action of these drugs is similar, the indications for use are also the same:
- Chronic course of pancreatitis
- Dyspeptic manifestations
- Restoration of the body after surgery on the gastrointestinal tract, as well as radiation
- The occurrence of Roemheld syndrome
- Treatment after pancreatectomy
- The development of diarrhea, which is characterized by non-infectious genesis.
Pancreatin
The drug can be used during the normal functioning of the gastrointestinal tract in order to normalize the process of digesting fried, fatty or spicy foods. The drug is used for impaired chewing function, a sedentary lifestyle, and a long period of immobilization. Along with this, the use of a medicine such as Pancreatin is often prescribed for the purpose of preparing for diagnostic procedures (ultrasound).
Festal is recommended for use for:
- Exocrine pancreatic insufficiency syndrome, which developed against the background of chronic pancreatitis
- Diffuse liver diseases
- Violation of bile formation and deterioration of its outflow.
Not everyone knows how Festal differs from Pancreatin, because both drugs include enzymes. To choose the best medicine, it is worth comparing their main characteristics.
Contraindications
The main conditions limiting the use of the drug:
- A history of allergic reactions to one or more components of the drug.
- Severe liver failure.
- Diarrhea of unknown origin.
- Intestinal obstruction.
- Cholelithiasis.
- Obstructive jaundice.
- Early childhood (up to 3 years).
Comparison of the safety of Pancreatin and Festal
The safety of a drug includes many factors.
At the same time, with Pancreatin it is quite similar to Festal. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Pancreatin, as well as of Festal, we look at which organ is the metabolizing organ and how critical the effect on it is.
The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Pancreatin does not have any risks when used, just like Festal.
Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Pancreatin and Festal.
Festal or Creon - which to choose?
Before choosing one of these drugs, it is important to carefully study the indications for their use and the realized effects. It is better to do this not on your own, but with the help of a specialist who will give you the correct diagnosis and select the most suitable medication.
If we rely on patient reviews and the opinion of doctors, Creon is a faster and more effective drug, but it also costs significantly more. This medication has a wide range of indications for use and has virtually no contraindications. Unlike Festal, Creon can be prescribed to children starting from the first year of life. If we compare the release forms, the latter is produced in the form of capsules, which dissolve better in the gastrointestinal tract.
Either way, these are just statistics. Only a doctor, based on your complaints, medical history and objective examination methods, can decide which of these drugs is best for you.
Comparison of addiction between Pancreatin and Festal
Like safety, addiction also involves many factors that must be considered when evaluating a drug.
So, the totality of the values of such parameters as “o syndrome” in Pancreatin is quite similar to the similar values in Festal. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, Pancreatin has quite a small value of “syndrome”, however, the same as Festal.
Characteristics of active ingredients
Pancreatin replenishes the deficiency of pancreatic enzymes for breaking down the food coma into simpler components and their further absorption.
The components of animal bile make it possible to correct biliary insufficiency, which often accompanies chronic pancreatitis. Thanks to them, the production, separation and movement of bile acids is improved and better breakdown of fats is ensured.
Hemicellulase facilitates the breakdown of plant fiber, fights flatulence and stimulates the process of food digestion.
Patient reviews
Tamara, 38 years old, Sochi: “I was diagnosed with gastritis 2 years ago. Now I watch every piece of food and follow a diet. I'm afraid that an attack will happen, because there is little pleasure in this. But sometimes there are breakdowns. In such cases, I always take Festal and other medications. I’ve never tried Pancreatin, but at a party I was once suggested this drug. I won’t say which one is better, the pain and heaviness disappear quickly.”
Gennady, 46 years old, Moscow: “For me there is no choice: Festal or Pancreatin. Many years ago I made a choice, having tried both expensive and cheap medicines, both ours and foreign ones. Only Festal brings relief. But I drink it exclusively in cases when I break my diet: I eat something fatty or spicy. Other pills only make the severity worse.”
special instructions
High doses of Festal provoke the development of hyperuricemia/hyperuricuria.
Enzymes are used with caution in cystic fibrosis and Alzheimer's disease. A preliminary consultation with a doctor is required.
Pregnancy and lactation
Modern medicine does not answer the question of how safe enzyme preparations are for pregnant women. Therefore, in each specific case, medications are prescribed by the attending physician.
During breastfeeding, Festal and Pancreatin are not prohibited.
Childhood
Children starting from 3 years of age can take Pancreatin and Festal. Since the tablets cannot be divided, otherwise their therapeutic effect is reduced to zero, a dosage of Pancreatin tablets of 125 mg (12.5 units) has been developed especially for small patients. If the child’s age is less than 3 years, he is prescribed “softer” analogues.
Elderly age
No adjustments to enzyme therapy are required for elderly people.
Directions for use and dosage
Pancreatin and Festal are taken orally during or after meals. An approximate dosage regimen is prescribed in the instructions for the medications. Festal is taken 1 tablet three times a day, Pancreatin - 1-2 tablets 3-4 times a day. If there is no proper result, the dose can be increased to 2 tablets once. The daily dose of medication should not exceed 6-8 tablets. The dosage form is washed down with plenty of warm water.
The principle of operation of the enzyme preparation
If the human body, for some reason, is not able to produce the required amount of enzymes involved in the breakdown of food for its further absorption, processing and elimination, it needs to ensure their supply from the outside with the help of tablets.
The release of enzymes occurs in the small intestine, so enzyme preparations are protected by a special shell, allowing them to easily bypass the aggressive environment of the stomach. Next, enzymes participate in the breakdown of proteins, fats and carbohydrates, accelerate metabolic processes and stabilize the functioning of the digestive tract, simultaneously destroying toxic cells in case of poisoning.
Is there a difference between the drugs
Both drugs contain an enzyme called “pancreatin”, which facilitates the digestion of food (protease breaks down protein, amylase breaks down carbohydrates and lipase breaks down fats).
Pancreatin is a single drug and is manufactured in Russia and Ukraine. Three-component Festal is produced in India and France. Its composition is expanded with hemicellulase and bile. Therefore, Festal’s activity is higher, and its list of indications is much wider. However, it cannot be taken in long courses, but Pancreatin can be taken.
Analogs
Medicines are considered structural analogues of each other with similar therapeutic effects. Medicines have a number of generics:
- Creon. Available in the form of capsules, inside of which there are pellets containing pancreatin. The medicine compensates for the deficiency of enzymes necessary for the normal functioning of the pancreas. Side effects are extremely rare. Price - from 300 rub.
- Mezim. The tablets contain pancreatin, the manufacturer provides the presence of additional components (talc, magnesium stearate, macrogol). Approved for use for dyspepsia and overeating. In case of acute pancreatitis, the drug should not be taken. Cost - from 75 rub.
- Pankreoflat. The tablet form contains dimethicone and pancreatin. The enzyme preparation can be taken during the rehabilitation period after surgery due to diseases of the digestive system. It is strictly forbidden for children to take this medication. Price - from 180 rub.
Indications for use
Enzymatic preparations are used in the following cases:
- when overeating;
- in the absence of physical activity;
- with poor nutrition (meager breakfast and large dinner);
- for chronic pancreatic disease.
In addition to the above, Festal is taken for constipation, increased gas formation, chronic gastritis, cholecystitis, liver diseases, disorders of the production and separation of bile, to replenish bile levels after cholecystectomy and as part of therapy after irradiation of the gastrointestinal tract.
Comparison of side effects of Pancreatin and Festal
Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.
Pancreatin's side effects are almost the same as Festal's. They both have few side effects. This implies that the frequency of their occurrence is low, that is, the indicator of how many cases of an undesirable effect of treatment are possible and registered is low. The undesirable effect on the body, the strength of influence and the toxic effect of Pancreatin are similar to Festal: how quickly the body recovers after taking it and whether it recovers at all.
