Download A Guide to Using Pancreatic Enzyme Replacement Therapy (Creon)

A Guide to Using Pancreatic
Enzyme Replacement Therapy
(Creon)
Patient Information
The aim of this leaflet is to provide you with information about using Pancreatic Enzyme
Replacement Therapy (Creon)
There are many reasons why people require Pancreatic Enzyme Replacement Therapy.
The most common reasons are Pancreatitis (inflammation of the pancreas) or Pancreatic
Cancer (where you may have had surgery to remove some or all of your pancreas, or your
pancreas is affected by cancer and cannot work as well as normal).
What is the role of the pancreas?
The pancreas is an organ in the body that helps you to digest your food by producing
substances called enzymes that help to break down fats, proteins and carbohydrates.
The main enzyme produced is called Lipase and this helps you breakdown and absorb the fat
in your food.
The pancreas also produces insulin, a hormone that helps you to absorb carbohydrates from
the digestive system into the bloodstream.
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If your pancreas is not working well or you have had part or all of it removed, you can struggle
to produce enough enzymes and in some cases not enough insulin.
This can lead to malabsorption, where fats, proteins and carbohydrates are undigested and
leave the body as waste in the stools (bowel motions).
How do I know if I have malabsorption?
The most obvious signs of malabsorption are seen when you look at your stools (bowel
motions).
If you have malabsorption your stools become greasy, pale in colour, they may float, they
may be difficult to flush away and they may smell foul. This is known as steattorhoea or fat
malabsorption.
You can also get other symptoms such as abdominal pain (which can be very painful,
particularly in pancreatitis), a sudden urgent need to move your bowels, bloating, indigestion,
wind, tiredness, weight loss or an inability to gain weight.
By taking pancreatic enzyme replacement therapy you can replace the enzymes your
pancreas would normally produce and reduce, if not stop, all of these symptoms.
What does pancreatic enzyme replacement therapy look like?
Pancreatic enzymes come in capsules with a special coating to help them move through your
stomach without being digested, so that they can travel to the part of your digestive system
where they can get to work.
There are three main brands available Creon, Nutrizym GR and Pancrease.
What dose do I need?
In NHS Tayside most adults use Creon capsules. Most people are given Creon 40,000 to
start with, but everyone is different, so your dose may need to be adjusted depending on how
well your pancreas is working and how much you are eating.
You need to take one of your Creon capsules with every meal, snack or nourishing drink, as
long as it contains fat or protein.
If it is just a sugary snack/drink such as squash, lemonade, fruit or fruit juices, boiled sweets
or jelly, then you do not need to take a capsule.
If your symptoms do not immediately improve, you may need to increase the number of
capsules you take, usually at the biggest meal of the day where there is more fat,
carbohydrate and protein to be digested. Your dietitian will be able to advise you of this.
If you are a healthy weight or overweight then you can follow normal healthy eating guidelines
in order to maintain or lose weight and use your Creon accordingly.
If, however, you are underweight, losing weight or need to gain weight for surgery, you should
try not to restrict fats in your diet and you should try to adjust your Creon to the foods you are
eating to avoid symptoms.
How do I know how much Creon to take for the foods I eat?
Remember, everyone is different, but the more fatty a food is, the more Creon you might
need. It can take a lot of trial and error before you remove all symptoms. The amount of
Creon you require will also alter over time, so your symptoms could come back if you
suddenly need more Creon than normal.
As a rough guide the following examples may help you to adjust your Creon accordingly.
Low Dose Foods (up to 10g fat per serving)
Take 1 Creon with these foods
Cereal with semi skimmed milk
Toast with margarine or butter
Porridge made with water
Beans on toast
Ham Sandwich
Chicken salad
Scrambled eggs on toast
Sardines in tomato sauce on toast
Slice of Victoria sponge
Fruit scone
Slice of malt loaf
Slice of fruitcake
Low fat yogurt
Hot chocolate made with full cream milk
Rice pot
Custard Pot
Individual trifle
Ice lollies
Sorbet
Medium Dose Foods (10 – 20g fat per serving)
Take 1 – 2 Creon with these foods
Porridge made entirely with full cream milk
Roast chicken with mash potatoes and vegetables
Spaghetti bolognaise
Pork chops with potatoes and vegetables
Chicken korma with rice
Chilli con carne
Cheese sandwich
Jacket potato with butter and cheese
Sweet and sour pork with rice
Beef burger in a bun
Sausage/bacon Sandwich
Bangers and mash
Salmon with potatoes and vegetables
Fish cakes/fish fingers/breaded fish with potatoes and vegetables
Crisps/Tortilla chips
Cheese and biscuits
Individual fruit pie
Ice-cream/Choc ices
A portion of chips
Ensure plus/Fortisip/Ensure two cal/Clinutren 1.5
High dose foods (greater than 20 g fat per serving)
Take 1 – 3 Creon with these foods or more if you have been advised to do this
Fish and chips
Macaroni cheese
Any pastry dish, for example: pork pie, steak pie, apple pie
Takeaways
Pizza
Roast beef and Yorkshire puddings
Christmas Dinner with all the trimmings
Toad in the hole
Chicken nuggets
Chicken Korma with rice
Lasagne
Apple turnovers
Chocolate Gateaux
Handful of nuts, for example: peanuts
Enshake/Scandishake
For further help and advice ask your health professional to refer you to a dietitian or arrange a
review appointment.
This leaflet was given out by: ________________________________________________
Contact details: ____________________________________________________________
This information leaflet was produced by Helen Webster, Upper GI and HPB Dietitian and
other members of the HPB Multi Disciplinary Team at Ninewells Hospital
Reviewed: 07/2014 Review: 12/2016 LN1271