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May 12, 1989

Adequate Enzyme Replacement After Total Pancreatectomy

Author Affiliations

The Upjohn Company Kalamazoo, Mich

The Upjohn Company Kalamazoo, Mich

JAMA. 1989;261(18):2638-2639. doi:10.1001/jama.1989.03420180062028

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To the Editor.—  Two years ago, at age 60 years, I developed multifocal adenocarcinoma of the pancreas. The only signs were some abdominal discomfort 2 to 3 hours after meals, two bowel movements per day instead of one, and softer stools. They persisted for about 3 weeks. Then, jaundice (without pain) was noticed by a colleague 1 week prior to hospitalization. The surgical treatment consisted of Whipple's operation (total pancreatectomy, duodenectomy, gastrojejunostomy, splenectomy, and cholecystectomy). Quite a job. This was followed by chemotherapy (fluorouracil, doxorubicin [Adriamycin], and mitomycin) and abdominal radiation. The pancreatectomy produced instant type I diabetes and total lack of digestive enzymes. To compensate for the latter, I first took three capsules of pancrelipase (Pancrease) before each meal. Later on, I switched to pancreatin and then Entolase HP. The insulin doses have been 20 U of insulin zinc suspension (Lente insulin) in the morning and 7 U of