Fibrosing colonopathy is a manifestation associated with high-dose pancreatic enzyme therapy. Which option below is a manifestation?

• A. Stomach ulcers
• B. Intestinal perforation
• C. Pancreatic cancer
• D. Fibrosing colonopathy (strictures of ascending colon)

Answer: (D)

Fibrosing colonopathy occurs when the colon is exposed to very high doses of pancreatic enzymes, particularly lipase, used in replacement therapy. This excessive exposure can trigger inflammatory injury that progresses to fibrosis, causing stricturing of the colon, classically in the ascending portion. Clinically, this presents as symptoms of partial bowel obstruction or abdominal discomfort due to the narrowed colonic segments. The finding is specifically linked to high-dose enzyme therapy and is the reason dosing is kept to the lowest effective amount and patients are monitored for GI symptoms. Other GI issues like stomach ulcers, intestinal perforation, or pancreatic cancer are not characteristic manifestations of high-dose pancreatic enzyme therapy.