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Fibrosing colonopathy happens when the colon is exposed to very high levels of pancreatic enzyme activity from enzyme replacement therapy. This was notably seen in cystic fibrosis patients who received high-dose pancreatic enzymes with potent formulations. The excessive enzymes in the intestinal lumen can irritate the colonic mucosa and trigger an inflammatory process that progresses to fibrosis, thickening the colonic wall and potentially causing obstruction. Because of this relationship, clinicians aim to use pancreatic enzyme dosing that is effective but not excessive, to minimize luminal enzyme exposure. The other options do not have this association with colonic fibrosis.