Pancreatic enzyme replacement effective in chronic pancreatitis

Last Updated: 2016-12-26

By Will Boggs MD

NEW YORK (Reuters Health) - Pancreatic enzyme replacement therapy (PERT) relieves symptoms and corrects exocrine pancreatic insufficiency in patients with chronic pancreatitis, according to a systematic review and meta-analysis.

"We recommend that all patients with a formally established diagnosis of chronic pancreatitis should be offered PERT unless pancreatic exocrine function has been demonstrated to be normal, e.g., by demonstration of bicarbonate secretion of 80 mEq or more (concentration) by endoscopic pancreatic function testing," Dr. Robert Sutton from University of Liverpool, UK told Reuters Health by email.

Exocrine pancreatic insufficiency (EPI) affects more than 50% of patients with chronic pancreatitis and results in compromised digestion, absorption, and nutrient metabolism. Previous evidence suggests that most patients with EPI secondary to chronic pancreatitis are undertreated.

Dr. Sutton and colleagues investigated the effects of PERT on EPI in chronic pancreatitis in their meta-analysis of 14 randomized controlled trials involving a total of 477 patients.

Study durations ranged from several days to two months, and only two open-label extension studies examined nutritional impacts over six months and 12 months, according to the December 9th Gut online report.

PERT increased the coefficient of fat absorption (CFA) from 63.1 at baseline to 83.7 and slightly improved the coefficient of nitrogen absorption, while significantly reducing fecal fat excretion (FFE), fecal nitrogen excretion, and fecal weight.

PERT was also associated with improved symptoms of flatulence, abdominal pain, and fecal consistency.

Higher doses of PERT tended to be associated with greater improvements in CFA and FFE.

The extension trials reported significant improvements in nutritional parameters, gastrointestinal symptoms, and quality of life, with a favorable safety and tolerability profile.

"Unlike in the previous Cochrane review with meta-analysis of only two studies," the researchers note, "our meta-analysis of 14 randomized controlled trials demonstrates that PERT is clearly indicated in chronic pancreatitis for EPI."

"The main point of the paper is to underline the importance of PERT in exocrine insufficiency from chronic pancreatitis, as this is under-prescribed and malnutrition severely impacts on the long-term health of patients," Dr. Sutton concluded. "The other point is that there are few long-term studies in this area, so the long-term impact has to be extrapolated - a topic for future research, as are developing regimens of even greater efficacy."

Dr. David Y. Graham from Baylor College of Medicine, Houston, Texas, who earlier reviewed PERT, told Reuters Health by email, "The studies largely compared drug with placebo and by and large they were effective with this extremely low bar. The companies have still not provided the data requested by the FDA to help understand the overall poor results and the lack of dose response."

SOURCE: http://bit.ly/2iwU5Ak

Gut 2016.