The benefits of pancreatic enzyme replacement therapy in chronic pancreatitis are inadequately defined.
Professor Robert Sutton and colleagues from the United Kingdom have undertaken a systematic review and meta-analysis of randomised controlled trials of pancreatic enzyme replacement therapy to determine the efficacy of pancreatic enzyme replacement therapy in exocrine pancreatic insufficiency from chronic pancreatitis.
Major databases were searched from 1966 to 2015 inclusive.
The team's primary outcome was coefficient of fat absorption.
Effects of pancreatic enzyme replacement therapy versus baseline and versus placebo, and of different doses, formulations and schedules were determined.
The research team included a total of 17 studies.
|Quantitative data were synthesized from 14 studies|
Quantitative data were synthesized from 14 studies.
The researchers found that pancreatic enzyme replacement therapy improved coefficient of fat absorption compared with baseline, and placebo.
Pancreatic enzyme replacement therapy improved coefficient of nitrogen absorption, reduced fecal fat excretion, fecal nitrogen excretion, fecal weight and abdominal pain, without significant adverse events.
The team demonstrated that pancreatic enzyme replacement therapy increased serum nutritional parameters, improved GI symptoms and quality of life without significant adverse events.
High-dose or enteric-coated enzymes showed a trend to greater effectiveness than low-dose or non-coated comparisons, respectively.
Subgroup, sensitive and meta-regression analyses revealed that sample size, chronic pancreatitis diagnostic criteria, study design and enzyme dose contributed to heterogeneity.
Professor Sutton's team concludes, "Pancreatic enzyme replacement therapy is indicated to correct exocrine pancreatic insufficiency, and malnutrition in chronic pancreatitis, and may be improved by higher doses, enteric coating, administration during food and acid suppression."
"Further studies are required to determine optimal regimens, the impact of health inequalities and long-term effects on nutrition."