Evidence-based Guidelines for the Management of Exocrine Pancreatic Insufficiency After Pancreatic Surgery

2016 ◽  
Vol 264 (6) ◽  
pp. 949-958 ◽  
Author(s):  
Luis Sabater ◽  
Fabio Ausania ◽  
Olaf J. Bakker ◽  
Jaume Boadas ◽  
J. Enrique Domínguez-Muñoz ◽  
...  
Keyword(s):  
Pancreatic Surgery ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Evidence Based ◽  
Evidence Based Guidelines

Pancreatic enzymes for exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery

2013 ◽  
Vol 17 (4) ◽  
pp. 134-139
Author(s):  
Shu Gong ◽  
Wen-Wu Shen ◽  
Qiang Guo ◽  
Hui-Min Lu ◽  
Xu-Bao Liu ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Surgery ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Enzymes

scholarly journals Pancreatology: debunked myths

2020 ◽  
Vol 48 (3) ◽  
pp. 44-53
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva
Keyword(s):  
Chronic Pancreatitis ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Overweight And Obesity ◽  
Evidence Based ◽  
Enzyme Preparations ◽  
Enzyme Replacement ◽  
European Guidelines ◽  
Relieve Pain

Enzyme replacement therapy is not always effective enough upon exocrine pancreatic insufficiency. One of the main reasons is myths — doctors’ misconceptions about the indications and rules of replacement therapy. In particular, there is an outdated opinion about the effectiveness of tablet enzyme preparations used for the relief of pancreatic pain. However, a number of evidence-based studies have proved that enzyme preparations are not effective enough to relieve pain in chronic pancreatitis, and thus should not be used for this purpose. This statement is recorded in the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis, as well as in the recommendations of the American College of Gastroenterology. In addition, tablet preparations are characterized by asynchronism of the passage of the chyme and the tablet along the digestive tract. The second myth is that drugs without an acid-resistant coat start hydrolyzing the components of the chyme in the stomach, which ensures higher efficiency as compared to Creon. But in the absence of a coat, enzymes are inactivated in the acidic environment of the stomach and cannot have any effect at all. The third myth is that enzyme preparations always cause constipation. In fact, constipation occurs in no more than 10% of cases. They are usually associated with an overdose of the drug, concomitant pathology or insufficient compliance. The fourth myth is that prescribing the doses of enzyme preparations indicated in the European Guidelines causes addiction. It is crucial to know that such doses do not exceed 10% of the pancreas’s own capacities, therefore, they cannot significantly affect these capabilities, which is also demonstrated by evidence-based studies. The fifth myth is that patients gain weight because of enzyme preparations, and they should not be prescribed upon overweight and obesity. Numerous data firmly show that pancreatic insufficiency often occurs in such cases, and enzyme preparations are required. The sixth myth is that a drug with a different composition can be produced under the usual established product name. For example, NEO is added to the name to “mask” a drug with a new composition. Doctors should carefully monitor the composition of such drugs. The seventh myth is that a minimicrospherical preparation (Creon) is as effective as microspherical preparation. However, this statement turned out to be a myth as well. Minimicrospherical preparations are proved to be significantly more effective in clinical practice. Thus, the above-mentioned myths, like many others, are based on insufficient knowledge in the field of pancreatology.

scholarly journals Evaluation of Pancreatotropic and Joint Efficiency of Intracellular Systemic Enzyme in Osteoarthritis

2021 ◽  
pp. 66-69
Author(s):  
Liliia Babynets ◽  
Iryna Halabitska
Keyword(s):  
Objective Assessment ◽  
Pancreatic Insufficiency ◽  
Study Groups ◽  
Exocrine Pancreatic Insufficiency ◽  
Evidence Based ◽  
Unresolved Issue ◽  
Orthopedic Surgeons ◽  
European League Against Rheumatism ◽  
Based Medicine ◽  
European League

Despite the advances of modern evidence-based medicine, the treatment of osteoarthritis (OA) remains a complex and unresolved issue. Of course, modification of the patient’s lifestyle improves the condition of a patient with osteoarthritis, but the management of a patient with osteoarthritis without drug therapy, which is mostly symptomatic, is almost impossible. The objective: was to investigate the effectiveness of intracellular systemic enzyme in the complex therapy of patients with primary OA in comorbidity with exocrine pancreatic insufficiency for the correction of pathological processes developing in patients. Materials and methods. 69 patients with primary OA in comorbidity with exocrine pancreatic insufficiency were examined. The diagnosis of OA was established on the basis of diagnostic criteria of the American College of Rheumatologists (ACR, 2018), the European Association of Rheumatologists (European League Against Rheumatism, EULAR, 2018). American Academy of Orthopedic Surgeons (AAOS, 2018), International Society for the Study of OA (OARSI, 2019). Examination of the joints included examination, palpation, and objective assessment of pain. OA symptoms were also assessed by Leken index and the Harris test. To assess the state of exocrine pancreatic insufficiency, the content of fecal α-elastase was determined and the coprogram was evaluated. Patients were divided into two groups: the 1st group received treatment of primary OA according to international recommendations, the 2nd group additionally received an enzymatic drug. Results. After the treatment, patients of the 1st group showed a statistically significant tendency to deterioration of fecal α-elastase and coprogram (p<0,05), in the 2nd group there was a statistically significant improvement of these indicators (p<0,05). There was also a statistically significant improvement in the course of primary OA in both study groups (p<0,05), but in the 2nd group the therapeutic effect was statistically significantly more significant (p<0,05). Conclusions. There was a statistically significant positive dynamics of exocrine pancreatic insufficiency and course of primary OA in the 2nd group compared to those in the 1st after treatment (p<0,05), which indicates the feasibility of using the enzyme drug in the treatment of patients with primary OA in comorbidity with exocrine pancreatic insufficiency.

scholarly journals Evidence-based pancreatology 2017/2018 (review of the results of studies on chronic pancreatitis and exocrine pancreatic insufficiency

2018 ◽  
Vol 40 (2) ◽  
pp. 12-20
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
G. M. Lukashevish ◽  
E. V. Berezhnaya
Keyword(s):  
Pancreatic Cancer ◽  
Cystic Fibrosis ◽  
Chronic Pancreatitis ◽  
Imaging Techniques ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Diagnosis And Treatment ◽  
Evidence Based

The article provides an overview of the European recommendations on the diagnosis and treatment of chronic pancreatitis. The results of evidence-based research related to the epidemiology, course of chronic pancreatitis, assessment of the informative value of various imaging techniques, reatment of pancreatic insufficiency upon chronic pancreatitis, cystic fibrosis, pancreatic cancer are analyzed. A conclusion is drawn about the need for further carrying out of evidence-based studies.

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