Efficacy and safety of pancreatic enzyme replacement therapy in pancreatic exocrine insufficiency: a systematic review protocol

Background & Aims: Pancreatic exocrine insufficiency may be under recognised in gastroenterological practice. We aimed to identify the prevalence of pancreatic insufficiency in secondary care gastroenterology clinics and determine if co-morbidity or presenting symptoms could predict diagnosis. A secondary aim was to assess response to treatment. Methods: A dual centre retrospective analysis was conducted in secondary care gastroenterology clinics. Patients tested for pancreatic exocrine insufficiency with faecal elastase-1 (FEL-1) between 2009 and 2013 were identified in two centres. Demographics, indication and co-morbidities were recorded in addition to dose and response to pancreatic enzyme replacement therapy. Binary logistic regression was used to assess if symptoms or co-morbidities could predict pancreatic insufficiency. Results: 1821 patients were tested, 13.1% had low FEL-1 (<200μg/g). This prevalence was sub-analysed with 5.4% having FEL-1 100-200μg/g (mild insufficiency) and 7.6% having faecal elastase readings <100μg/g. Low FEL-1 was most significantly associated with weight loss or steatorrhoea. Co-morbidity analysis showed that low levels were significantly associated with excess alcohol intake, diabetes mellitus or human immunodeficiency virus; 80.0% treated with enzyme supplements reported symptomatic benefit with no difference in response between high and low dose supplementation (p=0.761). Conclusion: Targeting the use of FEL-1 in individuals with specific symptoms and associated conditions can lead to improved recognition of pancreatic exocrine insufficiency in a significant proportion of secondary care patients. Intervening with lifestyle advice such as smoking cessation and minimising alcohol intake could improve outcomes. In addition, up to 80% of patients with low faecal elastase respond to supplementation. Abbreviations: CFA: coefficient of fat absorption; CP: chronic pancreatitis; ELISA: enzyme-linked immune-absorbent assay; PEI: pancreatic exocrine insufficiency; FEL-1: faecal elastase-1; HIV: human immunodeficiency virus; IBD: inflammatory bowel disease; IBS: irritable bowel syndrome; PERT: pancreatic enzyme replacement therapy.

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Contribution of pancreatic enzyme replacement therapy to survival and quality of life in patients with pancreatic exocrine insufficiency

World Journal of Gastroenterology ◽

10.3748/wjg.v25.i20.2430 ◽

2019 ◽

Vol 25 (20) ◽

pp. 2430-2441 ◽

Cited By ~ 7

Author(s):

Peter Layer ◽

Nataliya Kashirskaya ◽

Natalya Gubergrits

Keyword(s):

Quality Of Life ◽

Enzyme Replacement Therapy ◽

Replacement Therapy ◽

Pancreatic Enzyme ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Enzyme Replacement ◽

Pancreatic Enzyme Replacement Therapy ◽

Pancreatic Exocrine

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Pancreatic Exocrine Insufficiency as a Complication of Gastrointestinal Surgery and the Impact of Pancreatic Enzyme Replacement Therapy

Digestive Diseases ◽

10.1159/000501675 ◽

2019 ◽

Vol 38 (1) ◽

pp. 53-68 ◽

Cited By ~ 6

Author(s):

Adarsh Chaudhary ◽

J. Enrique Domínguez-Muñoz ◽

Peter Layer ◽

Markus M. Lerch

Keyword(s):

Enzyme Replacement Therapy ◽

Replacement Therapy ◽

Pancreatic Enzyme ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Metabolic Complications ◽

Enzyme Replacement ◽

Pancreatic Enzyme Replacement Therapy ◽

Pancreatic Exocrine ◽

The Impact

Background: Pancreatic exocrine insufficiency (PEI) is characterized by inadequate production, insufficient secretion, and/or inactivation of pancreatic enzymes, resulting in maldigestion. The aim of this review was to analyze the prevalence and pathophysiology of PEI resulting from gastrointestinal (GI) surgery and to examine the use of pancreatic enzyme replacement therapy (PERT) for effectively managing PEI. Summary: A targeted PubMed search was conducted for studies examining the prevalence and pathophysiology of PEI in patients following GI surgery and for studies assessing the effects of PERT in these patients. PEI is a common complication following GI surgery that can lead to nutritional deficiencies, which may contribute to morbidity and mortality in patients. Timely treatment of PEI with PERT can prevent malnutrition, increase quality of life, and possibly reduce the associated mortality. Treatment of PEI should aim not only to alleviate symptoms but also to achieve significant improvements in nutritional parameters. Dose optimization of PERT is required for effective management of PEI, in addition to regular assessment of nutritional status, appropriate patient education, and reassessment if symptoms return. Key Messages: Difficulties in detecting PEI following GI surgery can result in undiagnosed and untreated maldigestion, leading to metabolic complications and increased morbidity. Both are preventable by early administration and monitoring for optimal doses of PERT.

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