scholarly journals Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Mohammad Yaghoobi ◽  
Julia McNabb-Baltar ◽  
Raheleh Bijarchi ◽  
Peter B. Cotton
Keyword(s):  
Systematic Review ◽  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pain Score ◽  
Meta Analysis ◽  
Pancreatic Enzyme ◽  
Analgesic Consumption ◽  
Randomized Controlled ◽  
Enzyme Supplementation ◽  
Enteric Coated

Background. Pancreatic enzyme supplementation is widely used to treat pain in patients with chronic pancreatitis, despite little evidence for efficacy. We performed a systematic review of the literature and a meta-analysis to investigate its effectiveness.Methods. All randomized controlled parallel or crossover trials in patients with chronic pancreatitis comparing pancreatic enzyme supplementation to placebo were included. The main outcome was improvement in pain score or reduced analgesic consumption. Two independent reviewers extracted data. Mantel-Haenszel random effect model meta-analysis was used whenever methodologically appropriate.Results. Five out of 434 retrieved studies were included in the systematic review. All studies used relatively similar methodology. Four studies using enteric-coated pancreatic enzyme supplementation failed to show any improvement in pain as compared to placebo. The only study using non-enteric-coated enzymes did show reduction in the pain score. There was significant heterogeneity among studies in both analyses. Random model meta-analysis of three studies showed no significant difference in the mean of daily pain score (mean difference: 0.09 (1.57–1.39),p=0.91) or average weekly analgesic consumption (mean difference: −0.30 (−2.37–1.77),p=0.77) between the periods of administering pancreatic enzyme supplementation versus placebo.Conclusion. Pancreatic enzyme supplements do not seem to relieve abdominal pain in patients with chronic pancreatitis and should not be prescribed solely for this purpose, given their significant cost and potential side effects.

Pancreatic enzyme replacement therapy in chronic pancreatitis: Systematic review and meta-analysis

Pancreatology ◽  
2016 ◽  
Vol 16 (3) ◽  
pp. S94
Author(s):  
Daniel De la Iglesia García ◽  
W. Huang ◽  
P. Szatmary ◽  
Iria Bastón-Rey ◽  
Jaime González-López ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Meta Analysis ◽  
Pancreatic Enzyme ◽  
Enzyme Replacement ◽  
Pancreatic Enzyme Replacement Therapy

scholarly journals Antioxidant Therapy for Pain Relief in Patients with Chronic Pancreatitis: Systematic Review and Meta-analysis

2013 ◽  
Vol 6;16 (6;11) ◽  
pp. E521-E532
Author(s):  
Sheng-Xi Wu
Keyword(s):  
Systematic Review ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Antioxidant Therapy ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomized Controlled ◽  
Mean Differences

Background: Currently, there is no specific therapy for chronic pancreatitis (CP). The treatment of micronutrient antioxidant therapy for painful CP has been sporadically used for more than 30 years, however, its efficacy are still poorly understood. Objective: The purpose of this meta-analysis is to investigate the safety and efficacy of antioxidant therapy for pain relief in patients with CP. Setting: University Hospital in China Study Design: Systematic review and meta-analysis Methods: Two authors independently reviewed the search results and extracted data and disagreements were resolved by discussion. Effects were summarized using standardized mean differences (SMDs), weighted mean differences, or odds ratio (OR) according to the suitable effect model. MEDLINE, PsycINFO, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from 1980 through December 2012. Randomized controlled trials (RCTs) that studied antioxidant supplementation for pain relief in patients with CP were analyzed. Results: Nine randomized controlled trials (RCTs) involving 390 patients were included. Overall, there was no association of antioxidant therapy with pain reduction in CP patients (SMD, −0.55; 95% CI, −1.22 to 0.12; P = 0.67). However, antioxidant therapy significantly increased blood levels of antioxidants in CP patients versus the placebo group (SMD, 1.08; 95% CI, 0.74 to 1.43; P < 0.00001). Interestingly, combined antioxidant (selenium, β-carotene, vitamin C, vitamin E, methionine) therapy was found to be associated with pain relief (SMD, -0.93; 95% CI, -1.72 to -0.14; P = 0.02), while the trials in which a single antioxidant was used revealed no significant pain relief (SMD, -0.12; 95% CI, -1.23 to 0.99; P = 0.83) in CP patients. Strong evidence was obtained that the antioxidants increased adverse effects (OR, 6.09; 95% CI, 2.29 to 16.17, P < 0.01); nevertheless, none was serious. Limitations: Because of the small sample, a consolidated conclusion cannot be reached based on current RCTs. Large-sample RCTs are needed to clarify the analgesic effect of antioxidants in CP patients. Conclusions: Combined antioxidant therapy seems to be a safe and effective therapy for pain relief in CP patients. Measures of total antioxidant status may not help to monitor the efficacy of antioxidant therapy for patients with CP. Key words: Antioxidant, pain, chronic pancreatitis, meta-analysis

scholarly journals Efficacy of pancreatic enzyme replacement therapy in chronic pancreatitis: systematic review and meta-analysis

Gut ◽  
2016 ◽  
Vol 66 (8) ◽  
pp. 1354.1-1355 ◽  
Author(s):  
Daniel de la Iglesia-García ◽  
Wei Huang ◽  
Peter Szatmary ◽  
Iria Baston-Rey ◽  
Jaime Gonzalez-Lopez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Meta Analysis ◽  
Pancreatic Enzyme ◽  
Enzyme Replacement ◽  
Pancreatic Enzyme Replacement Therapy

scholarly journals Pancreatic Safety of DPP-4 Inhibitors in Type 2 Diabetes Millitus—Protocol for a Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Fan Yang ◽  
Quanlin Zhao ◽  
Youzi Dong ◽  
Baohua Li ◽  
Bobiao Ning
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Randomized Controlled Trials ◽  
English Language ◽  
Meta Analysis ◽  
Pancreatic Enzyme ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomized Controlled

Abstract Background: Dipeptidyl-peptidase IV inhibitor (DPP-4i) is a common hypoglycemic medication in treating type 2 diabetes millitus (T2DM). It has become widely utilized in clinical practice due to its ability to effectively manage blood glucose while posing a low risk of hypoglycemia and weight gain. However, there is no consensus on DPP-4i's pancreatic safety due to a paucity of clinical evidence. The safe event appears to be easily overlooked. This review aims to evaluate the pancreatic safety of DPP-4i in patients with type 2 diabetes mellitus using the standard pairwise and network meta-analysis (NMA) methods.Methods: MEDLINE, Embase, Pubmed, Web of Science, and the Cochrane Central Register of Controlled Trials will be used to search for published literature and clinical trial registries (such as www.ClinicalTrials.gov) will be used to look for unpublished trials. English-language randomized controlled trials (RCTs) will be included. Two independent reviewers will screen literature for eligibility, extract available data, and assess the risk of bias. All divergences will be resolved after rechecking the source papers and further discussion among the reviewers with a complete consensus before inclusion. Pancreatic safety events involving acute pancreatitis, chronic pancreatitis, and pancreatic cancer will be the primary outcome. The secondary result will be the change in pancreatic enzyme from the baseline. A random-effects model will be used for pairwise meta-analysis with a 95% confidence interval, and Bayesian network meta-analysis will be conducted between the various interventions.Discussion: This systematic review and network meta-analysis will evaluate the pancreatic safety of DPP-4i in patients with type 2 diabetes millitus. The findings of this study may supplement the evidence-based information on DPP-4i, improve existing understanding of this issue, and assist patients and clinicians in making better treatment decisions by raising their awareness of the problem. Systematic review registration: submitted in PROSPERO, 31 August 2021

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