Increased Risk of Mortality Associated With Pancreatic Exocrine Insufficiency in Patients With Chronic Pancreatitis

Iglesia‐García, Daniel de la; Vallejo-Senra, Nicolau; Iglesias‐García, Julio; López‐López, Andrea; Nieto, Laura; Domínguez‐Muñoz, J. Enrique

doi:10.1097/mcg.0000000000000917

Cited by 90 publications

(60 citation statements)

References 45 publications

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“…While long‐term randomised placebo‐controlled trials are lacking, medium term follow up studies note improved nutritional parameters, weight, symptoms, and quality of life 37,38 . One retrospective study suggested exocrine pancreatic insufficiency was associated with reduced survival in patients with chronic pancreatitis 39 . A number of cohort studies, 22,40,41 a population‐based cohort study, 26 and some small randomised trials 42,43 have assessed the benefit of PERT in patients with pancreatic cancer.…”

Section: Discussionmentioning

confidence: 99%

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Forsmark

Tang

et al. 2020

Aliment Pharmacol Ther

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Background: Patients with chronic pancreatitis or pancreatic cancer commonly develop exocrine pancreatic insufficiency, and may not be adequately treated with pancreatic enzyme replacement therapy (PERT). Aims:To estimate the frequency of diagnostic testing for exocrine insufficiency, and appropriate use of PERT, in a commercially insured population in the US. Methods:We utilised a nationally representative administrative database representing 48.67 million individuals in over 80 US healthcare plans to assess testing for and treatment of exocrine insufficiency in patients who received a diagnosis of chronic pancreatitis (n = 37 061) or pancreatic cancer (n = 32 461) from 2001 to 2013. We identified the details of any testing for exocrine insufficiency and PERT use. We defined appropriate PERT use as a dosage of ≥120 000 USP units of lipase daily. Multiple logistic regression was used to identify predictors of appropriate use of PERT. Results:In patients with chronic pancreatitis, 6.5% had any testing for exocrine insufficiency, 30.4% filled a prescription for PERT, and 8.5% were prescribed an adequate dose. In those with pancreatic cancer, 1.9% had testing for exocrine insufficiency, 21.9% filled a prescription for PERT, and 5.5% were prescribed an adequate dose.Number of comorbidities, testing for exocrine insufficiency, pancreatic surgery and duration of enrolment were independent predictors for use and appropriate dosing. Conclusions:Testing for exocrine insufficiency, and appropriate dosing of PERT in patients with chronic pancreatitis or pancreatic cancer, is infrequent and inconsistent in an insured US population. Efforts are needed to educate medical providers on the best practices for managing exocrine pancreatic insufficiency in these patients. | 959FORSMARK et Al.

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Section: Discussionmentioning

confidence: 99%

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Forsmark

Tang

et al. 2020

Aliment Pharmacol Ther

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“…The prevalence of exocrine pancreatic insufficiency (EPI) is 60%‐90% in advanced chronic pancreatitis (CP) and 50%‐90% in pancreatic cancer (PC) 1 . Untreated, EPI results in fat and protein malnutrition, muscle wasting, metabolic bone disease, reduced quality of life and even mortality 2 . Based on various clinicopathological parameters, the diagnosis of PC is usually accurate.…”

Section: Chronic Pancreatitis (N = 37 061) Pancreatic Cancer (N mentioning

confidence: 99%

Editorial: management of exocrine pancreatic insufficiency remains a challenge—can we do better?

Kharbat

Craig

2020

Aliment Pharmacol Ther

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“…This can lead to osteoporosis, poor immunity status, and an increased risk of cardiovascular events. All these complications seriously affect the quality of life of patients with PEI …”

Section: Clinical Manifestationsmentioning

confidence: 99%

Chinese guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency (2018 edition)

Zou

et al. 2019

J of Digest Diseases

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Increased Risk of Mortality Associated With Pancreatic Exocrine Insufficiency in Patients With Chronic Pancreatitis

Abstract: PEI was a significant independent risk factor for mortality in patients with CP. These results support further research into the optimal treatment of PEI to reduce mortality in this population.

Cited by 90 publications

References 45 publications

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Editorial: management of exocrine pancreatic insufficiency remains a challenge—can we do better?

Chinese guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency (2018 edition)

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