Pancreatic enzymes for chronic pancreatitis

Shafiq, Nusrat; Rana, Surinder Singh; Bhasin, Deepak K.; Pandhi, P; Srivastava, Puja; Sehmby, Surjit S; Kumar, Rajesh; Malhotra, Samir

doi:10.1002/14651858.cd006302.pub2

Cited by 68 publications

(57 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There is no evidence and hence no recommendation for smoking cessation in CP and PEI despite some reports, 5,15 even in acute pancreatitis. [2][3][4][5] Smoking cessation is recommended (Evidence 3b, recommendation A). In chronic pancreatitis, however, smoking cessation will reduce the pain 16 Patient compliance regarding diet and intake of medication should be assured (recommendation A).…”

Section: General Measurementsmentioning

confidence: 99%

Synopsis of recent guidelines on pancreatic exocrine insufficiency

Löhr

Oliver²,

Frulloni

2013

UEG Journal

View full text Add to dashboard Cite

Background: In recent years, three national gastroenterology societies established guidelines for the diagnosis and therapy of pancreatic exocrine insufficiency (PEI). In addition, the Cochrane Collaboration issued a review. Objective: The purpose of this paper is to present an overview of the recommendations and concordance between the four recent published guidelines and stimulate further discussion. Methods: A review of the Australian, German and Italian guidelines and the Cochrane review was conducted, and a synthesis was made of common statements.Results: There is a high degree of agreement on almost all items within these guidelines, both in the diagnosis of PEI and in terms of therapy and approach to management of PEI. In addition, novel emerging developments are highlighted, such as the fecal elastase-1 test, which is widely used but is not suitable for measuring mild-to-moderate PEI despite its ability to positively establish the diagnosis of severe PEI. One of the few novel tests proving to be useful is the 13 C mixed-chain triglycerides (MCT) breath test. This test, albeit an excellent quantitative test, is not widely used and is rarely available. The use of this test is making it apparent that there is a difference between treating the symptoms of PEI and treating malnutrition, the broader underlying defect. This may have direct consequences for the dosing of pancreatic enzymes (pancreatin), in that the consensus starting dose of all guidelines may be too low for some patients. Although chronic pancreatitis in adults and cystic fibrosis in children account for the main evidence base used for PEI, other indications are also discussed. Conclusions: There is good concordance between recommendations provided by international groups. More prospective studies are required in many areas, including the use of pancreatic enzymes in other gastrointestinal disorders, such as celiac disease and irritable bowel syndrome (IBS). We also need to assess the feasibility of the 13 C MCT breath test. At the same time, it needs to be confirmed that higher doses of pancreatic enzymes are really necessary to not only relieve the symptoms of PEI but also treat malnutrition appropriately.

show abstract

Section: General Measurementsmentioning

confidence: 99%

Synopsis of recent guidelines on pancreatic exocrine insufficiency

Löhr

Oliver²,

Frulloni

2013

UEG Journal

View full text Add to dashboard Cite

show abstract

“…Two small studies using non-enteric-coated enzymes demonstrated a reduction in pain, while three other studies using entericcoated preparations showed no improvement in pain. A meta-analysis and a Cochrane review corroborated that enzymes are ineffective for pain [16,17]. However, the South African guidelines advise a 6-week trial of high-dose pancreatic enzymes (in uncoated tablet form) in patients who fail to acetaminophen or NSAIDs which contrasts with the Italian guidelines [12].…”

Section: Discussionmentioning

confidence: 99%

A wide variation in diagnostic and therapeutic strategies in chronic pancreatitis: A Dutch national survey

et al. 2012

View full text Add to dashboard Cite

Context Optimal diagnostic and treatment modalities in chronic pancreatitis are controversial due to lack of evidence. Objective To evaluate current clinical practice, we conducted a survey with the primary objective to evaluate decisions regarding the diagnosis, management and screening in chronic pancreatitis. Design We developed a vignette survey. Setting We surveyed Dutch gastroenterologists, internists, gastrointestinal surgeons and an international expert panel. Results A total of 110 questionnaires (31% gastroenterologists, 39% internists and 20% gastrointestinal surgeons) were returned out of the 1,324 sent (response 8.3%). There was a wide variation in strategies regarding diagnosis, treatment and screening in chronic pancreatitis. As a diagnostic test, serum amylase is used frequently by internists, while gastroenterologists and experts often use fecal elastase. Most respondents preferred CT-scanning for diagnosis, while experts preferred transabdominal ultrasonography as an initial test. Respondents frequently use pancreatic enzymes for treatment of pain in chronic pancreatitis. The majority advised to perform an intervention (endoscopic or surgical) in case of morphological changes of the pancreatic duct. Conclusions The results of our survey identify important differences between physicians in diagnosis and management of chronic pancreatitis. This is often due to lack of evidence and consensus in literature. Certain wide-spread practices are in contrast with available evidence, and should be addressed by improved education and adherence to guidelines.

show abstract

“…54 A systematic review of ten trials on the administration of pancreatic enzymes in the management of chronic pancreatitis was completed by Shafiq et al in 2009. 55 The main objective of their systematic review was to assess whether treatment with PERT caused any changes in pain frequency and intensity and in the use of pain medications, steatorrhea, weight loss, and quality of life. 55 Each of the studies was a randomized controlled trial with or without blinding.…”

Section: Pancreatic Enzyme Replacementmentioning

confidence: 99%

“…55 The main objective of their systematic review was to assess whether treatment with PERT caused any changes in pain frequency and intensity and in the use of pain medications, steatorrhea, weight loss, and quality of life. 55 Each of the studies was a randomized controlled trial with or without blinding. Together the studies included 361 patients.…”

Section: Pancreatic Enzyme Replacementmentioning

confidence: 99%

See 1 more Smart Citation

Nutritional advice for prevention of acute pancreatitis: review of current opinion

Lowe¹,

Sevilla²

2012

NDS

View full text Add to dashboard Cite

Pancreatitis is inflammation of the pancreas that can be acute and self-limiting or, in a small percentage of patients, recurrent. Patients with recurrent episodes of acute pancreatitis (RAP) often progress to chronic pancreatitis. Pancreatitis in all forms causes significant economic and social burdens. Prevention of RAP may decrease those burdens and halt progression to chronic disease. Unfortunately, no therapy has proven effective at altering the course of RAP. While enteral nutritional therapy plays an important role in the treatment of acute pancreatitis during episodes, nutritional advice provided to patients in an attempt to prevent recurrent episodes has not proven effective in most cases. Discontinuing alcohol consumption and treating dyslipidemia with diet and medication can help patients with these issues. In patients whose pancreatitis is associated with celiac disease or eosinophilic gastroenteritis, a gluten-free diet and avoidance of food allergens can be effective in stopping RAP. Advice to take pancreatic enzyme replacement therapy, lose weight, control diabetes, decrease dietary sucrose, decrease dietary fat or avoid monosodium glutamate has little to no evidence of efficacy. Some studies suggest that an antioxidant cocktail may decrease the frequency of RAP and the intensity of chronic pain, but the evidence is weak. Nutritional therapy may have a role in the treatment of patients with RAP. At present, there are no clear guidelines for nutritional advice to give these patients. More studies are needed to identify nutritional interventions that will benefit patients with RAP.

show abstract

Pancreatic enzymes for chronic pancreatitis

Abstract: The role of pancreatic enzymes for abdominal pain, weight loss, steatorrhoea, analgesic use and quality of life in patients with chronic pancreatitis remains equivocal. Good quality, adequately powered studies are much warranted.

Cited by 68 publications

References 37 publications

Synopsis of recent guidelines on pancreatic exocrine insufficiency

Synopsis of recent guidelines on pancreatic exocrine insufficiency

A wide variation in diagnostic and therapeutic strategies in chronic pancreatitis: A Dutch national survey

Nutritional advice for prevention of acute pancreatitis: review of current opinion

Contact Info

Product

Resources

About