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Pancreatic enzymes for chronic pancreatitis
Nusrat Shafiq1, Surinder Rana, Deepak Bhasin
1Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012.
The Cochrane Database of Systematic Reviews
|October 13, 2009
Summary
Pancreatic enzyme supplements show a significant reduction in fecal fat but do not consistently improve pain, weight loss, or steatorrhea in chronic pancreatitis patients. More research is needed to clarify their overall efficacy.
Area of Science:
- Gastroenterology
- Clinical Nutrition
- Evidence-Based Medicine
Background:
- The effectiveness of pancreatic enzyme replacement therapy (PERT) for chronic pancreatitis symptoms remains uncertain.
- Existing evidence on PERT's utility in managing pain and steatorrhea requires thorough evaluation.
Purpose of the Study:
- To assess the efficacy of pancreatic enzymes in patients diagnosed with chronic pancreatitis.
- To compare pancreatic enzymes against placebo, evaluate different enzyme preparations, and analyze various dosage schedules.
- To examine outcomes including abdominal pain, steatorrhea, weight changes, fecal fat, and quality of life.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (CENTRAL, MEDLINE, EMBASE) up to April 2009.
- Included randomized controlled trials (RCTs), with data extraction and pooling performed independently by two authors.
- Continuous data were analyzed using standardized mean difference (SMD), and dichotomous data using odds ratios (OR).
Main Results:
- Ten RCTs involving 361 participants met the inclusion criteria.
- Pancreatic enzymes demonstrated a significant reduction in fecal fat (SMD -1.03; 95% CI -1.60 to -0.46).
- No significant benefits were observed for weight loss, pain, or steatorrhea, and no specific enzyme type or schedule proved superior.
Conclusions:
- The role of pancreatic enzymes in managing chronic pancreatitis symptoms like pain, weight loss, and steatorrhea is still inconclusive.
- High-quality, adequately powered studies are essential to definitively establish the efficacy of pancreatic enzyme therapy.
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