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Pancreatic Enzyme Use Reduces Pancreatitis Frequency in Children With Acute Recurrent or Chronic Pancreatitis: A
Alvin Jay Freeman1, Kenneth Ng2, Fuchenchu Wang3
1Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Insights
Pancreatic enzyme therapy (PERT) reduced acute pancreatitis (AP) episodes in children with pancreatic-sufficient acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). Further clinical trials are recommended to confirm PERT
Area of Science:
- Pediatric Gastroenterology
- Pancreatology
- Clinical Outcomes Research
Background:
- Acute pancreatitis (AP) episodes are painful and lead to complications in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP).
- Currently, no interventions exist to prevent AP episodes in this pediatric population.
- This study investigates the impact of pancreatic enzyme therapy (PERT) on clinical outcomes in children with pancreatic-sufficient ARP or CP.
Purpose of the Study:
- To assess the effect of pancreatic enzyme therapy (PERT) on the incidence of acute pancreatitis (AP) episodes in children with pancreatic-sufficient ARP or CP.
- To identify predictors of response to PERT in this patient group.
Main Methods:
- Retrospective cohort study of children with pancreatic-sufficient ARP or CP from the INSPPIRE-2 cohort.
- Comparison of clinical outcomes between children receiving and not receiving PERT.
- Analysis of AP frequency before and after PERT initiation, using logistic regression to identify response predictors.
Main Results:
- Among 356 participants, 60 received PERT; 42% remained free of subsequent AP episodes over a mean 2.1-year follow-up.
- Children with SPINK1 mutations and those with ARP were less likely to experience AP after starting PERT.
- The mean annual incidence rate of AP decreased significantly from 3.14 to 0.71 after PERT initiation (P < 0.001).
Conclusions:
- Pancreatic enzyme therapy (PERT) use was associated with a reduced incidence rate of AP in children with pancreatic-sufficient ARP or CP.
- These findings suggest PERT may be beneficial for managing AP in children.
- A prospective clinical trial is warranted to confirm the efficacy of PERT for improving clinical outcomes in pediatric ARP and CP.
Introduction:
Among children who suffer from acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP), acute pancreatitis (AP) episodes are painful, often require hospitalization, and contribute to disease complications and progression. Despite this recognition, there are currently no interventions to prevent AP episodes. In this retrospective cohort study, we assessed the impact of pancreatic enzyme therapy (PERT) use on clinical outcomes among children with pancreatic-sufficient ARP or CP.
Methods:
Children with pancreatic-sufficient ARP or CP in the INSPPIRE-2 cohort were included. Clinical outcomes were compared for those receiving vs not receiving PERT, as well as frequency of AP before and after PERT. Logistic regression was used to study the association between development of AP episodes after starting PERT and response predictors.
Results:
Among 356 pancreatic-sufficient participants, 270 (76%) had ARP, and 60 (17%) received PERT. Among those on PERT, 42% did not have a subsequent AP episode, during a mean 2.1 years of follow-up. Children with a SPINK1 mutation ( P = 0.005) and those with ARP (compared with CP, P = 0.008) were less likely to have an AP episode after starting PERT. After initiation of PERT, the mean AP annual incidence rate decreased from 3.14 down to 0.71 ( P < 0.001).
Discussion:
In a retrospective analysis, use of PERT was associated with a reduction in the incidence rate of AP among children with pancreatic-sufficient ARP or CP. These results support the need for a clinical trial to evaluate the efficacy of PERT to improve clinical outcomes among children with ARP or CP.
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