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Pancreatic enzyme therapy in childhood celiac disease. A double-blind prospective randomized study
A Carroccio1, G Iacono, G Montalto
1Cattedra di Medicina Interna, Università di Palermo, Italy.
Insights
Pancreatic enzyme substitution therapy significantly improved weight gain in infants with celiac disease within the first 30 days post-diagnosis. Benefits were not sustained at 60 days, suggesting a short-term therapeutic window.
Area of Science:
- Pediatric Gastroenterology
- Nutritional Science
Background:
- Celiac disease diagnosis in infants often presents with malabsorption and failure to thrive.
- Pancreatic enzyme insufficiency can exacerbate nutritional deficits in celiac disease.
Purpose of the Study:
- To investigate the efficacy of pancreatic enzyme substitution therapy (PEST) in infants diagnosed with celiac disease.
- To assess the impact of PEST on anthropometric measurements over a 60-day period.
Main Methods:
- A double-blind, placebo-controlled study involving 40 infants diagnosed with celiac disease.
- Patients were randomized into two groups: one receiving PEST and the other a placebo.
- Anthropometric variables were measured at diagnosis, and at 30 and 60 days post-initiation of a gluten-free diet.
Main Results:
- Infants receiving PEST showed significantly greater weight gain (1131g vs 732g) and weight-for-age increase (9.2% vs 5.0%) after 30 days compared to the placebo group (P < 0.006 and P < 0.002, respectively).
- While other anthropometric measures showed trends favoring the PEST group, differences were not statistically significant.
- No significant differences in any measured parameters were observed between the groups after 60 days of therapy.
Conclusions:
- Pancreatic enzyme substitution therapy demonstrates significant short-term benefits for weight restoration in infants with celiac disease during the initial 30 days post-diagnosis.
- The therapeutic window for PEST appears limited, with benefits not persisting at 60 days.
- Further research may explore optimal timing and duration for PEST in pediatric celiac disease management.
Abstract:
The validity of pancreatic enzyme substitution therapy in the two months following diagnosis of celiac disease was investigated. Twenty patients (8 males, 12 females), mean age 14.2 months (group A) received an enzyme substitution preparation. The control group (group B) included 20 patients (9 males, 11 females), mean age 14.5 months, treated with placebo. Before starting treatment, we performed a stratification for age, weight-for-age at diagnosis, and degree of pancreatic insufficiency. The therapies were then administered randomly in double-blind fashion. On diagnosis and 30 and 60 days after commencement of a gluten-free diet with identical calorie intake in both groups, a series of anthropometric variables were determined. After 30 days weight increase in group A patients was significantly higher (in grams) than in group B: 1131 +/- 461 vs 732 +/- 399 (P < 0.006). Weight-for-age increase also was greater in group A than in group B: 9.2 +/- 5.1% vs 5.0 +/- 4.0% (P < 0.002). The increase in height Z score, weight-for-height, arm circumference, and subscapular and tricipital fold measurements were greater in group A patients than those in group B, but the difference was not significant. After 60 days of therapy none of the parameters considered were significantly different in the two groups. We concluded that pancreatic enzyme therapy is certainly useful in the first 30 days after diagnosis of celiac disease.