Efficacy of pancreatic enzyme replacement therapy in chronic pancreatitis: systematic review and meta-analysis
ObjectiveThe benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic review and meta-analysis of randomised controlled trials of PERT to determine the efficacy of PERT in exocrine pancreatic insufficiency (EPI) f...
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| Vydané v: | Gut Ročník 66; číslo 8; s. 1354 - 1355 |
|---|---|
| Hlavní autori: | , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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England
BMJ Publishing Group LTD
01.08.2017
BMJ Publishing Group |
| Edícia: | Original article |
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| ISSN: | 0017-5749, 1468-3288, 1468-3288 |
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| Abstract | ObjectiveThe benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic review and meta-analysis of randomised controlled trials of PERT to determine the efficacy of PERT in exocrine pancreatic insufficiency (EPI) from CP.DesignMajor databases were searched from 1966 to 2015 inclusive. The primary outcome was coefficient of fat absorption (CFA). Effects of PERT versus baseline and versus placebo, and of different doses, formulations and schedules were determined.ResultsA total of 17 studies (511 patients with CP) were included and assessed qualitatively (Jadad score). Quantitative data were synthesised from 14 studies. PERT improved CFA compared with baseline (83.7±6.0 vs 63.1±15.0, p<0.00001; I2=89%) and placebo (83.2±5.5 vs 67.4±7.0, p=0.0001; I2=86%). PERT improved coefficient of nitrogen absorption, reduced faecal fat excretion, faecal nitrogen excretion, faecal weight and abdominal pain, without significant adverse events. Follow-up studies demonstrated that PERT increased serum nutritional parameters, improved GI symptoms and quality of life without significant adverse events. High-dose or enteric-coated enzymes showed a trend to greater effectiveness than low-dose or non-coated comparisons, respectively. Subgroup, sensitive and meta-regression analyses revealed that sample size, CP diagnostic criteria, study design and enzyme dose contributed to heterogeneity; data on health inequalities were lacking.ConclusionsPERT is indicated to correct EPI and malnutrition in CP and may be improved by higher doses, enteric coating, administration during food and acid suppression. Further studies are required to determine optimal regimens, the impact of health inequalities and long-term effects on nutrition. |
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| AbstractList | Objective The benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic review and meta-analysis of randomised controlled trials of PERT to determine the efficacy of PERT in exocrine pancreatic insufficiency (EPI) from CP. Design Major databases were searched from 1966 to 2015 inclusive. The primary outcome was coefficient of fat absorption (CFA). Effects of PERT versus baseline and versus placebo, and of different doses, formulations and schedules were determined. Results A total of 17 studies (511 patients with CP) were included and assessed qualitatively (Jadad score). Quantitative data were synthesised from 14 studies. PERT improved CFA compared with baseline (83.7±6.0 vs 63.1±15.0, p<0.00001; I2=89%) and placebo (83.2±5.5 vs 67.4±7.0, p=0.0001; I2=86%). PERT improved coefficient of nitrogen absorption, reduced faecal fat excretion, faecal nitrogen excretion, faecal weight and abdominal pain, without significant adverse events. Follow-up studies demonstrated that PERT increased serum nutritional parameters, improved GI symptoms and quality of life without significant adverse events. High-dose or enteric-coated enzymes showed a trend to greater effectiveness than low-dose or non-coated comparisons, respectively. Subgroup, sensitive and meta-regression analyses revealed that sample size, CP diagnostic criteria, study design and enzyme dose contributed to heterogeneity; data on health inequalities were lacking. Conclusions PERT is indicated to correct EPI and malnutrition in CP and may be improved by higher doses, enteric coating, administration during food and acid suppression. Further studies are required to determine optimal regimens, the impact of health inequalities and long-term effects on nutrition. The benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic review and meta-analysis of randomised controlled trials of PERT to determine the efficacy of PERT in exocrine pancreatic insufficiency (EPI) from CP. Major databases were searched from 1966 to 2015 inclusive. The primary outcome was coefficient of fat absorption (CFA). Effects of PERT versus baseline and versus placebo, and of different doses, formulations and schedules were determined. A total of 17 studies (511 patients with CP) were included and assessed qualitatively (Jadad score). Quantitative data were synthesised from 14 studies. PERT improved CFA compared with baseline (83.7±6.0 vs 63.1±15.0, p<0.00001; I =89%) and placebo (83.2±5.5 vs 67.4±7.0, p=0.0001; I =86%). PERT improved coefficient of nitrogen absorption, reduced faecal fat excretion, faecal nitrogen excretion, faecal weight and abdominal pain, without significant adverse events. Follow-up studies demonstrated that PERT increased serum nutritional parameters, improved GI symptoms and quality of life without significant adverse events. High-dose or enteric-coated enzymes showed a trend to greater effectiveness than low-dose or non-coated comparisons, respectively. Subgroup, sensitive and meta-regression analyses revealed that sample size, CP diagnostic criteria, study design and enzyme dose contributed to heterogeneity; data on health inequalities were lacking. PERT is indicated to correct EPI and malnutrition in CP and may be improved by higher doses, enteric coating, administration during food and acid suppression. Further studies are required to determine optimal regimens, the impact of health inequalities and long-term effects on nutrition. ObjectiveThe benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic review and meta-analysis of randomised controlled trials of PERT to determine the efficacy of PERT in exocrine pancreatic insufficiency (EPI) from CP.DesignMajor databases were searched from 1966 to 2015 inclusive. The primary outcome was coefficient of fat absorption (CFA). Effects of PERT versus baseline and versus placebo, and of different doses, formulations and schedules were determined.ResultsA total of 17 studies (511 patients with CP) were included and assessed qualitatively (Jadad score). Quantitative data were synthesised from 14 studies. PERT improved CFA compared with baseline (83.7±6.0 vs 63.1±15.0, p<0.00001; I2=89%) and placebo (83.2±5.5 vs 67.4±7.0, p=0.0001; I2=86%). PERT improved coefficient of nitrogen absorption, reduced faecal fat excretion, faecal nitrogen excretion, faecal weight and abdominal pain, without significant adverse events. Follow-up studies demonstrated that PERT increased serum nutritional parameters, improved GI symptoms and quality of life without significant adverse events. High-dose or enteric-coated enzymes showed a trend to greater effectiveness than low-dose or non-coated comparisons, respectively. Subgroup, sensitive and meta-regression analyses revealed that sample size, CP diagnostic criteria, study design and enzyme dose contributed to heterogeneity; data on health inequalities were lacking.ConclusionsPERT is indicated to correct EPI and malnutrition in CP and may be improved by higher doses, enteric coating, administration during food and acid suppression. Further studies are required to determine optimal regimens, the impact of health inequalities and long-term effects on nutrition. The benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic review and meta-analysis of randomised controlled trials of PERT to determine the efficacy of PERT in exocrine pancreatic insufficiency (EPI) from CP.OBJECTIVEThe benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic review and meta-analysis of randomised controlled trials of PERT to determine the efficacy of PERT in exocrine pancreatic insufficiency (EPI) from CP.Major databases were searched from 1966 to 2015 inclusive. The primary outcome was coefficient of fat absorption (CFA). Effects of PERT versus baseline and versus placebo, and of different doses, formulations and schedules were determined.DESIGNMajor databases were searched from 1966 to 2015 inclusive. The primary outcome was coefficient of fat absorption (CFA). Effects of PERT versus baseline and versus placebo, and of different doses, formulations and schedules were determined.A total of 17 studies (511 patients with CP) were included and assessed qualitatively (Jadad score). Quantitative data were synthesised from 14 studies. PERT improved CFA compared with baseline (83.7±6.0 vs 63.1±15.0, p<0.00001; I2=89%) and placebo (83.2±5.5 vs 67.4±7.0, p=0.0001; I2=86%). PERT improved coefficient of nitrogen absorption, reduced faecal fat excretion, faecal nitrogen excretion, faecal weight and abdominal pain, without significant adverse events. Follow-up studies demonstrated that PERT increased serum nutritional parameters, improved GI symptoms and quality of life without significant adverse events. High-dose or enteric-coated enzymes showed a trend to greater effectiveness than low-dose or non-coated comparisons, respectively. Subgroup, sensitive and meta-regression analyses revealed that sample size, CP diagnostic criteria, study design and enzyme dose contributed to heterogeneity; data on health inequalities were lacking.RESULTSA total of 17 studies (511 patients with CP) were included and assessed qualitatively (Jadad score). Quantitative data were synthesised from 14 studies. PERT improved CFA compared with baseline (83.7±6.0 vs 63.1±15.0, p<0.00001; I2=89%) and placebo (83.2±5.5 vs 67.4±7.0, p=0.0001; I2=86%). PERT improved coefficient of nitrogen absorption, reduced faecal fat excretion, faecal nitrogen excretion, faecal weight and abdominal pain, without significant adverse events. Follow-up studies demonstrated that PERT increased serum nutritional parameters, improved GI symptoms and quality of life without significant adverse events. High-dose or enteric-coated enzymes showed a trend to greater effectiveness than low-dose or non-coated comparisons, respectively. Subgroup, sensitive and meta-regression analyses revealed that sample size, CP diagnostic criteria, study design and enzyme dose contributed to heterogeneity; data on health inequalities were lacking.PERT is indicated to correct EPI and malnutrition in CP and may be improved by higher doses, enteric coating, administration during food and acid suppression. Further studies are required to determine optimal regimens, the impact of health inequalities and long-term effects on nutrition.CONCLUSIONSPERT is indicated to correct EPI and malnutrition in CP and may be improved by higher doses, enteric coating, administration during food and acid suppression. Further studies are required to determine optimal regimens, the impact of health inequalities and long-term effects on nutrition. |
| Author | Nunes, Quentin M Prada-Ramallal, Guillermo Huang, Wei Gonzalez-Lopez, Jaime de la Iglesia-García, Daniel Mukherjee, Rajarshi Domínguez-Muñoz, J Enrique Szatmary, Peter Sutton, Robert Baston-Rey, Iria |
| AuthorAffiliation | 1 NIHR Liverpool Pancreas Biomedical Research Unit , Royal Liverpool University Hospital, University of Liverpool , Liverpool , UK 2 Department of Gastroenterology and Hepatology , University Hospital of Santiago de Compostela , Compostela , Spain 5 Department of Preventive Medicine and Public Health , University of Santiago de Compostela , Compostela , Spain 3 Department of Integrated Traditional Chinese and Western Medicine , Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University , Chengdu , China 4 Department of Pharmacy , University Hospital of Santiago de Compostela , Compostela , Spain |
| AuthorAffiliation_xml | – name: 5 Department of Preventive Medicine and Public Health , University of Santiago de Compostela , Compostela , Spain – name: 1 NIHR Liverpool Pancreas Biomedical Research Unit , Royal Liverpool University Hospital, University of Liverpool , Liverpool , UK – name: 3 Department of Integrated Traditional Chinese and Western Medicine , Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University , Chengdu , China – name: 4 Department of Pharmacy , University Hospital of Santiago de Compostela , Compostela , Spain – name: 2 Department of Gastroenterology and Hepatology , University Hospital of Santiago de Compostela , Compostela , Spain |
| Author_xml | – sequence: 1 givenname: Daniel surname: de la Iglesia-García fullname: de la Iglesia-García, Daniel email: r.sutton@liverpool.ac.uk organization: Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Compostela, Spain – sequence: 2 givenname: Wei surname: Huang fullname: Huang, Wei email: r.sutton@liverpool.ac.uk organization: Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China – sequence: 3 givenname: Peter surname: Szatmary fullname: Szatmary, Peter email: r.sutton@liverpool.ac.uk organization: NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK – sequence: 4 givenname: Iria surname: Baston-Rey fullname: Baston-Rey, Iria email: r.sutton@liverpool.ac.uk organization: Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Compostela, Spain – sequence: 5 givenname: Jaime surname: Gonzalez-Lopez fullname: Gonzalez-Lopez, Jaime email: r.sutton@liverpool.ac.uk organization: Department of Pharmacy, University Hospital of Santiago de Compostela, Compostela, Spain – sequence: 6 givenname: Guillermo surname: Prada-Ramallal fullname: Prada-Ramallal, Guillermo email: r.sutton@liverpool.ac.uk organization: Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Compostela, Spain – sequence: 7 givenname: Rajarshi surname: Mukherjee fullname: Mukherjee, Rajarshi email: r.sutton@liverpool.ac.uk organization: NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK – sequence: 8 givenname: Quentin M surname: Nunes fullname: Nunes, Quentin M email: r.sutton@liverpool.ac.uk organization: NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK – sequence: 9 givenname: J Enrique surname: Domínguez-Muñoz fullname: Domínguez-Muñoz, J Enrique email: r.sutton@liverpool.ac.uk organization: Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Compostela, Spain – sequence: 10 givenname: Robert orcidid: 0000-0001-6600-562X surname: Sutton fullname: Sutton, Robert email: r.sutton@liverpool.ac.uk organization: NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27941156$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Contributor | Manby, Karen Cameron, Graham Lancaster, John Whitby, Mary Rodgers, Jason Warrington, Douglas Swindlehurst, William Lucas, Amy Jones, Georgia McLaren, Tor Rodgers, Catherine Symon, Neil Donaldson, Kirsty |
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| Copyright | Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. Copyright: 2016 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2016 |
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| DOI | 10.1136/gutjnl-2016-312529 |
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| Issue | 8 |
| Keywords | NUTRIENT ABSORPTION PANCREATITIS PANCREATIC ENZYMES EXOCRINE PANCREATIC FUNCTION |
| Language | English |
| License | This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. |
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| Snippet | ObjectiveThe benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic... The benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic review and... Objective The benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic... |
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| SubjectTerms | Abdomen Alcohol Clinical trials Coatings Cystic fibrosis Diabetes Dietary Fats - metabolism Drug dosages Enzyme Therapy Enzymes Enzymes - administration & dosage Excretion Exocrine Pancreatic Insufficiency - blood Exocrine Pancreatic Insufficiency - drug therapy Exocrine Pancreatic Insufficiency - etiology Feces - chemistry Health disparities Humans Long-term effects Malnutrition Meta-analysis Nutritional Status Osteoporosis Pain Pancreas Pancreas - enzymology Pancreatitis Pancreatitis, Chronic - blood Pancreatitis, Chronic - complications Pancreatitis, Chronic - drug therapy Quality of Life Randomized Controlled Trials as Topic Studies Surgery |
| Title | Efficacy of pancreatic enzyme replacement therapy in chronic pancreatitis: systematic review and meta-analysis |
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