Article Text

other Versions

Download PDFPDF
Pancreatic enzyme replacement therapy in chronic pancreatitis: a long way to go
  1. John A Windsor
  1. Correspondence to Professor John A Windsor, Department of Surgery, University of Auckland, 85 Park Road, Grafton, Auckland 1022, New Zealand; j.windsor{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Pancreatic exocrine insufficiency (PEI) in chronic pancreatitis (CP) is underdiagnosed and undertreated. An important and expertly conducted meta-analysis in this issue examines the efficacy of pancreatic enzyme replacement therapy (PERT) in patients with CP.1 The key findings are that PERT increases fat and protein absorption and does so more effectively with higher dosing, enteric coating, administration with food and concomitant acid suppression. The follow-up studies indicated that PERT increases serum nutritional parameters, improves GI symptoms and quality of life without significant adverse events. While none of these findings are new, the study provides a higher level of evidence for them.

The meta-analysis is important for several other reasons. First, only level 1 evidence is used (n=14 randomised controlled trials) for the quantitative analysis of fat absorption. Second, it counters the inconclusive Cochrane Review2 and should remove any lingering doubt about the efficacy of PERT in CP. Third, it is confined to CP and does not complicate things by attempting to address the more challenging questions about the role of PERT in other pancreatic diseases, after pancreatic …

View Full Text


  • Contributors This commentary is entirely my own writing except where there are quotes and references.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

Linked Articles

  • Pancreas
    Daniel de la Iglesia-García Wei Huang Peter Szatmary Iria Baston-Rey Jaime Gonzalez-Lopez Guillermo Prada-Ramallal Rajarshi Mukherjee Quentin M Nunes J Enrique Domínguez-Muñoz Robert Sutton NIHR Pancreas Biomedical Research Unit Patient Advisory Group NIHR Pancreas Biomedical Research Unit Patient Advisory Group Graham Cameron Kirsty Donaldson Georgia Jones John Lancaster Amy Lucas Karen Manby Tor McLaren Catherine Rodgers Jason Rodgers William Swindlehurst Neil Symon Douglas Warrington Mary Whitby