PT  - JOURNAL ARTICLE
AU  - Daniel de la Iglesia-García
AU  - Wei Huang
AU  - Peter Szatmary
AU  - Iria Baston-Rey
AU  - Jaime Gonzalez-Lopez
AU  - Guillermo Prada-Ramallal
AU  - Rajarshi Mukherjee
AU  - Quentin M Nunes
AU  - J Enrique Domínguez-Muñoz
AU  - Robert Sutton
AU  - NIHR Pancreas Biomedical Research Unit Patient Advisory Group
TI  - Efficacy of pancreatic enzyme replacement therapy in chronic pancreatitis: systematic review and meta-analysis
AID  - 10.1136/gutjnl-2016-312529
DP  - 2017 Aug 01
TA  - Gut
PG  - 1354--1355
VI  - 66
IP  - 8
4099  - http://gut.bmj.com/content/66/8/1354.1.short
4100  - http://gut.bmj.com/content/66/8/1354.1.full
SO  - Gut2017 Aug 01; 66
AB  - 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.