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Chronic pancreatitis and enzyme supplements


Chronic pancreatitis is uncommon (perhaps 20 cases per 100,000 population). Problems are pain and steatorrhoea, and the treatment of choice advocated by well-known textbooks is pancreatic enzyme supplementation. A new meta-analysis of the use of enzyme supplements to reduce pain [1] shows them to be without effect.

Searching

The search was not exhaustive. Only MEDLINE was searched, and only English language papers used.

Results

All studies included were of a randomised, double-blind crossover design, and of two weeks to eight months duration. There were six studies, with a total of 189 patients, with six different pancreatic enzyme supplements. Pain scoring methods seemed sensible.

Only one trial of the six showed a statistical improvement over placebo as judged by patient preference - that of the two-week duration (Figure).


Overall the relative benefit was 1.2 (95% confidence interval 0.8 to 1.8).

Comment

While the search strategy employed for this meta-analysis was sub-optimal, the results were consistent: pancreatic enzyme supplementation is not judged to be effective by patients.

Reference:

  1. A Brown, M Hughes, S Tenner, PA Banks. Does pancreatic enzyme supplementation reduce pain in patients with chronic pancreatitis: a meta-analysis. American Journal of Gastroenterology 1997 92: 2032-5.



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