Pancreatic enzyme treatment in chronic pancreatitis: Quality of management and adherence to guidelines-A cross-sectional observational study.

Autor: Erchinger F; Department of Clinical Medicine, University of Bergen, Bergen, Norway., Tjora E; Pediatric Department, Haukeland University Hospital, Bergen, Norway., Nordaas IK; Department of Medicine, Haukeland University Hospital, Bergen, Norway., Dimcevski G; Department of Clinical Medicine, University of Bergen, Bergen, Norway., Olesen SS; Department of Gastroenterology and Hepatology, Centre of Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark., Jensen N; Department of Gastroenterology, Bispebjerg University Hospital, Copenhagen, Denmark., Dahl EE; Department of Gastroenterology, Bispebjerg University Hospital, Copenhagen, Denmark., Borch A; Department of Gastroenterology, Herlev University Hospital, Herlev, Denmark., Nøjgaard C; Department of Gastroenterology, Hvidovre University Hospital, Herlev, Denmark., Novovic S; Department of Gastroenterology, Hvidovre University Hospital, Herlev, Denmark., Barauskas G; Department of Gastrointestinal Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania., Ignatavicius P; Department of Gastrointestinal Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania., Vujasinovic M; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.; Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden., Lőhr M; Department of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden., Laukkarinen J; Department of Gastroenterology and Alimentary Tract Surgery, Tampere, University Hospital, Tampere, Finland., Parhiala M; Department of Gastroenterology and Alimentary Tract Surgery, Tampere, University Hospital, Tampere, Finland., Drewes AM; Department of Gastroenterology and Hepatology, Centre of Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark., Engjom T; Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Jazyk: angličtina
Zdroj: United European gastroenterology journal [United European Gastroenterol J] 2022 Oct; Vol. 10 (8), pp. 844-853. Date of Electronic Publication: 2022 Aug 18.
DOI: 10.1002/ueg2.12276
Abstrakt: Objectives: Pancreatic exocrine insufficiency (PEI) is a common complication in patients with chronic pancreatitis (CP), leading to increased morbidity and mortality if not treated adequately. Pancreatic enzyme replacement therapy|pancreas enzyme replacement therapy (PERT) is the cornerstone in treatment of patients with PEI. In the present study, we use data from the Scandinavian Baltic Pancreatic Club database to examine adherence of PERT according to United European Gastroenterology evidence-based guidelines treatment of CP.
Patients and Methods: Patients with definitive or probable CP according to M-ANNHEIM diagnostic criteria were included. We collected information on exposures, exocrine function, intake of pancreatic enzymes, and markers of nutrition. Fecal elastase <200 μg/g was defined as a marker for PEI. Enzyme replacement therapy of 100,000 lipase units or more was defined as adequate treatment.
Results: We included 1006 patients from 8 centers in five countries. Sixty-four percent of the patients were correctly treated. Twenty-five per cent of PEI patients were not taking enzymes at all, and 20% of PEI patients were undertreated with insufficient PERT doses according to the guidelines. Fourteen percent of patients with sufficient pancreatic function were receiving enzymes despite normal exocrine pancreatic function. There were center differences. Current smoking was associated with lack of treatment and alcohol abuse was associated with under-treatment. There were no associations between "no treatment" or "under-treatment" for underweight or vitamin D deficiency.
Conclusion: In our CP expert centers, the adherence to guidelines for enzyme treatment is insufficient. Both patient factors and center differences have influence on treatment adherence.
(© 2022 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)
Databáze: MEDLINE
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