Pancreatic enzyme replacement therapy use in acute pancreatitis – a systematic review of current practice

IF 3.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2026-09-01 Epub Date: 2026-06-25 DOI:10.1016/j.hpb.2026.06.010

Lewis A. Hall, Joshua S.S. Baxter, Sarah Powell-Brett, Mary E. Phillips, Keith J. Roberts, Sanjay Pandanaboyana, Andrew M. Smith, Matthew Lee, Natalie S. Blencowe, Samir Pathak

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引用次数: 0

Abstract

Background

Up to two-thirds of inpatients with acute pancreatitis (AP) may develop pancreatic exocrine insufficiency (PEI), persisting long-term in one third. The prevalence, indications, and outcomes of pancreatic enzyme replacement therapy (PERT) following AP remain poorly defined, with limited AP-specific guidance in current international guidelines. This systematic review aimed to determine the prevalence of PERT use after AP and its associated outcomes.

Methods

Medline, via Ovid and Pubmed, and Embase were searched for studies reporting PERT prescription rates, indications, timing, or outcomes during or after AP. Randomised and non-randomised primary studies in adult populations were eligible. Single-proportion random-effects meta-analyses estimated pooled prescribing rates; evidence certainty was assessed using GRADE.

Results

Twenty-eight studies (14,874 patients) were included. Pooled PERT prescription rates across non-randomised studies, were 17.8% (95% CI 11.4–26.7%) overall, rising to 28.4% (95% CI 15.5–46.0%) in necrotising AP and 42.7% (95% CI 23.8–64.0%) in severe disease, versus 5.0% (95% CI 0.3–45.5%) in mild disease. Outcomes data were inconsistent across biochemical, symptom, and quality-of-life endpoints; heterogeneity precluded meta-analysis of treatment effect. Overall evidence certainty was low.

Conclusions

PERT is infrequently prescribed after AP, and evidence for its benefit remains inconsistent. Well-designed trials stratified by severity, including patient-reported outcomes, are needed.

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胰酶替代疗法在急性胰腺炎中的应用-当前实践的系统回顾。

背景：多达三分之二的急性胰腺炎（AP）住院患者可能发展为胰腺外分泌功能不全（PEI），三分之一的患者长期持续。胰酶替代疗法（PERT）的流行、适应症和预后仍然不明确，目前的国际指南中对AP的特异性指导有限。本系统综述旨在确定AP术后PERT使用的流行程度及其相关结果。方法：Medline，通过Ovid和Pubmed以及Embase检索报告AP期间或之后PERT处方率，适应症，时间或结果的研究。成人人群的随机和非随机主要研究符合条件。单比例随机效应荟萃分析估计了合并处方率；证据确定性采用GRADE评估。结果：纳入28项研究（14874例患者）。在非随机研究中，总的PERT处方率为17.8% (95% CI 11.4-26.7%)，坏死性AP为28.4% (95% CI 15.5-46.0%)，严重疾病为42.7% (95% CI 23.8-64.0%)，而轻度疾病为5.0% （95% CI 0.3-45.5%）。结果数据在生化、症状和生活质量终点上不一致；异质性妨碍了治疗效果的荟萃分析。总体证据确定性较低。结论：在AP后很少使用PERT，其益处的证据仍然不一致。需要设计良好的按严重程度分层的试验，包括患者报告的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).