Published online May 28, 2019. doi: 10.3748/wjg.v25.i20.2430
Peer-review started: January 22, 2019
First decision: February 21, 2019
Revised: April 2, 2019
Accepted: April 19, 2019
Article in press: April 20, 2019
Published online: May 28, 2019
The objective of this study was to analyze the current evidence for the use of pancreatic enzyme replacement therapy (PERT) in affecting survival and quality of life in patients with pancreatic exocrine insufficiency (PEI). Systematic searches of the literature were performed using the PubMed database. Articles were selected for inclusion if they reported findings from trials assessing the effects of PERT on quality of life, survival, malabsorption, growth parameters (such as height, body weight and body mass index), or gastrointestinal symptoms (such as abdominal pain, stool consistency and flatulence). PERT improved PEI-related malabsorption and weight maintenance in patients with cystic fibrosis, chronic pancreatitis, pancreatic cancer, and post-surgical states. In patients with chronic pancreatitis, PERT improved PEI-related symptoms and quality of life measures. Several small retrospective studies have also suggested that PERT may have a positive impact on survival, but long-term studies assessing this effect were not identified. PERT is effective for treating malnutrition and supporting weight maintenance, and it is associated with improved quality of life and possibly with enhanced survival in patients with PEI. However, there is evidence that not all patients with PEI receive adequate PERT. Future work should aim to assess the long-term effects of PERT on the survival of patients with PEI.
Core tip: Malnutrition associated with pancreatic exocrine insufficiency (PEI) can have serious consequences, leading to increased morbidity and reduced survival. Awareness and education may be needed to ensure that patients with PEI are managed appropriately in order to increase their survival and improve long-term quality of life. There is currently a lack of evidence for the long-term effects of pancreatic enzyme replacement therapy (PERT) on survival in patients with PEI; however, there is substantial evidence supporting its efficacy in improving PEI-related malnutrition. Furthermore, the available evidence indicates that PERT improves PEI-related symptoms and quality of life measures in patients with PEI.