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Pancreatic enzyme replacement therapy in patients with pancreatic exocrine insufficiency

Mila Kovacheva- Slavova, Sylvie Siminkovitch, Jordan Genov, Branimir Golemanov, Rumyana Mitova, Plamen Gecov, Dobrin Svinarov, Borislav Vladimirov


Background: Malnutrition is a typical complication of pancreatic diseases. Pancreatic enzyme replacement therapy (PERT) is a present standard in treating pancreatic exocrine insufficiency (PEI) independently of its aetiology. Clinical and nutritional status reassessment ensures an optimal therapeutic effect.

Aim: To monitor PERT and correct suboptimal treatment.

Materials and methods: Study enrolled 142 patients (mean age 52, 88-males) with PEI due to chronic pancreatitis (CP), acute pancreatitis (AP), pancreatic cancer/ pancreatic resection (PC/PR). All patients received PERT in doses based on PEI severity. 58 patients were followed-up 3-12 months after optimization suboptimal PERT. Nutritional status was evaluated by prealbumin, retinol binding protein (RBP), fat-soluble vitamins A, D, E; magnesium and BMI in addition to routine biochemical markers; CP was assessed by M-ANNHEIM classification. Statistical analysis was performed via SPSS v22.

Results: Suboptimal PERT with nutritional deficiencies in asymptomatic patients was observed within all patients groups. Protein malnutrition with prealbumin (mean:0,208±0,105g/L) and RBP (mean:0,0389±0,0258g/L) below reference limits was observed in 67 and 47 of all patients. They correlated significantly to magnesium, hemoglobin, albumin, BMI and structural changes (p<0,05). Vitamin A, D, E insufficiencies were present in 21,95; 94,49 and 40,96% of all evaluated patients, respectively. Moreover 33,86% had vitamin D deficiency (<25 nmol/L). During second follow-up we demonstrated clinical improvement with a significant increase in BMI, prealbumin, vitamins A,E,D, hemoglobin and albumin, p<0.01.

Conclusion: Proper follow-up and correction of suboptimal PERT reduce the risk of severe malnutrition complications, associated morbidity and mortality and ensures better quality of life for patients with PEI.

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