TY - JOUR

T1 - Pancreatic enzyme treatment in chronic pancreatitis

T2 - Quality of management and adherence to guidelines–A cross-sectional observational study

AU - Erchinger, Friedemann

AU - Tjora, Erling

AU - Nordaas, Ingrid Kvåle

AU - Dimcevski, Georg

AU - Olesen, Søren Schou

AU - Jensen, Nanna

AU - Dahl, Eva Efsen

AU - Borch, Anders

AU - Nøjgaard, Camilla

AU - Novovic, Srdan

AU - Barauskas, Giedrus

AU - Ignatavicius, Povilas

AU - Vujasinovic, Miroslav

AU - Lőhr, Matthias

AU - Laukkarinen, Johanna

AU - Parhiala, Mikael

AU - Drewes, Asbjørn Mohr

AU - Engjom, Trond

N1 - Publisher Copyright: © 2022 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

KW - chronic pancreatitis

KW - pancreatic enzyme replacement therapy

KW - pancreatic exocrine insufficiency

KW - scandinavian baltic pancreatic club

KW - United European Gastroenterology

U2 - 10.1002/ueg2.12276

DO - 10.1002/ueg2.12276

M3 - Journal article

C2 - 35981311

AN - SCOPUS:85135901341

VL - 10

SP - 844

EP - 853

JO - United European Gastroenterology Journal

JF - United European Gastroenterology Journal

SN - 2050-6406

IS - 8

ER -