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Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials.
Can J Gastroenterol Hepatol. 2016; 2016:8541839.CJ

Abstract

Background.

Pancreatic enzyme supplementation is widely used to treat pain in patients with chronic pancreatitis, despite little evidence for efficacy. We performed a systematic review of the literature and a meta-analysis to investigate its effectiveness. Methods. All randomized controlled parallel or crossover trials in patients with chronic pancreatitis comparing pancreatic enzyme supplementation to placebo were included. The main outcome was improvement in pain score or reduced analgesic consumption. Two independent reviewers extracted data. Mantel-Haenszel random effect model meta-analysis was used whenever methodologically appropriate.

Results.

Five out of 434 retrieved studies were included in the systematic review. All studies used relatively similar methodology. Four studies using enteric-coated pancreatic enzyme supplementation failed to show any improvement in pain as compared to placebo. The only study using non-enteric-coated enzymes did show reduction in the pain score. There was significant heterogeneity among studies in both analyses. Random model meta-analysis of three studies showed no significant difference in the mean of daily pain score (mean difference: 0.09 (1.57-1.39), p = 0.91) or average weekly analgesic consumption (mean difference: -0.30 (-2.37-1.77), p = 0.77) between the periods of administering pancreatic enzyme supplementation versus placebo.

Conclusion.

Pancreatic enzyme supplements do not seem to relieve abdominal pain in patients with chronic pancreatitis and should not be prescribed solely for this purpose, given their significant cost and potential side effects.

Authors+Show Affiliations

Division of Gastroenterology, McMaster University, Hamilton, ON, Canada.Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.Division of Respirology, St Michael's Hospital, Toronto, ON, Canada.Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

27446871

Citation

Yaghoobi, Mohammad, et al. "Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients With Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials." Canadian Journal of Gastroenterology & Hepatology, vol. 2016, 2016, p. 8541839.
Yaghoobi M, McNabb-Baltar J, Bijarchi R, et al. Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials. Can J Gastroenterol Hepatol. 2016;2016:8541839.
Yaghoobi, M., McNabb-Baltar, J., Bijarchi, R., & Cotton, P. B. (2016). Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials. Canadian Journal of Gastroenterology & Hepatology, 2016, 8541839. https://doi.org/10.1155/2016/8541839
Yaghoobi M, et al. Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients With Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials. Can J Gastroenterol Hepatol. 2016;2016:8541839. PubMed PMID: 27446871.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials. AU - Yaghoobi,Mohammad, AU - McNabb-Baltar,Julia, AU - Bijarchi,Raheleh, AU - Cotton,Peter B, Y1 - 2016/04/24/ PY - 2015/03/17/received PY - 2015/07/20/accepted PY - 2016/7/23/entrez PY - 2016/7/23/pubmed PY - 2017/7/18/medline SP - 8541839 EP - 8541839 JF - Canadian journal of gastroenterology & hepatology JO - Can J Gastroenterol Hepatol VL - 2016 N2 - Background. Pancreatic enzyme supplementation is widely used to treat pain in patients with chronic pancreatitis, despite little evidence for efficacy. We performed a systematic review of the literature and a meta-analysis to investigate its effectiveness. Methods. All randomized controlled parallel or crossover trials in patients with chronic pancreatitis comparing pancreatic enzyme supplementation to placebo were included. The main outcome was improvement in pain score or reduced analgesic consumption. Two independent reviewers extracted data. Mantel-Haenszel random effect model meta-analysis was used whenever methodologically appropriate. Results. Five out of 434 retrieved studies were included in the systematic review. All studies used relatively similar methodology. Four studies using enteric-coated pancreatic enzyme supplementation failed to show any improvement in pain as compared to placebo. The only study using non-enteric-coated enzymes did show reduction in the pain score. There was significant heterogeneity among studies in both analyses. Random model meta-analysis of three studies showed no significant difference in the mean of daily pain score (mean difference: 0.09 (1.57-1.39), p = 0.91) or average weekly analgesic consumption (mean difference: -0.30 (-2.37-1.77), p = 0.77) between the periods of administering pancreatic enzyme supplementation versus placebo. Conclusion. Pancreatic enzyme supplements do not seem to relieve abdominal pain in patients with chronic pancreatitis and should not be prescribed solely for this purpose, given their significant cost and potential side effects. SN - 2291-2797 UR - https://www.unboundmedicine.com/medline/citation/27446871/Pancreatic_Enzyme_Supplements_Are_Not_Effective_for_Relieving_Abdominal_Pain_in_Patients_with_Chronic_Pancreatitis:_Meta_Analysis_and_Systematic_Review_of_Randomized_Controlled_Trials_ L2 - https://dx.doi.org/10.1155/2016/8541839 DB - PRIME DP - Unbound Medicine ER -