The daily practice of pancreatic enzyme replacement therapy after pancreatic surgery: a northern European survey: enzyme replacement after surgery

J Gastrointest Surg. 2012 Aug;16(8):1487-92. doi: 10.1007/s11605-012-1927-1. Epub 2012 Jun 19.

Abstract

Introduction: After pancreatic surgery, up to 80 % of patients will develop exocrine insufficiency. For enzyme supplementation to be effective, prescribing an adequate dose of pancreatic enzymes is mandatory but challenging because the required dose varies. Data on the practice of enzyme replacement therapy after surgery are lacking, and therefore, we conducted this analysis.

Methods: An anonymous survey was distributed to members of the Dutch and German patient associations for pancreatic disorders. The target population consisted of patients with chronic pancreatitis or pancreatic cancer who had undergone pancreatic surgery and were using enzymes to treat exocrine insufficiency. Results were compared to a similar group of non-operated patients.

Results: Ninety-one cases were analyzed (84 % underwent a resection procedure). The median daily enzyme dose was 6, and 25 % took three or less capsules. Despite treatment, 68 % of patients reported steatorrhea-related symptoms, 48 % adhered to a non-indicated dietary fat restriction, and only 33 % had visited a dietician. The outcome was equally poor for the 91 non-operated patients.

Conclusion: Most patients suffering from exocrine insufficiency after pancreatic surgery are undertreated. To improve efficacy, physicians should be more focused on treating exocrine insufficiency and educate patients to adjust the dose according to symptoms and their diet.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cross-Sectional Studies
  • Diet, Fat-Restricted
  • Drug Administration Schedule
  • Drug Dosage Calculations
  • Enzyme Replacement Therapy / methods
  • Enzyme Replacement Therapy / statistics & numerical data*
  • Exocrine Pancreatic Insufficiency / diet therapy
  • Exocrine Pancreatic Insufficiency / drug therapy*
  • Exocrine Pancreatic Insufficiency / etiology
  • Female
  • Germany
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Pancreatectomy*
  • Pancreatic Extracts / therapeutic use*
  • Pancreaticojejunostomy*
  • Patient Compliance / statistics & numerical data
  • Postoperative Complications / diet therapy
  • Postoperative Complications / drug therapy*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prospective Studies
  • Treatment Outcome

Substances

  • Pancreatic Extracts