Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials
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...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-01-01
|
| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2016/8541839 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849409058368389120 |
|---|---|
| author | Mohammad Yaghoobi Julia McNabb-Baltar Raheleh Bijarchi Peter B. Cotton |
| author_facet | Mohammad Yaghoobi Julia McNabb-Baltar Raheleh Bijarchi Peter B. Cotton |
| author_sort | Mohammad Yaghoobi |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-76f4a4b519eb4d3e9f2f82f461129074 |
| institution | Kabale University |
| issn | 2291-2789 2291-2797 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-76f4a4b519eb4d3e9f2f82f4611290742025-08-20T03:35:37ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972016-01-01201610.1155/2016/85418398541839Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled TrialsMohammad Yaghoobi0Julia McNabb-Baltar1Raheleh Bijarchi2Peter B. Cotton3Division of Gastroenterology, McMaster University, Hamilton, ON, CanadaDivision of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USADivision of Respirology, St Michael’s Hospital, Toronto, ON, CanadaDivision of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USABackground. 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.http://dx.doi.org/10.1155/2016/8541839 |
| spellingShingle | Mohammad Yaghoobi Julia McNabb-Baltar Raheleh Bijarchi Peter B. Cotton 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 and Hepatology |
| title | Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials |
| title_full | Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials |
| title_fullStr | Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials |
| title_full_unstemmed | Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials |
| title_short | Pancreatic Enzyme Supplements Are Not Effective for Relieving Abdominal Pain in Patients with Chronic Pancreatitis: Meta-Analysis and Systematic Review of Randomized Controlled Trials |
| title_sort | pancreatic enzyme supplements are not effective for relieving abdominal pain in patients with chronic pancreatitis meta analysis and systematic review of randomized controlled trials |
| url | http://dx.doi.org/10.1155/2016/8541839 |
| work_keys_str_mv | AT mohammadyaghoobi pancreaticenzymesupplementsarenoteffectiveforrelievingabdominalpaininpatientswithchronicpancreatitismetaanalysisandsystematicreviewofrandomizedcontrolledtrials AT juliamcnabbbaltar pancreaticenzymesupplementsarenoteffectiveforrelievingabdominalpaininpatientswithchronicpancreatitismetaanalysisandsystematicreviewofrandomizedcontrolledtrials AT rahelehbijarchi pancreaticenzymesupplementsarenoteffectiveforrelievingabdominalpaininpatientswithchronicpancreatitismetaanalysisandsystematicreviewofrandomizedcontrolledtrials AT peterbcotton pancreaticenzymesupplementsarenoteffectiveforrelievingabdominalpaininpatientswithchronicpancreatitismetaanalysisandsystematicreviewofrandomizedcontrolledtrials |