Subject: Understanding Usage of pancreatic exocrine replacement therapy (PERT) in pancreatic exocrine insufficiency (PEI) associated with Chronic Pancreatitis.
The increasing prevalence of pancreatic disorders worldwide has provided challenges in its clinical care and management. Globally, the number of prevalent cases of pancreatitis was 3,038,787 in 1990 which increased to 6,115,833 in 2017, with an age-standardized prevalence rate of 67.2 in 1990 and 76.2 in 2017 per lakh population. Prevalence rates varying from 36 to 125 per 100000 population have been reported from Japan, China, and India, of which India has the highest prevalence. Southern Indian study has shown highest incidences of pancreatitis, ranging from 114-200/100,000 population.
There are multiple causes of pancreatic exocrine insufficiency including chronic pancreatitis (CP), cystic fibrosis and pancreatic cancer. Chronic pancreatitis is a multifactorial, fibro-inflammatory syndrome in which repetitive episodes of pancreatic inflammation lead to extensive fibrotic tissue replacement, resulting in chronic pain, exocrine and endocrine pancreatic insufficiency, reduced quality of life, and a shorter life expectancy.
Alcohol and tobacco use are the most prevalent risk factors among adult patients with chronic pancreatitis, however it is now known that it is rare for a single risk factor, rather than multiple susceptibilities, to cause chronic pancreatitis.
The clinical manifestations of exocrine insufficiency are related to maldigestion, which can result in steatorrhea (oily stools), weight loss, and fat-soluble vitamin deficiencies. Abdominal pain is present in more than 80% of patients with CP. Patients may also experience nausea, vomiting, or both, especially during exacerbations of pain attacks or during episodes of acute pancreatitis.
Pancreatic enzyme replacement therapy is the cornerstone in treatment of patients with Pancreatic exocrine insufficiency (PEI). There are two different formulations of pancreatic enzymes available in market coated pancreatic enzymes and uncoated pancreatic enzymes. Both formulations are used in management of pancreatic enzyme insufficiency but uncoated pancreatic enzymes are also recommended in management of pain in patients with chronic pancreatitis by various guidelines as initial therapy as it is devoid of side effects associated with other therapies.
Uncoated pancreatic enzymes should be taken in combination with a proton pump inhibitor as there is chance that gastric acidic environment may cause destruction of active enzymes. Such requirement is not there with coated enzymes so it becomes critical for efficacy of uncoated pancreatic enzymes.
Limited data available about the real-world use of pancreatic enzymes especially in Indian scenario. Taking this unmet need in consideration this cross-sectional survey was planned to understand real-world use of pancreatic enzyme supplement amongst Indian clinicians.
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