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


CONCLUSIONS
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.
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, PO Box 2040, 3015 CE, Rotterdam, The Netherlands. e.sikkens@erasmusmc.nl
Edmée C M
EC
Sikkens
Djuna L
DL
Cahen
Casper
C
van Eijck
Ernst J
EJ
Kuipers
Marco J
MJ
Bruno
D000368:Aged; D003430:Cross-Sectional Studies; D018752:Diet, Fat-Restricted; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D056947:Enzyme Replacement Therapy / Q000379:methods / Q000706:statistics & numerical data*; D010188:Exocrine Pancreatic Insufficiency / Q000178:diet therapy / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010180:Pancreatectomy; D010184:Pancreatic Extracts / Q000627:therapeutic use*; D010193:Pancreaticojejunostomy; D010349:Patient Compliance / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000178:diet therapy / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016896:Treatment Outcome
D010184:Pancreatic Extracts