Exploring the role of pancreatic enzyme replacement therapy in patients with short bowel syndrome: Nutritional and Anthropometric Outcomes

TL;DR

This study examines whether pancreatic enzyme replacement therapy helps patients with short bowel syndrome by improving nutrition and growth.

Contribution

The study provides new insights into the limited effectiveness of PERT in SBS patients due to anatomical constraints.

Findings

One patient stopped parenteral nutrition after 6 months of PERT.

Fat-soluble vitamin deficiency persisted in three patients despite supplementation.

No significant improvement in anthropometric measurements was observed after 6 months of PERT.

Abstract

Pancreatic enzyme replacement therapy (PERT) has been proposed as a treatment for patients with short bowel syndrome (SBS) to address fat malabsorption and promote growth. However, research on the effectiveness of PERT in this population remains limited. This study aims to investigate the impact of PERT on nutritional status and anthropometric measurements in individuals with SBS.

We retrospectively analyzed medical records of 14 patients with SBS under 25 years at our institution who were prescribed PERT over a twelve-year period. Nutritional status factors including enteral and parenteral calorie intake, fat-soluble vitamin deficiency, vitamin supplement use, along with anthropometric measurements, were assessed across three-time frames: 6 months pre-PERT administration, at PERT initiation, and 6 months post-PERT. Statistical tests, including Mann-Whitney rank sum, Chi-squared, and regression tests, were conducted with a significance level set at 0.05.

Of the 14 patients with SBS who were using PERT, six had elastase levels suggesting pancreatic insufficiency (PI). Among the 14 patients, one discontinued parenteral nutrition (PN) support after 6 months of PERT. Fat soluble vitamin deficiency persisted among three patients despite vitamin supplementation. Six months post-PERT, there was a non-significant decrease in all mean anthropometric z-scores, except for the weight z-scores (p > 0.84). Significant decreases in mean BMI z-scores (p = 0.03) and non-significant reductions in all remaining anthropometric measurements (p > 0.13) were observed among patients with PI following 6 months of PERT use.

PERT utilization may not significantly address fat malabsorption or promote growth in patients with SBS, likely due to anatomical constraints of a shortened bowel that affect nutrient absorption. Further investigation is warranted to determine the efficacy of PERT as a treatment tool for patients with SBS.

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