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Children on Pancreatic Enzymes Experience Fewer Acute Pancreatitis Episodes

Children on Pancreatic Enzymes Experience Fewer Acute Pancreatitis Episodes 1024 429 Mary Bates, PhD

Pancreatic enzyme therapy benefitted patients with pancreatic-sufficient acute recurrent pancreatitis and chronic pancreatitis. 

A new study shows that children with both acute recurrent pancreatitis and chronic pancreatitis had significantly lower incidence of acute pancreatitis episodes per year after starting pancreatic enzyme therapy. The findings support the need for a clinical trial to determine the treatment’s efficacy in pediatric patients.  

Children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP) can experience acute pancreatitis (AP) episodes that are painful, require hospitalization and contribute to disease complications and progression. There are currently no interventions to prevent AP episodes or delay disease progression in children or adults with ARP or CP.   

For the new study, researchers leveraged data from the INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE) study, an international consortium of 22 tertiary care centers for pediatric pancreatitis.  

Lead author A. Jay Freeman, MD, medical director of Pancreatic Care for the Pancreas and Liver Care Center at Nationwide Children’s Hospital, had noticed an interesting trend in the INSPPIRE database: Although evidence supporting the efficacy of pancreatic enzyme therapy in children with pancreatic sufficient ARP and CP is lacking, the treatment is not uncommon.  

“There was a significant number of patients who did not have exocrine pancreatic insufficiency yet were given pancreatic enzymes, either in hopes of modifying their pain or gaining some other clinical benefit,” he says. 

To investigate further, Dr. Freeman and colleagues conducted a retrospective cohort study assessing the impact of pancreatic enzyme therapy on clinical outcomes among children with pancreatic-sufficient ARP or CP in the INSPPIRE dataset.  

The researchers found that nearly 17% of children with pancreatic-sufficient ARP and CP were treated with pancreatic enzymes. Children started on pancreatic enzyme therapy experienced fewer AP episodes annually, and approximately 40% of children on pancreatic enzyme therapy had no additional AP episodes over approximately two years of follow-up. Children with a SPINK1 mutation and those with ARP (compared with CP) were less likely to have an AP episode after initiating pancreatic enzyme therapy. 

The association with ARP suggests that pancreatic enzyme therapy may be more effective for preventing AP episodes early, before the disease progresses to CP. However, the researchers emphasize that a randomized, placebo-controlled clinical trial is necessary to evaluate the true impact of pancreatic enzymes for these patients — and they are currently working to make that happen

“We would like to see if pancreatic enzyme therapy helps prevent the progression of ARP to CP, or the sequelae of CP,” says Dr. Freeman, who is also a professor of pediatrics at The Ohio State University College of Medicine.  

“If the clinical trial is positive, this would be the first drug that we have that shows clinical efficacy in treating ARP and CP and potentially helps these patients.”  

 

This article appeared in the Fall/Winter 2024 issue. Download the full issue.

 

 Reference: 

Freeman AJ, Ng K, Wang F, Abu-El-Haija MA, Chugh A, Cress GA, Fishman DS, Gariepy CE, Giefer MJ, Goday P, Gonska TY, Grover AS, Lindblad D, Liu QY, Maqbool A, Mark JA, McFerron BA, Mehta MS, Morinville VD, Noel RA, Ooi CY, Perito ER, Schwarzenberg SJ, Sellers ZM, Wilschanski M, Zheng Y, Yuan Y, Andersen DK, Lowe ME, Uc A; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC). Pancreatic Enzyme Use Reduces Pancreatitis Frequency in Children With Acute Recurrent or Chronic Pancreatitis: A Report From INSPPIRE. American Journal of Gastroenterology. 2024 Apr 18. DOI: 10.14309/ajg.0000000000002772. Epub ahead of print. 

Image credit: Adobe Stock

About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.

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