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Pancreatic enzyme replacement therapy use in acute pancreatitis – a systematic review of current practice

Lookup NU author(s): Professor Sanjay PandanaboyanaORCiD

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Abstract

© 2026Background: Up to two-thirds of inpatients with acute pancreatitis (AP) may develop pancreatic exocrine insufficiency (PEI), persisting long-term in one third. The prevalence, indications, and outcomes of pancreatic enzyme replacement therapy (PERT) following AP remain poorly defined, with limited AP-specific guidance in current international guidelines. This systematic review aimed to determine the prevalence of PERT use after AP and its associated outcomes. Methods: Medline, via Ovid and Pubmed, and Embase were searched for studies reporting PERT prescription rates, indications, timing, or outcomes during or after AP. Randomised and non-randomised primary studies in adult populations were eligible. Single-proportion random-effects meta-analyses estimated pooled prescribing rates; evidence certainty was assessed using GRADE. Results: Twenty-eight studies (14,874 patients) were included. Pooled PERT prescription rates across non-randomised studies, were 17.8% (95% CI 11.4–26.7%) overall, rising to 28.4% (95% CI 15.5–46.0%) in necrotising AP and 42.7% (95% CI 23.8–64.0%) in severe disease, versus 5.0% (95% CI 0.3–45.5%) in mild disease. Outcomes data were inconsistent across biochemical, symptom, and quality-of-life endpoints; heterogeneity precluded meta-analysis of treatment effect. Overall evidence certainty was low. Conclusions: PERT is infrequently prescribed after AP, and evidence for its benefit remains inconsistent. Well-designed trials stratified by severity, including patient-reported outcomes, are needed.

Publication metadata

Author(s): Hall LA, Baxter JSS, Powell-Brett S, Phillips ME, Roberts KJ, Pandanaboyana S, Smith AM, Lee M, Blencowe NS, Pathak S

Publication type: Review

Publication status: Published

Journal: HPB

Year: 2026

Pages: epub ahead of print

Online publication date: 25/06/2026

Acceptance date: 18/06/2026

ISSN (print): 1365-182X

ISSN (electronic): 1477-2574

Publisher: Elsevier B.V.

URL: https://doi.org/10.1016/j.hpb.2026.06.010

DOI: 10.1016/j.hpb.2026.06.010

PubMed id: 42436070

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