The effect of pancreatic enzyme supplementation in patients with steatorrhoea after total gastrectomy

Systematic Review of Exocrine Pancreatic Insufficiency after Gastrectomy for Cancer

“…Fifteen out of 23 treated patients experienced an improvement of symptoms, while only 6 out of 24 placebo-treated patients experienced an improvement. Brägelmann et al [17] did not find any significant decrease in the median fecal fat output in the enzyme-treated patients ( p = 0.1).…”

“…The individual symptom scores did not significantly change and the fecal fat excretion did not change overall. Brägelmann et al [17] found an improvement in the overall well-being, whereas no differences in individual symptom scores were observed. It should be noted that both studies used very different dosages, with one study only substituting one third of the proposed necessary levels [16,24] .…”

“…Selection bias could easily be present in the studies investigating pancreatic insufficiency because of the lack of a proper description of patient selection [14,15] . Performance and detection bias are most likely little or completely absent in the 2 studies investigating the supplementation of pancreatic enzymes because the study design included the double-blinding of both the patients and the researchers [16,17] . There was no evidence that attrition or reporting bias could influence the results in all 4 of the included studies.…”

“…Two studies investigated the effects of enzyme supplementation on gastro-intestinal symptoms in patients with exocrine pancreatic insufficiency after total gastrec- [16,17] : one randomized controlled trial and one crossover trial. Armbrecht et al [16] performed the double blind crossover study with 15 patients in which every patient underwent a 7 days intervention period, followed or after a 7 days long placebo period.…”

“…Brägelmann et al [17] performed a prospective parallel, randomized, placebo-controlled, double blind trial on pancreatic enzyme supplementation after total gastrectomy on 52 patients. Although the symptoms -dyspepsia, bloating, early satiety, reflux, and postprandial vomiting -did not differ in the enzyme-treated group in comparison with the placebo group, the patients who had had the pancreas enzyme supplementation reported a significant improvement in the quality of life ( p = 0.006).…”