Digestive Enzymes Research
44 peer-reviewed studies · Evidence score: 8.5/10
Postprocedure serum amylase or lipase levels predict postendoscopic retrograde cholangiopancreatography pancreatitis: Meta-analysis of diagnostic test accuracy studies and utility assessment
Hirota M et al. • Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (2024)
Despite a high risk of bias due to various reference standards, this updated meta-analysis and the utility assessment by a decision tree showed the utility of serum amylase or lipase levels more than 3 times ULN measured 2-4 h after ERCP for predicting PEP.
- Meta-analysis of eight studies (4389 participants) showed a pooled sensitivity of 71.1% (95% confidence interval [CI] 56.1-82.5) and pooled specificity of 91.2% (95% CI 85.9-94.6) for the serum amylase cut-off value at 3 times the upper limit of normal (ULN).
- Another meta-analysis of five studies (1970 participants) showed a pooled sensitivity of 85.8% (95% CI 61.9-95.7) and pooled specificity of 85.3% (95% CI 81.9-88.1) for the serum lipase cut-off value at 3 times ULN.
- Despite a high risk of bias due to various reference standards, this updated meta-analysis and the utility assessment by a decision tree showed the utility of serum amylase or lipase levels more than 3 times ULN measured 2-4 h after ERCP for predicting PEP.
Postdischarge interventions for children hospitalized with severe acute malnutrition: a systematic review and meta-analysis
Noble CCA et al. • The American journal of clinical nutrition (2021)
Several biological and psychosocial interventions show promise in improving outcomes in children following hospitalization for SAM and require further exploration in larger randomized mortality trials.
- Compared with standard care, pancreatic enzyme supplementation reduced inpatient mortality (37.8% compared with 18.6%, P < 0.05).
- In meta-analysis there was some evidence that prebiotics or synbiotics reduced mortality (RR: 0.72; 95% CI: 0.51, 1.00; P = 0.049).
- Psychosocial stimulation reduced mortality in meta-analysis of the 2 trials reporting deaths (RR: 0.36; 95% CI: 0.15, 0.87), and improved neurodevelopmental scores in ≥1 domain in all studies.
Prevalence and Outcomes of Pancreatic Enzymes Elevation in Patients With COVID-19: A Meta-Analysis and Systematic Review
Zhou Y et al. • Frontiers in public health (2022)
PE elevation was a common phenomenon in patients with COVID-19, and was associated with poor clinical outcomes.
- In addition, the subgroup analysis revealed that although PE elevated to > 3 × upper normal limit (ULN) was significantly related to the mortality (OR = 4.4, 2.1-9.4), it seemed that mild elevation of PE to 1-3 ULN also had a considerable risk of mortality (OR = 2.3, 1.5-3.5).
- PE elevation was a common phenomenon in patients with COVID-19, and was associated with poor clinical outcomes.
- However, due to the limited numbers of included studies, the result of our study still needed to be validated.
Endoplasmic stress-inducing variants in CPB1 and CPA1 and risk of pancreatic cancer: A case-control study and meta-analysis
Kawamoto M et al. • International journal of cancer (2022)
Rare variants in CPB1 and CPA1 that induce ER stress are associated with increased odds of developing pancreatic cancer.© 2021 UICC.
- Of the 1385 patients with PDAC, 0.65% were found to harbor an ER stress-inducing variant in CPA1 or CPB1, compared to 0.17% of the 64 026 controls (odds ratio [OR]: 3.80 [1.92-7.51], P = .0001).
- ER stress-inducing variants in the CPA1 gene were identified in 4 of 1385 PDAC cases vs 77 of 64 026 gnomAD controls (OR: 2.4 [0.88-6.58], P = .087), and variants in CPB1 were detected in 5 of 1385 cases vs 33 of 64 026 controls (OR: 7.02 [2.74-18.01], P = .0001).
- Meta-analysis demonstrated strong associations for pancreatic cancer and ER-stress inducing variants for both CPA1 (OR: 3.65 [1.58-8.39], P < .023) and CPB1 (OR: 9.51 [3.46-26.15], P < .001).
Dietary intake in patients with chronic pancreatitis: A systematic review and meta-analysis
Ul Ain Q et al. • World journal of gastroenterology (2021)
Although patients with CP had similar calorie intake to controls, studies that analysed the contribution of alcohol to energy intake showed that patients with CP consumed fewer non-alcohol calories than healthy controls.
- Those with alcohol-related CP consumed more mean (standard deviation) calories than CP patients with a non-alcohol aetiology [2642 (1090) kcal and 1372 (394) kcal, respectively, P = 0.046], as well as more protein, fat, but not carbohydrate.
- Although patients with CP had similar calorie intake to controls, studies that analysed the contribution of alcohol to energy intake showed that patients with CP consumed fewer non-alcohol calories than healthy controls.
- A high calorie intake, made up to a large degree by alcohol, may in part contribute to poor nutritional status in CP.
Systematic Review of Exocrine Pancreatic Insufficiency after Gastrectomy for Cancer
Straatman J et al. • Digestive surgery (2017)
Gastrointestinal symptoms such as steatorrhea, bloating, and dumping syndrome may be related to exocrine pancreatic function, initiated by total gastrectomy.
- Exocrine pancreatic insufficiency was investigated by 2 studies; the results showed a significant decrease of total exocrine pancreatic function of up to 76%.
- Gastrointestinal symptoms such as steatorrhea, bloating, and dumping syndrome may be related to exocrine pancreatic function, initiated by total gastrectomy.
- Treatment with pancreatic enzymes had a minor positive effect on patients.
Efficacy of pancreatic enzyme replacement therapy in chronic pancreatitis: systematic review and meta-analysis
de la Iglesia-García D et al. • Gut (2017)
PERT is indicated to correct EPI and malnutrition in CP and may be improved by higher doses, enteric coating, administration during food and acid suppression.
- PERT improved CFA compared with baseline (83.7±6.0 vs 63.1±15.0, p<0.00001; I2=89%) and placebo (83.2±5.5 vs 67.4±7.0, p=0.0001; I2=86%).
- PERT is indicated to correct EPI and malnutrition in CP and may be improved by higher doses, enteric coating, administration during food and acid suppression.
- Further studies are required to determine optimal regimens, the impact of health inequalities and long-term effects on nutrition.
Complementary and Alternative Medicine for Autism - A Systematic Review
Doherty M et al. • Journal of autism and developmental disorders (2025)
This systematic-review examined the effects of Digestive Enzymes.
- The results of this systematic review identified that for autistic people, vitamin and mineral supplements may only be of benefit if there is a deficiency.
- The results also found that the main interventions used were dietary interventions and nutraceuticals, including targeted supplements, vitamins and minerals, omega 3 s and prebiotics, probiotics and digestive enzymes.
- Further research warranted to confirm findings
Exocrine pancreatic insufficiency after esophagectomy: a systematic review of literature
Blonk L et al. • Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (2021)
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- Fecal elastase-1 levels <200 μg/g were reported in 16% of patients at 4 months, 18% at 6 months, and 31% at 18-24 months postoperatively.
- A decreased fecal fat absorption was noticed in 57% 1 month postoperatively.
- In patients with fecal elastase-1 levels <200 μg/g, 90% of patients reported improvement in symptoms and 70% reported improvement in weight.
Vitamin E supplementation in people with cystic fibrosis
Okebukola PO et al. • The Cochrane database of systematic reviews (2020)
Vitamin E supplementation may lead to an improvement in vitamin E levels in people with cystic fibrosis, although evidence we assessed was low quality.
- Water-soluble vitamin E Water-soluble vitamin E may improve serum vitamin E levels compared with control at six months, one study (45 participants), mean difference (MD) 19.74 umol/L (95% confidence interval (CI) 13.48 to 26.00) (low-quality evidence).
- Similar results were also seen at one month, two studies (32 participants), MD 17.66 umol/L (95% CI 10.59 to 24.74) and at three months, one study (45 participants), MD 11.61 umol/L (95% CI 4.77 to 18.45).
- Vitamin E supplementation may lead to an improvement in vitamin E levels in people with cystic fibrosis, although evidence we assessed was low quality.
Omega-3 fatty acid supplementation for cystic fibrosis
Watson H et al. • The Cochrane database of systematic reviews (2020)
This review found that regular omega-3 supplements may provide some limited benefits for people with cystic fibrosis with relatively few adverse effects: however, the quality of the evidence across all outcomes was very low.
- The remaining studies did not report any difference in lung function at three months (unit of measurement not specified) or at six months and one year (FEV1 % predicted and FVC % predicted).
- This review found that regular omega-3 supplements may provide some limited benefits for people with cystic fibrosis with relatively few adverse effects: however, the quality of the evidence across all outcomes was very low.
- The current evidence is insufficient to draw firm conclusions or recommend routine use of these supplements in people with cystic fibrosis.
Single-Cell Meta-Analysis Uncovers the Pancreatic Endothelial Cell Transcriptomic Signature and Reveals a Key Role for NKX2-3 in PLVAP Expression
Khan ST et al. • Arteriosclerosis, thrombosis, and vascular biology (2024)
We defined a validated transcriptomic signature of pancreatic ECs and uncovered their intratissue transcriptomic heterogeneity.
- DNA-binding motif analysis found NKX2-3 motifs in ≈40% of the signature genes.
- We defined a validated transcriptomic signature of pancreatic ECs and uncovered their intratissue transcriptomic heterogeneity.
- We showed that NKX2-3 acts upstream of PLVAP and provided a single-cell online resource that can be further explored by the community: https://vasconcelos.shinyapps.io/pancreatic_endothelial/.
Omega-3 fatty acids for cystic fibrosis
Oliver C et al. • The Cochrane database of systematic reviews (2016)
This review found that regular omega-3 supplements may provide some benefits for people with cystic fibrosis with relatively few adverse effects, although evidence is insufficient to draw firm conclusions or recommend routine use of these supplements in people with cystic fibrosis.
- Only one short-term study (19 participants) comparing omega-3 to placebo reported a significant improvement in lung function and Shwachman score and a reduction in sputum volume in the omega-3 group.
- Another study (43 participants) demonstrated a significant increase in serum phospholipid essential fatty acid content and a significant drop in the n-6/n-3 fatty acid ratio following omega-3 fatty acid supplementation compared to control.
- The longer-term study (17 participants) demonstrated a significant increase in essential fatty acid content in neutrophil membranes and a significant decrease in the leukotriene B4 to leukotriene B5 ratio in participants taking omega-3 supplements compared to placebo.
Clinical Efficacy and Safety of Treatments for Exocrine Pancreatic Insufficiency: A Systematic Literature Review
Chu P et al. • Digestion (2025)
This SLR confirmed that PERT is an effective and tolerable treatment option for patients with EPI.
- Mean change in CFA ranged from 7.5% in patients with CP who received placebo to 36% in patients with CP treated with Creon®.
- Only one study compared PERT brands head-to-head: no significant differences were reported in the CNA-72 h values (Creon® 82.0% [SE: 1.2] vs.
- Zenpep® 80.9% [SE: 1.2]).
Isoniazid-induced pancreatitis: A systematic review
Baral T et al. • Tuberculosis (Edinburgh, Scotland) (2024)
We found the latency period for isoniazid-induced pancreatitis to be ranged from 12 to 45 days after initiation of isoniazid therapy.
- We found the latency period for isoniazid-induced pancreatitis to be ranged from 12 to 45 days after initiation of isoniazid therapy.
- A low threshold for screening of pancreatitis by measuring pancreatic enzymes in patients on isoniazid presenting with acute abdominal pain is recommended.
- This would facilitate an early diagnosis and discontinuation of isoniazid, thus reducing the severity of pancreatitis and preventing the complications of pancreatitis.
Pancreatic Disorders in Children with Inflammatory Bowel Disease
Jakimiec P et al. • Medicina (Kaunas, Lithuania) (2021)
As the number of IBD incidences with concomitant pancreatic diseases is constantly increasing in the pediatric population, it is important to include pancreatic enzymes level measurement in the workup of IBD.
- The pancreatic involvement can be strictly related to the activity of IBD and can also precede the diagnosis of IBD in some pediatric patients.
- The course of AP is mild in most cases and may occasionally lead to the development of CP, mainly in cases with a genetic predisposition.
- Conclusions: The involvement of the pancreas in the course of IBD may be considered as an EIM or a separate co-morbid disease, but it can also be a side effect of IBD therapy, therefore a differential diagnosis should always be performed.
The ageing pancreas: a systematic review of the evidence and analysis of the consequences
Löhr JM et al. • Journal of internal medicine (2018)
Therapeutic intervention, which may consist of supplementation of pancreatic enzymes and/or vitamins in aged individuals with proven exocrine pancreas insufficiency, could contribute to healthy ageing.© 2018 The Association for the Publication of the Journal of Internal Medicine.
- Five per cent of people older than 70 years and ten per cent older than 80 years have pancreatic exocrine insufficiency (PEI) with a faecal elastase-1 below 200 μg g-1 stool, and 5% have severe PEI with faecal elastase-1 below 100 μg g-1 stool.
- Malnutrition consists of deficits of fat-soluble vitamins and is affecting both patients with PEI and the elderly.
- Secondary consequences may include decreased bone mineral density and results from impaired absorption of fat-soluble vitamin D due to impaired pancreatic exocrine function.
Nutritional and Dietary Interventions for Autism Spectrum Disorder: A Systematic Review
Sathe N et al. • Pediatrics (2017)
There is little evidence to support the use of nutritional supplements or dietary therapies for children with ASD.
- There is little evidence to support the use of nutritional supplements or dietary therapies for children with ASD.
- Published in Pediatrics (2017)
- Further research warranted to confirm findings
Pancreatic enzymes for chronic pancreatitis
Shafiq N et al. • The Cochrane database of systematic reviews (2009)
The role of pancreatic enzymes for abdominal pain, weight loss, steatorrhoea, analgesic use and quality of life in patients with chronic pancreatitis remains equivocal.
- The role of pancreatic enzymes for abdominal pain, weight loss, steatorrhoea, analgesic use and quality of life in patients with chronic pancreatitis remains equivocal.
- Good quality, adequately powered studies are much warranted.
- Further research warranted to confirm findings
Autism
Parr J • BMJ clinical evidence (2010)
We performed a GRADE evaluation of the quality of evidence for interventions.
- Systematic review examining Digestive Enzymes efficacy
- Published in BMJ clinical evidence (2010)
- Further research warranted to confirm findings