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High-dose digestive enzymes prevent NAFLD after pancreaticoduodenectomy

Journal of the American College of Surgeons
Reuters Health - 28/09/2020 - The use of high-dose digestive enzymes is associated with a reduced incidence of nonalcoholic fatty liver disease (NAFLD) following pancreaticoduodenectomy (PD) compared with normal-dose enzyme replacement, a randomized, non-blinded clinical trial shows.

"Pancreatic exocrine dysfunction leads to impaired nutrient absorption; however, replacement therapy is quite effective for these problems," Dr. Koya Yasukawa of Shinshu University School of Medicine, in Asahi, Japan, told Reuters Health by email.

Between 8% and 37% of patients develop NAFLD after PD. One recent study suggested that diminished digestive absorption due to pancreatic exocrine dysfunction is involved in the development of NAFLD after PD.

Patients commonly receive a digestive-enzyme preparation after PD to compensate for the reduction in exocrine pancreatic capacity, and one report indicated that NAFLD improved after administration of high-dose pancreatic digestive enzymes.

Dr. Yasukawa and colleagues investigated whether high-dose digestive-enzyme treatment versus a normal dose of digestive enzymes could prevent NAFLD after PD in their study of 84 patients, 80 of whom were included in the analyses (41 in the high-dose study group and 39 normal-dose controls).

Within 12 months after PD, NAFLD occurred in 41.3% of patients overall, including 19.5% (8/41) of patients in the treatment group and 64.1% (25/39) of patients in the control group (P<0.001), the researchers report in the Journal of the American College of Surgeons.

The incidence of NAFLD was also significantly higher in the control group than in the high-dose treatment group at three and six months after PD.

After switching to high-dose digestive-enzyme treatment, 22 of 24 patients in the control group who developed NAFLD showed improvement during the observation period.

In multivariable analyses, independent risk factors for the development of postoperative NAFLD included normal-dose administration of digestive enzymes, serum total protein concentrations of 6.5 g/dL or lower, serum pre-albumin concentrations of 22.0 mg/dL or lower, and pancreatic function diagnostic test values of 70% or lower.

"Throughout our study, not all patients needed high-dose postoperative administration of digestion enzymes, but it seemed to be necessary for certain patients," Dr. Yasukawa said. "It may not be necessary to administer high-dose enzymes for all patients who undergo PD, but if NAFLD is diagnosed, it is likely to be useful in its treatment."

He added, "One of the most important things to say is that NAFLD after PD is not to be underestimated. Most people who are diagnosed with NAFLD are of the subclinical course, but some may progress to nonalcoholic steatohepatitis and develop cirrhosis, so it is important to prevent it if possible."

By Will Boggs MD

SOURCE: https://bit.ly/3ky51NM Journal of the American College of Surgeons, online September 10, 2020

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