Efficacy of pancreatic enzyme replacement therapy on exocrine pancreatic insufficiency: a systematic review and meta-analysis.

Authors

Xiuming Yang, Lina Yang, Weiwei Zhang, Lixia Zhong, Yulin Zheng

Published in

European journal of gastroenterology & hepatology. Jun 12, 2026. Epub Jun 12, 2026.

Abstract

Exocrine pancreatic insufficiency (EPI) results in impaired digestion of fat, protein, and carbohydrates due to inadequate pancreatic enzyme secretion and is commonly managed with pancreatic enzyme replacement therapy (PERT). However, the extent to which PERT improves objective measures of nutrient absorption across different etiologies of EPI has not been fully clarified. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and Google Scholar was performed from inception through December 2025. Randomized controlled trials (RCTs) comparing PERT with placebo in patients diagnosed with EPI were included. Eligible studies were required to report data on the coefficient of fat absorption (CFA) and the coefficient of nitrogen absorption (CNA). Data were pooled using a random-effects model, and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Subgroup, sensitivity, and publication bias analyses were performed. Fourteen RCTs involving 684 patients were included. PERT significantly improved fat absorption compared with placebo (CFA: SMD = 1.57, 95% CI: 1.20-1.94) and also enhanced protein absorption (CNA: SMD = 1.52, 95% CI: 0.97-2.06). Etiology-based subgroup analyses showed significant improvements in CFA among patients with cystic fibrosis (CF)-related EPI (SMD = 1.87, 95% CI: 1.48-2.25) and chronic pancreatitis-related EPI (SMD = 1.08, 95% CI: 0.67-1.49). Similarly, PERT significantly increased CNA in CF-associated EPI (SMD = 1.90, 95% CI: 1.30-2.50) and in EPI secondary to chronic pancreatitis (SMD = 0.74, 95% CI: 0.31-1.18). PERT substantially improves both fat and protein absorption in patients with EPI, with consistent efficacy across major etiological subgroups. These findings reinforce the role of enzyme replacement therapy as a cornerstone of EPI management and support its continued use to optimize digestive and nutritional outcomes.

PMID:
42467921
Bibliographic data and abstract were imported from PubMed on 18 Jul 2026.

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