UF Health MedMatters

Pancreatic Enzyme Replacement Therapy Improves Patient Quality of Life, Recovery

You don’t know what you’ve got until it’s gone — or not working properly.3D illustration of human body organs anatomy (pancreas)

A healthy pancreas stays behind the scenes, creating digestive enzymes that convert food into nutrition that your body needs to keep it running smoothly. But in patients diagnosed with pancreatic diseases, the organ falls short, and a host of unwelcome side effects can occur.

Without being able to properly extract nutrition from food, patients with exocrine insufficiency can end up suffering from brittle bones or vitamin deficiency disorders and experience difficulty controlling for their blood sugar.

For patients with pancreatic cancer, exocrine insufficiency can hasten weight and muscle loss, reduce their ability to tolerate chemotherapy or surgery and even increase their mortality.

“If you can’t digest what you eat, especially during an intensive period when you’re critically ill, the consequences are far-reaching,” said Steven J. Hughes, MD, chief of the UF College of Medicine’s division of surgical oncology. “Your body needs proper nutrition in order to get better. We needed to find a way to ensure some of our sickest patients were being given their best chance.”

Currently, pancreatic enzyme replacement therapy, or PERT, is one of the most viable solutions available. Typically in pill form, the medication replaces the enzymes a healthy pancreas would make and helps the patient digest food by breaking down carbohydrates, fats and proteins.

But what about patients who are on ventilators or receiving nutrition through tubes — and whose outcomes depend their body’s ability to heal?

The most severely ill patients also need a reliable way to access medication that would facilitate correct digestion. Breaking up the enzyme replacement pills has proven ineffective, so Hughes and his team identified a substance that would help emulsify fat in tube feeds, allowing for easy absorption.

“Your body needs proper nutrition in order to get better. We needed to find a way to ensure some of our sickest patients were being given their best chance," said Steven J. Hughes, MD, chief of the UF College of Medicine's division of surgical oncology.

The success of this new treatment has established it a permanent part of UF Health’s protocol for any patient with severe pancreatic disease in the ICU, and supports the institution’s recognition as a National Pancreas Foundation Center of Excellence. Now, patients with chronic pancreatitis or pancreatic cancer are tested for exocrine insufficiency, and receive the appropriate dosing of PERT.

This attention to detail in protocol also echoes a bigger push in the field for more attention toward the role of pancreatic enzymes as crucial in managing pancreatic patient disease and nutrition, Hughes said.

After more than two decades treating patients, Hughes can attest that the best possible patient care — and best possible outcomes — occur when physicians really listen to what patients say is important. Accordingly, the changes in protocol took patient perspectives into account. He and his team found affordable ways of accessing the medication for patients who cited financial challenges, allowing for increased adherence and better outcomes — like shorter hospitalizations and fewer complications.

“Our job is to see our patients get better,” Hughes said. “We know many centers fail to adequately treat patients with exocrine insufficiencies. Here, we’ve been able to surpass adequate and provide care we are genuinely proud of.”

About UF Health Shands Hospital

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University of Florida Health Shands Hospital has been recognized among the nation’s best hospitals in seven adult medical specialties. Overall, UF Health Shands Hospital was recognized as one of the best hospitals in Florida. In addition to being ranked among the nation’s top 50 hospitals in seven specialties, UF Health Shands Hospital also was listed as “high performing” in seven specialties, including abdominal aortic aneurysm repair, colon cancer surgery, COPD, heart failure, lung cancer surgery, neurology & neurosurgery and orthopaedics.