Efficiency of pancreatic enzyme replacement in treatment of patients with moderate-to-severe malnutrition

Mis D.M, Efficiency Of Pancreatic Enzyme Replacement in Treatment Of Patients With Moderate-To-Severe Malnutrition, Van Yüzüncü Yıl University, Faculty of Medicine, Department of Pediatrics, Thesis, Van, 2019. Purpose: In this study, we aim at investigating the possible efficiency of pancreatic enzyme replacement traetment (PERT) along with proper nutrition regimen on weight gain in patients diagnosed with moderate-to-severe malnutrition according to the classification made by World Health Organization (WHO). Material and Method: 45 children (22 female, 23 male) aged between 3 months and 17 years who applied as outpatient to Yüzüncü Yıl University Pediatric Health and Diseases Department's Pediatric Gastroenterology and General Pediatric clinics between November 1st 2018 and February 1st 2019, and diagnosed with moderate-to-severe malnutrition were included in our study. Demographic properties, antropometric measurements and laboratuary data of patients were analyzed. In addition to proper nutrition regimens in accordance with their age and body weight, the first group was given only hypercaloric food whereas the second group was given PERT of 2000 U lipase/kg/day dosage as well as hypercaloric food. In first-month and second-month examinations of patients, antropometric measurements were performed, and by studying fecal elastase, desnutrin and ghrelin levels, it was evaluated whether PERT affects weight gain and other laboratuary values. Findings: Out of 45 patients, 22 (48.8%) were female and 23 (51.2%) were male. None of our patients had any additional disease. All of the patients had pancreatic insufficiency. When comparing values of two patient groups after first-month and second-month examinations; it was observed that the group who received PERT had more weight gain, however there was no statistically significant difference between two groups in that sense. There was also no meaningful difference between two groups in terms of fecal elastase, desnutrin and ghrelin levels. Conclusion: Today, where malnutrition is still among serious public health problems, developing new treatment methods keeps its importance. While PERT is a considerable choice, literature in that field is still limited. To our knowledge, our study is the one with the most number of patients and the longest treatment duration of PERT. In this study, where we investigated clinical and biochemical effects of PERT in malnourished patients; it was observed that while the PERT group had better weight gain, this treatment neither made any meaningful change for weight gain nor resulted in different biochemical indicators compared to regular nutrition support.