Therapeutic Management of Exocrine Pancreatic Insufficiency in Patients with Cystic Fibrosis: An Integrative Review

Authors

DOI:

https://doi.org/10.11606/issn.1679-9836.v104i6e-234037

Keywords:

Pancreas, lung, cystic fibrosis, treatment

Abstract

The study analyzed evidence on therapy for exocrine pancreatic insufficiency in patients with cystic fibrosis, based on a search conducted in the PubMed and Virtual Health Library (Biblioteca Virtual de Saúde) databases. Studies published between 2019 and 2024 were included, resulting in a final selection of 48 articles, 24 of which focused on therapeutic interventions. The management of pancreatic insufficiency relies on three pillars: pancreatic enzyme replacement therapy (PERT), nutritional support, and continuous monitoring. PERT is essential for correcting malabsorption, utilizing enzymes derived from pigs, but it faces challenges such as patient adherence and variability in treatment response. The need to take multiple capsules and errors in administration are obstacles that require ongoing follow-up. Nutritional support is crucial, involving high-calorie diets and supplementation with fat-soluble vitamins. Despite the importance of nutrition, patient adherence to interventions remains low. CFTR modulators, such as ivacaftor, have emerged as innovative alternatives, but treatment discontinuation reverses the benefits, highlighting the need for further research. The article underscores the importance of integrated and personalized strategies for managing pancreatic insufficiency in cystic fibrosis.

Downloads

Download data is not yet available.

References

Hörning A, Urbonas V, Scheers I. Congenital etiologies of exocrine pancreatic insufficiency. Front Pediat. 2022. Doi:10.3389/fped.2022.909925

Drzymała-Czyż S, Krzyżanowska-Jankowska P, Dziedzic K, Lisowska A, Kurek S, Goździk-Spychalska J, et al. Severe Genotype, Pancreatic Insufficiency and Low Dose of Pancreatic Enzymes Associate with Abnormal Serum Sterol Profile in Cystic Fibrosis. Biomolecules. 2021;11(2):313. Doi: 10.3390/biom11020313

Shrivastava S, Shaw K, Lee M, Reitich P, Hunter S, Klosterman M, et al. Association of in-line digestive enzyme cartridge with enteral feeds on improvement in anthropometrics among pediatric patients with cystic fibrosis. Nutr Clin Pract. 2024;39(4):903-10. Doi: 10.1002/ncp.11142.

Cohen-Cymberknoh M, Atia O, Gileles-Hillel A, Kerem E, Reiter J. Sleep disorders in patients with primary ciliary dyskinesia, cystic fibrosis with and without pancreatic insufficiency. Respir Med. 2019;151:96-101. Doi:10.1016/j.rmed.2019.03.022

Shteinberg M, Lulu AB, Downey DG, Blumenfeld Z, Rousset-Jablonski C, Perceval M, et al. Failure to conceive in women with CF is associated with pancreatic insufficiency and advancing age. J Cyst Fibros. 2019;18(4):525-9. Doi: 10.1016/j.jcf.2018.10.009

Gonzales ACS, Vieira SMG, Maurer RL, E Silva FAA, Silveira TR. Utilidade da concentração da elastase-1 fecal monoclonal na avaliação da função pancreática nos pacientes com fibrose cística. J Pediatr (Rio J). 2011;87(2):157-62. Doi:10.2223/JPED.2075

Yılmaz K, Hattapoğlu S, Şen V, Karabel M, Kan A, Yılmaz ED, et al. Evaluation of children and adolescent with cystic fibrosis by pancreatic elastography. Pediatr Int. 2022;64(1):e14951. Doi: 10.1111/ped.14951.

Sellers ZM. Pancreatic complications in children with cystic fibrosis. Curr Opin Pediatr. 2020;32(5):661-7. Doi:10.1097/MOP.0000000000000934

Boon M, Calvo-Lerma J, Claes I, Havermans T, Asseiceira I, Bulfamante A, et al. Use of a mobile application for self-management of pancreatic enzyme replacement therapy is associated with improved gastro-intestinal related quality of life in children with Cystic Fibrosis. J Cyst Fibros. 2020;19(4):562-8. Doi: 10.1016/j.jcf.2020.04.001.

Bass R, Brownell JN, Stallings VA. The impact of highly effective cftr modulators on growth and nutrition status. Nutrients. 2021;13(9). Doi:10.3390/nu13092907

Garcete Mañotti L, Cázares Mendez JM, Ortiz Paranza L, Rodriguez González L, Wagener M. Enzyme replacement treatment in exocrine pancreatic insufficiency associated with cystic fibrosis. Anal Facult Cienc Med. (Asunción). 2022;55(3):76-85. Doi:10.18004/anales/2022.055.03.76

Barto TL, Morency CF, Schaap N, Patel AB, Monticello DJ. Intestinal Absorption of Lipids Using a Pancreatic Enzyme‐Free Nutritional Supplement in Patients with Cystic Fibrosis: A Randomized, Double‐Blind, Crossover Pilot Trial. Nutrients. 2022;14(3). Doi:10.3390/nu14030680

Freswick PN, Reid EK, Mascarenhas MR. Pancreatic Enzyme Replacement Therapy in Cystic Fibrosis. Nutrients. 2022;14(7). Doi:10.3390/nu14071341

Ng C, Major G, Smyth AR. Timing of pancreatic enzyme replacement therapy (PERT) in cystic fibrosis. Cochrane Database of Systematic Reviews. 2021;2021(8). Doi:10.1002/14651858.CD013488.pub2

Konrad J, Eber E, Stadlbauer V. Changing paradigms in the treatment of gastrointestinal complications of cystic fibrosis in the era of cystic fibrosis transmembrane conductance regulator modulators. Paediatr Respir Rev. 2022;42:9-16. Doi:10.1016/j.prrv.2020.12.001

Olsen MF, Kjøller-Svarre MS, Møller G, Katzenstein TL, Nielsen BU, Pressler T, et al. Correlates of Pancreatic Enzyme Replacement Therapy Intake in Adults with Cystic Fibrosis: Results of a Cross-Sectional Study. Nutrients. 2022;14(7):1330. Doi: 10.3390/nu14071330.

Raspini MH, Alasio CE, Blasi S. Evaluación de la técnica de conteo de grasas y ajuste de enzimas pancreáticas en un grupo de pacientes con insuficiencia pancreática secundaria a fibrosis quística con seguimiento en un hospital de alta complejidad. Med infant. 2022;29:17-22.

Ramsey ML, Hart PA, Forsmark CE. Evaluation and management of exocrine pancreatic insufficiency: Pearls and pitfalls. Curr Opin Gastroenterol. 2023;39(5):428-35. Doi:10.1097/MOG.0000000000000951

Lewis GF. Fatty acid malabsorption followed by chylomicron malformation, not pancreatic insufficiency, cause metabolic defects in cystic fibrosis. J Lipid Res. 2024;65(5):1-2. Doi:10.1016/j.jlr.2024.100549

Costa JCB, Souza EL. Comparação de custos da terapia de reposição enzimática empírica com terapia guiada por diagnóstico laboratorial da insuficiência pancreática. Revista de Ciências Médicas e Biológicas. 2021;20(3):387-93. Doi:10.9771/cmbio.v20i3.47079

Nowak JK, Sobkowiak P, Drzymała-Czyż S, Krzyżanowska-Jankowska P, Sapiejka E, Skorupa W, et al. Fat-Soluble Vitamin Supplementation Using Liposomes, Cyclodextrins, or Medium-Chain Triglycerides in Cystic Fibrosis: A Rand Control Trial. Nut. 2021;13(12):4554. Doi: 10.3390/nu13124554.

Hommel KA, Rausch J, Towner EK, et al. Adherence to nutritional supplementation in cystic fibrosis. J Pediatr Nurs. 2019;47:18-22. doi:10.1016/j.pedn.2019.04.011

Marpole R, Wilson AC. Benefits of reviewing pancreatic function in children with cystic fibrosis. Pediatr Pulmonol. 2022;57(6):1537-9. Doi:10.1002/ppul.25884

Munce D, Lim M, Akong K. Persistent recovery of pancreatic function in patients with cystic fibrosis after ivacaftor. Pediatr Pulmonol. 2020;55(12):3381-3. Doi:10.1002/ppul.25065

Coffey MJ, Ooi CY. Paediatric pancreatic diseases. J Paediatr Child Health. 2020;56(11):1694-701. Doi:10.1111/jpc.14688

Published

2025-11-18

Issue

Section

Artigos de Revisão/Review Articles

How to Cite

Heidemann, H. M., Rodrigues, Y. G., Carvalho, L. C. de, & Weirich, B. E. (2025). Therapeutic Management of Exocrine Pancreatic Insufficiency in Patients with Cystic Fibrosis: An Integrative Review. Revista De Medicina, 104(6), e-234037. https://doi.org/10.11606/issn.1679-9836.v104i6e-234037