Image
ADVERTISEMENT
SPONSORED
Significance of Follow-Up and Pancreatic Enzyme Replacement Therapy (PERT) Dose Adjustment
04/08/2024
In this video, Dr Yang explains the strategies for evaluating PERT effectiveness, emphasizing the importance of ongoing patient monitoring.
Transcript:
Welcome, and thank you for watching this video series on the patient experience and clinical insights into PERT, pancreatic enzyme replacement therapy. I'm Dr Allison Yang. I'm a board-certified gastroenterologist specializing in pancreatic diseases. I'm excited to review this important topic, so let's get started.
In this final video of the 3-part series, we will discuss dose adjustments for PERT and the significance of follow-up from healthcare providers after starting treatment.
As many of you may already know, exocrine pancreatic insufficiency, or EPI, is a condition marked by the reduced production, secretion, or activity of pancreatic enzymes. This deficiency results in suboptimal digestion and malabsorption of dietary fat and nutrients. PERT helps EPI patients replace some of the pancreatic enzymes.
EPI is often underdiagnosed and undertreated, so finding the appropriate PERT dose is of paramount importance. PERT evaluation should be an ongoing effort between the patient and the clinician.
When initiating PERT and assessing the patient's experience, it's helpful to take clinical measurements at baseline and during monitoring. Global guidance such as the UK Practical Guidelines for the Management of EPI and the Canadian Consensus Expert Panel recommend regular assessment of weight, micronutrient status, diabetes risk, bone mineral density, in addition to clinical signs and symptoms.
Of note, pancreatic fecal human elastase-1 is a measure of intrinsic pancreas function and is not affected by PERT. Although fecal elastase can be helpful for diagnosing EPI, it should not be used to assess response to treatment.
For evaluating EPI management success in my clinical practice, I look for a reduction in the number of bowel movements with oily stools and stabilization or improvements in weight. You may also consider observing whether there's improvement in other gastrointestinal symptoms and improvements in levels of fat-soluble vitamins.
About 1 to 2 weeks after PERT initiation, you may want to follow-up with patients to discuss symptoms and assess the need for dose adjustment. If signs and symptoms of malabsorption persist, the dose may need to be increased.
Let's move on to some of the challenges and unmet needs associated with PERT.
One of the biggest challenges noted by patients is remembering to take PERT with every meal and every snack. Patients have noted several ways that healthcare providers can help them with treatment adherence, including education on why PERT is needed, clarity on PERT dosage and administration, understanding potential side effects of PERT, and close follow-up for response to treatment.
Undertreatment is common among patients with EPI, so clear and concise guidance on PERT dosage and administration remains imperative. If signs and symptoms of malabsorption persist despite treatment adherence and PERT dose adjustment, assessment for other gastrointestinal disorders may be needed.
In summary, untreated or inadequately treated EPI has significant consequences, so providing an adequate dose of PERT is important.
Non-adherence is an ongoing issue that regular patient–provider touchpoints may help to resolve. In addition to regular follow-up appointments after treatment initiation to assess symptoms and the need for dosage adjustment, healthcare providers should continuously monitor patients for PERT effectiveness.
Thank you for listening. Remember to test your knowledge with the post-test question.
ABBV-US-01480-MC
Approved 04/2024
AbbVie Medical Affairs
Allison Yang, MD, MPH
Dr Allison Yang is the medical director of the Pancreas Program at Weill Cornell Medicine. She is an Assistant Professor of Medicine at Weill Cornell Medical College and Attending Physician at New York Presbyterian Hospital/Weill Cornell Medical Center. She is a clinical gastroenterologist with a focus on the multi-disciplinary care of patients with pancreatic disease.
Dr Yang received her BA from Columbia University in New York, her MD from the University of Illinois, and her MPH from the Harvard School of Public Health. She completed her internal medicine residency training at the Mayo Clinic, and her gastroenterology fellowship at Brigham and Women’s Hospital/Harvard Medical School.
Dr Yang’s primary clinical and research interests are in the effective diagnosis and treatment of pancreatic disease including acute and chronic pancreatitis, recognition and treatment of cystic neoplasms of the pancreas, and management of high-risk pancreas patients.
