Rational use of pancreatic enzymes in patients with chronic pancreatitis

摘要

We read with interest the study by Lindkvist et al. which concludes that serum magnesium of lower than 2.05 mg/dl is a good predictor of pancreatic exocrine insufficiency (PEI); and that such patient should be considered for pancreatic enzyme replacement therapy (PERT) [1]. Chronic pancreatitis (CP) is a complex disease with significant heterogeneity in pathogenic mechanisms, presentation and response to treatment. Even though PEI is a frequent manifestation of advanced CP, objective documentation is difficult since the currently available diagnostic modalities are either cumbersome, or not available widely. Hence, in general clinical practice PERT is often prescribed based on clinical grounds, which runs the risk of overtreating these patients. Therefore, it is certainly essential to develop surrogate markers of PEI. However, with the currently available data, it appears to be too premature to consider PERT for patients with magnesium level of below 2.05 mg/dl.