The edition · Gastroenterology & Hepatology
Non-enteric-coated pancreatic enzymes did not relieve pain in chronic pancreatitis
A double-blind trial of non-enteric-coated enzyme therapy found no pain benefit over placebo at 12 or 24 weeks. Also: a 30% fall in liver stiffness is only a modest marker of fibrosis regression in MASH, rebamipide as gastroprotection on DOACs, and a generic omeprazole supplement.
The edition in brief
A 24-week double-blind trial randomised 107 adults with painful chronic pancreatitis to non-enteric-coated pancreatic enzyme replacement or placebo for 12 weeks; Izbicki pain scores did not differ (difference −2.5, 95% CI −9.3 to 4.2), and results were similar at 24 weeks. In 160 adults with biopsy-proven MASH and F2–F3 fibrosis from a pegozafermin trial, a 30% or greater fall in transient elastography liver stiffness detected fibrosis regression with an AUC of 0.68 (0.62 in a validation cohort), though it was independently associated with regression (adjusted OR 4.23). The open-label REGATA trial of 210 patients with AF on DOACs found rebamipide alone or with pantoprazole was non-inferior to pantoprazole for a composite of GI bleeding, mucosal injury and severe dyspepsia in a per-protocol analysis of 118, and lowered faecal calprotectin and zonulin. The FDA recorded a supplement to Dr Reddy's generic omeprazole application, an administrative action.
A 30% fall in liver stiffness is only a modest marker of fibrosis regression in MASH
Use a 30% fall in liver stiffness as one sign of MASH treatment response, alongside other markers, not as a stand-alone test.
FDA records a supplement to Dr Reddy's generic omeprazole application
Treat this as an administrative change to a generic omeprazole; use it as a prompt to review long-term PPI indications.
Rebamipide was non-inferior to pantoprazole for gastroprotection on DOACs in a small open-label trial
Continue PPIs for gastroprotection in high-risk anticoagulated patients; rebamipide is a possible alternative on weak evidence.
In chronic pancreatitis pain, look for the treatable structural cause first
In painful chronic pancreatitis, look for obstructive causes and stop alcohol and smoking before escalating drugs.
Non-enteric-coated pancreatic enzymes did not reduce chronic pancreatitis pain
Stop using non-enteric-coated pancreatic enzymes as a pain treatment in chronic pancreatitis; they did not beat placebo.
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