Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Effective management of nutritional deficiencies in patients with chronic pancreatitis involves several key steps:
- Pancreatic enzyme replacement therapy (PERT): Initiate PERT (a combination of lipase, amylase, and protease) to address pancreatic exocrine insufficiency, which is common in chronic pancreatitis. PERT should be taken with meals and snacks, and doses adjusted under specialist supervision until symptoms and malabsorption improve.
- Dietitian assessment and nutritional support: Refer patients to a specialist dietitian for tailored advice on diet, supplements, and long-term enzyme therapy. Nutritional status should be regularly monitored, including weight and BMI assessments.
- Fat-soluble vitamin supplementation: Assess for malabsorption of fat-soluble vitamins (A, D, E, K) and provide supplementation as needed to correct deficiencies.
- Regular monitoring: Conduct clinical and biochemical assessments for pancreatic exocrine insufficiency and malnutrition at least annually, adjusting treatment accordingly.
- Screening for diabetes and osteoporosis: Screen for type 3c diabetes every 6 months and offer bone density assessments every 2 years to manage related complications that can affect nutritional status.
- Address risk factors: Support cessation of alcohol and smoking, as these can worsen pancreatic function and nutritional status.
These interventions aim to improve nutrient absorption, maintain weight, and prevent complications related to malnutrition in chronic pancreatitis patients.
References: NICE CKS,NICE NG104,NICE CG100