2.3　Pancreatic Enzyme and the Negative Feedback Th...

It is believed that ductal and intereitial hypertension caused by pancreatitic secretion can further increase pancreatic ductal pressure，thus likely leading to pain（Hobbs et al.2016）.But there is no definitive evidence that pancreatic enzyme replacement therapy（PERT）provide general pain relief in CP.Meta-analysis of six doubleblinded RCTs from 1983 to 1995 involving 186 patients demonstrated no prominent benefit of PERT in relieving pain caused by CP（Talukdar and Reddy 2013）.Jan et al.（D'Haese et al.2014）evaluated 294 patients with PERT only to find although less patients reported pain recurrence over the 1-year observation period，with confounding effect of other pain-relieving medications，it remained unclear about the effect.Recently，a meta-analysis consisting of five studies conveyed a negative result（Yaghoobi et al.2016）.Of the five studies，only the oldest study using non-enteric-coated enzymes showed improvement in pain score while the other four studies with enteric-coated ones showing opposite results.However，no subgroup data was reported as half of the patients had undergone surgery and it may also have something to do with the use of non-enteric-coated enzyme supplementation which corresponded to the negative feedback theory.However，for initial medical management，oral pancreatic enzyme supplements in adequate dose and with rapid release have been shown to provide some pain relief（Anderson et al.2016）.(https://www.daowen.com)