Current Status of Pancreatic Exocrine Insufficiency Diagnosis and Pancreatic Enzyme Replacement Therapy Implementation in Patients With Chronic Pancreatitis

ABSTRACT Aims The prevalence of chronic pancreatitis (CP) is increasing in Japan. This study aimed to elucidate the current status of pancreatic exocrine insufficiency (PEI) diagnosis and the prescription of pancreatic enzyme replacement therapy (PERT) in Japanese patients with CP. Methods We conducted a retrospective observational study using a large‐scale claims database in Japan with a data collection period between April 2008 and August 2022. Patients with CP were categorized into PERT and no‐PERT cohorts based on the presence or absence of PERT prescriptions. Results We found an increase in the number of CP diagnoses, PERT prescriptions, and PEI diagnoses over the past decade. The median PERT persistence time was 254.0 days (95% confidence interval: 219.0–288.0), and the 5‐year persistence rate was 20.4%. Patients in the PERT cohort ( n = 3056) were younger (61.9 vs. 65.4 years), had a higher mean Charlson Comorbidity Index (1.7 vs. 1.3), and were more likely to be underweight (body mass index < 18.5 kg/m 2 , 13.7% vs. 6.0%) than those in the no‐PERT cohort ( n = 32 861). Patients in the PERT cohort had higher rates of in‐hospital deaths (6.3% vs. 4.7%), weight loss (13.3% vs. 9.2%), pancreatic diabetes (1.7% vs. 0.7%), and pancreatic cancer (1.7% vs. 0.7%) than those in the no‐PERT cohort. Conclusion The number of PEI diagnoses and PERT prescriptions for patients with CP has increased in Japan over the past decade. The low PERT persistence rate suggests the need for further research to understand the factors that affect treatment persistence in CP management.