Pancreatic Enzymes Do Not Relieve Chronic Pancreatitis Pain: Gut | September 2026

What Did the Study Find?

Could non-enteric-coated pancreatic enzymes relieve pain even though earlier enzyme studies have been unconvincing? Investigators at two centres randomised 107 adults with chronic pancreatitis and persistent abdominal pain to non-enteric-coated pancreatic enzyme replacement therapy (54 patients) or placebo (53 patients). The treatment comparison was assessed at 12 weeks, with further follow-up at 24 weeks.

On intention-to-treat analysis, enzymes did not improve pain more than placebo. The between-group difference in the Izbicki pain score at 12 weeks was −2.5 points (95% CI −9.3 to 4.2); the later findings were similar. Most participants were young adults, and approximately two-thirds had idiopathic chronic pancreatitis. The trial therefore directly tests a commonly proposed approach in a clinically relevant population, although it cannot settle every question about other formulations or patient subgroups.

Why Does It Matter?

Pancreatic enzymes remain important when pancreatic exocrine insufficiency requires treatment. This result argues against prescribing a non-enteric-coated formulation solely as an analgesic or escalating its dose simply because pain persists. Pain requires its own mechanism-based assessment and management.

GastroAGI takeaway: Treat exocrine insufficiency with enzymes; do not expect enzymes alone to treat chronic pancreatitis pain.