The use of high-dose digestive enzymes is associated with a reduced incidence of nonalcoholic fatty liver disease (NAFLD) following  pancreaticoduodenectomy compared with normal-dose enzyme replacement, a trial shows.

Between 8% and 37% of patients develop NAFLD after the surgery, also known as a Whipple procedure. Patients commonly receive a digestive-enzyme preparation after Whipple, to compensate for the reduction in exocrine pancreatic capacity, the Japanese authors said.

The team investigated whether high-dose digestive-enzyme treatment versus a normal dose of digestive enzymes could prevent NAFLD after Whipple procedure in their study of 80 patients in the randomised, but unblinded trial.

One year after the procedure, NAFLD had occurred in 19.5% (8/41) of patients in the high-dose treatment group and 64% (25/39) of patients in the normal dose group, the researchers reported in the Journal of the American College of Surgeons.