Оптимізація корекції ентеропанкреатичного синдрому у комплексній реабілітації пацієнтів з хронічним панкреатитом у поєднанні з цукровим діабетом 2 типу

Abstract

Objective — to investigate the effectiveness of rehabilitation of patients with chronic pancreatitis (CP) with concomitant type 2 diabetes mellitus (DM 2) with the inclusion of a course of drinking mineral waters form field in Skhidnytsya in terms of its’s effects on the parameters of the pancreas functional status and bacteriogram of colon fecal mass.Materials and methods. The analysis has been performed for the treatment results of 51 patients with CP in combination with DM 2, who were subjects to regular medical check-up in Ternopil center of primary medical care and passed the course sanatorium treatment on Skhidnytsya resort (medical and health complex TuStan). The case histories of outpatients and sanatorium and health resort card forms of patients with CP for the years 2015 — 2019 served as a source of information for the clinical-anamnestic analysis. Patients’ age was 25 to 65 years, the mean age 52.86 ± 0.83 years. The mean disease duration was 10.96 ± 0.39 years. Patients were divided into two groups depending on the treatment program: 1st group (n = 26) received the protocol treatment with ademetionine in sublingual tablets (Ahepta) 400 mg twice a day for one month, 2nd group (n = 25) received additional 14-days course of treatment with drinking mineral waters of the Skhidnytsya field in accordance with proposed scheme.Results and discussion. Before the treatment, colon dysbiosis of II stage was revealed in patients. The inclusion of the 14-days course of drinking mineral waters of the Skhidnytsya field in accordance with proposed scheme in the protocol scheme of treatment of patients with CP and DM 2 promoted more significant improvement of the indices of endo- and exocrine pancreatic functions (р < 0.05) vs protocol treatment complex: the level of fecal α-elastase increased by 93.4 and 82.6 %, blood glucose levels decreased by 19.5 and 13.3 %, glycosylated hemoglobin levels decreased (HbA1c) by 12.2 and 9.2 %, coprogram change level by 55.2 and 38.6 %. The colon microflora state restored practically up to normal indices under the influence of the treatment with inclusion of drinking mineral water: the number of lactobacilli has increased up to 107, bifidobacteria — up to 108, E. coli — decreased to 106, hemolytic microorganisms and pathogenic Staphylococcus aureus disappeared.Conclusions. The results gave the proof of efficacy of the inclusion in the protocol scheme of treatment of ademetionine in sublingual tablets 400 mg twice a day for one month and 14-days course of treatment with drinking mineral waters of the Skhidnytsya field in accordance with proposed scheme with significant improvement of the indices of exocrine and endocrine pancreatic functions (р < 0.05).