Chronic pancreatitis is an acid dependent disease. Which mark to put at the end of the sentence: interrogative, exclamation, dot or ellipsis?

Abstract

Chronic pancreatitis (CP) is one of the most widespread gastroenterological diseases, the pathogenic mechanisms of which are still under investigation. The authors gave a short overview of the main stages in the research of the relationships between gastric and pancreatic secretion, and the results of physiological studies, performed by I. P. Pavlov and his students. Being а strict follower of «nervousness» theory, the great physiologist and his associates made the incorrect conclusions about the presence of local nerve connections (peripheral reflex arc) between the duodenum and pancreas, not suggesting the presence of humoral interactions. The modern data have been presented that give the evidence that duodenal acidification results in the secondary deficiency of endogenous pancreatic enzymes, increased stimulation of pancreatic secretion, exacerbated symptoms of exocrine pancreatic insufficiency, increased secretory tension in pancreatic tissue, duct and tissue pressure, and increased risk of CP attack.However, a dot at the end of a statement «CP is an acid-dependent disease» is tentative. The proton pump inhibitors (PPIs) are used throughout for the treatment of acid-dependent diseases. However, neither European, nor Russian recommendations do include PPIs as a basic treatment for CP. The results of a prospective randomized controlled trial, which proved the effectiveness of CP treatment with the use of combination of analgesics and PPIs have been considered. However, the results of the only study are not enough to recommend the inclusion of PPI in the basic CP therapy. The analysis has been performed for the provisions of the European Guidelines for the Diagnosis and Treatment of Pancreatitis. These guidelines describe situations when PPIs should be included in the complex CP treatment. The data of evidence-based medicine have been presented, illustrating that suppression of gastric secretion can increase the effectiveness of enzyme preparations in comparison with the administration of pancreatin monotherapy. The advantages of pantoprazole among other of the PPIs’ representatives have been analyzed. A clinical case of CP treatment with a reasonable pantoprazole (Nolpaza) administration have been considered.