Comorbidity of chronic pancreatitis and metabolic syndrome: mechanisms of development

Abstract

In this article, the authors analyze a number of known and probable mechanisms involved in the formation of metabolic disorders upon chronic pancreatitis in comorbidity with metabolic syndrome. The issue of involvement of pancreatic endocrine apparatus in development of insulin resistance upon chronic pancreatitis, namely, the role of such a hormone as insulin, is highlighted. The role of this hormone in development of disorders of fat metabolism, obesity and arterial hypertension is presented. The authors emphasize the role of adrenal hormones, estrogen in the pathogenesis of both diseases. The issue of effect of endocrine function disorders on the state of external pancreatic secretion with subsequent development of disorders in the microbiota composition is considered (which also contributes to the progression of both diseases).
 The data on presence of a possible relationship between the composition, functional activity of the intestinal microbiota and development of metabolic syndrome, chronic pancreatitis are given. The significance of intestinal microbiota in the maintenance of various vital processes of a healthy person, food digestion, as well as synthesis, metabolism, recycling, utilization of various biologically active substances (vitamins, hormones, steroids, immunoglobulins) and elimination of toxins is revealed. The role of microorganisms in the formation of feeding behavior via axis “intestinal microbiome — intestine — brain” is analyzed. Modern ideas on the ability of microorganisms to provoke formation of metabolic disorders upon chronic pancreatitis are presented. The data confirming connection of certain dysbiotic changes (increased ratio of Firmicutes/Bacteroidetes, reduced number of Bacteroidetes and increased number of Firmicutes) with development of obesity, overweight, type 2 diabetes mellitus (known risk factors of metabolic syndrome) is given. It is suggested to prevent formation of metabolic syndrome in chronic pancreatitis by increasing the number of specimens of Bifidobacterium genus and Faecalibacteriumprausnitzii strains in the intestine.