Efficiency of Shidnitsa mineral waters in complex rehabilitation of patients with chronic pancreatitis with concomitant diabetes mellitus

Abstract

Relevance. Rehabilitation of patients with chronic pancreatitis (CP) combined with diabetes mellitus (DM) requires a complex systemic and personified approach, since such comorbidity is characterized by complicated interactions of these nosology items, with more lesions of pancreas as the main organ involved in the formation and depth pathological manifestations of each patient, as well as the involvement of adjacent organs of the gastrointestinal tract, other organs and systems. Process of integrated rehabilitation, which purpose is to maximally restore the lost functions of the above organs, especially the pancreas, should include, in addition to standard protocol approaches, the adjuvant effective techniques that showed their practical effectiveness but require research and scientific substantiation. Such techniques include the use of therapeutic mineral water (MW) both in resorts and in outpatient practice according to the place of residence of patients.
 The aim of the study is to investigate the effectiveness of rehabilitation of patients with CP and concomitant DM with the use of the drug ademetionin in the sublingual form (Agepta) and the course of treatment with drinking MW of the Shidnitsa deposit.
 Material and methods of research. 77 patients with CP and concomitant DM were examined. According to treatment programs, patients were divided into 3 groups: Group 1 (protocol treatment (PT) — 26 patients) — received enzyme preparation of pure pancreatin, proton pump inhibitor (pantoprazole 40 mg), anesthetics (mebeverin) and/or prokinetic (motilium), metformin 1000 mg twice a day); Group 2 (PT + ademetionin — 26 patients) — in addition to PT received a drug ademetionin (sublingual tablets Agepta 400 mg) 1 tablet 2 times per day 30–60 min before eating, holding under tongue at least 15–20 min — until complete dissolution, 1 month course; Group 3 — in addition to PT and Agepta in the above-mentioned scheme, they took the course of treatment by drinking MW of the Shidnitsa deposit according to the proposed scheme.
 Results. Positive dynamics in all groups of comparison was revealed, but its intensity differed in those groups. Improvement of exocrine and endocrine pancreatic function was found: level of fecal α-elastase increased by 58.5% in Group 1, by 82.6% in Group 2, by 93.4% in Group 3; level of blood glucose decreased by 9.2% in Group 1, by 13.3% in Group 2, by 19.5% in Group 3; level of HbA1c — by 4.9% in Group 1, by 9.2% in Group 2, by 12.2% in Group 3; changes in the coprogram — by 24.5% in Group 1, by 38.6% in Group 2, by 55.2% in Group 3.
 Discussion. There was a statistically significant improvement in the results of Group 2 as compared to Group 1 (p<0.05), which indicates the effectiveness of use of ademetionin (Agepta sublingual tablets) in a comprehensive correction program for patients with CP and DM. However, the most evident dynamics of indicators of exocrine and endocrine pancreatic function was found in Group 3 as compared to Groups 2 and 1, respectively, indicating the expediency of the additional appointment of the therapeutic course of drinking MW of the Shidnitsa deposit according to the proposed scheme.
 Conclusion. The effectiveness of inclusion of ademetionin in complex standard protocol program of treatment of patients with CP with concomitant DM in sublingual tablets (Agepta) with 400 mg twice a day during 1 month and 14-day course of treatment with drinking MW of the Shidnitsa deposit according to the proposed scheme was proved by statistically significant improvement of the indices of exocrine and endocrine pancreatic function (p<0.05).