Features of the clinical course of chronic pancreatitis in patients with chronic obstructive pulmonary disease

Abstract

Aim. The purpose of the study is to determine the intensity of the manifestation of clinical syndromes in the comorbid course of chronic pancreatitis (CP) in patients with chronic obstructive pulmonary disease (COPD) in comparison with the isolated course of CP and to assess the intensity of the mutual burden syndrome. Material and methods. A prospective cohort study was conducted, analyzing the medical records of 212 inpatients. The first group comprised 96 individuals with an isolated course of chronic pancreatitis (CP), while the second group included 116 patients with CP and comorbid chronic obstructive pulmonary disease (COPD), categorized as Group E. The study focused on subjective manifestations of pain syndrome in CP, the extent of exocrine pancreatic insufficiency, clinical blood analysis, biochemical research regarding the content of markers indicating pancreatic enzyme deviation in the blood, and the level of elastase-1 in feces. Additionally, ultrasonographic examination of the organs in the abdominal cavity was performed. Results. Patients in group 2 exhibited manifestations of abdominal pain syndrome 1.2 times more frequently than those in group 1 (p < 0.05). The frequency of pain in the pancreas radiating to the right subcostal region was 1.9 times higher in group 2 compared to group 1 (p < 0.05), along with a 2.1 times increase in the symptom of girdled pain radiating to the back (p < 0.05). Although the frequency of dyspeptic syndrome was slightly higher in group 2 (1.3 times, p > 0.05), astheno-vegetative syndrome was significantly more pronounced, exceeding the frequency in group 1 by 1.7 times (p < 0.05). Ultrasonography parameters of the pancreas in both groups revealed characteristic signs of chronic pancreatitis (CP). The analysis of pancreatic functional state indicators during exacerbation indicated hyperenzymemia syndrome, with α-amylase activity significantly higher in patients of both groups compared to the control group – by 1.8 and 2.6 times, respectively (p < 0.05). Conclusions. CP with chronic obstructive pulmonary disease (COPD) is characterized by a significantly lower frequency of paroxysmal abdominal pain syndrome but a higher frequency of constant aching pain in the pancreas area. Additionally, it is associated with the maximum intensity of inflammation, hyperfermentemia, a decrease in the activity of elastase-1 in feces, and a higher intensity of astheno-vegetative, painful, dyspepsia, intoxication syndromes. Moreover, there is a more pronounced exocrine dysfunction of the pancreas and more significant changes in the sonographic structure of the pancreas compared to cases with the isolated course of CP.