Optimization of the complex treatment of chronic pancreatitis in elderly patients using systemic enzyme therapy

Abstract

In the last few years, the number of young people with pancreatic pathology has increased.  However, exacerbation of chronic pancreatitis (CP) in “favorable conditions” occurs at any age, leading to extremely unfavorable consequences.
 The aim is to study clinical and etiological factors of CP in elderly patients and optimize the complex treatment of this category of patients by including a systemic enzyme therapy agent.
 Materials and methods. The study included 98 CP patients, with a mean age of 71.3±1.4 years, who were randomized into two groups. All patients received the standard conventional treatment complex (CTC): pantoprazole 40 mg on an empty stomach on demand; prolonged enzyme replacement therapy with pure pancreatin at an adequate dose with each meal; prokinetics and/or antispasmodics as needed for 6 weeks. The study group was randomized into two groups: group I (CTC) — 20 patients got only CTC; group II (CTC+W) — 78 patients received Wobenzym in addition to CTC, 5 tablets three times per day.
 Results and discussion. It has been proven that CP in elderly patients occurs against the background of mixed etiopathogenetic factors: ischemic (87.7%), gastroduodenal (84.7%), and dyslipid (70.4%). Clinically, asthenic and dyspeptic syndromes predominate (92.8% and 77.5%, respectively). According to the anthropometric examination, body weight deficiency is observed in 64.3% of the examined, with endocrine pancreatic insufficiency in 29.6% in terms of fasting glucose and exocrine pancreatic insufficiency in 70.4% in terms of FαE. The use of CTC contributed to the reduction of dyspeptic and painful abdominal syndromes (p˂0.05), a decrease in body weight deficit by 4.3% in terms of body mass index, and a tendency to normalize pancreatic function.
 Conclusions. The addition of CTC with Wobenzym resulted in a decrease in the clinical manifestations of the disease (p<0.03–p<0.05), an improvement in carbohydrate imbalance in terms of postprandial glycemia (p<0.05), and a trend towards a decrease in the level of glycated hemoglobin by an average of 0.2%. The administration of Wobenzym in the complex treatment of CP in elderly patients contributed to an increase in the level of FαE by 42.6% compared to this index before treatment (p<0.001) and a decrease in nutrient deficiency due to the elevated body mass index of this category of patients by 7.0%.