Relief of symptoms of gastric and intestinal dyspepsia in chronic pancreatitis

Abstract

The authors examined 62 patients with chronic pancreatitis (CP). The diagnosis was confirmed by the typical clinical picture of CP, the phenomenon of “deviation” of enzymes in the blood (monitored by the levels of α-amylase, pancreatic blood isoamylase, and blood lipase), and typical sonographic changes in the pancreas. There were 34 (54.8%) women and 28 (45.2%) men among the patients. Their ages ranged from 27 to 63. The control group had 30 almost healthy people.
 The severity of subjective manifestations (complaints) was assessed before and after treatment by an indicator of moderate severity using a semi-quantitative scale.
 To assess the gastric evacuation rate, a 13C-octane breath test was performed before and after treatment.
 To diagnose the small intestinal bacterial overgrowth syndrome, a hydrogen breath test was performed before and after treatment.
 The patients were divided into two groups. The main group included 32 (51.6%) patients, and the comparison group included 30 (48.4%) patients. Patients of the main group were administered conventional CP treatment (antisecretory drugs, infusion therapy, if necessary, antibiotics, analgesics, and Creon® as an enzyme preparation), as well as domperidone 10 mg 3 times a day 15–20 min before meals, a preparation containing Bacillus clausii spores, one vial 3 times a day between meals (at regular intervals) for 3 weeks. Patients in the comparison group received only conventional treatment.
 The inclusion of domperidone and a preparation containing Bacillus clausii spores in the therapeutic complex for CP patients (provided that Creon® was used as an enzyme preparation in the basic therapy) helps reduce the severity of the clinical manifestations of the disease. The obvious advantages of this therapeutic complex relate to the relief of pain and dyspeptic syndromes, especially the elimination of symptoms of intestinal dyspepsia.
 Under the influence of treatment with domperidone, a drug that contains Bacillus clausii spores, and Creon®, the exocrine pancreatic function is optimized much better than when only conventional therapy is used. This is likely because Creon® is more effective in duodenal decontamination. 
 Domperidone significantly accelerates initially delayed gastric evacuation in patients with CP.
 The addition of a preparation containing Bacillus clausii spores to the conventional treatment effectively eliminates the bacterial overgrowth syndrome in exocrine pancreatic insufficiency.
 The prospects of research are to study the dynamics of the sonographic manifestations of CP under the impact of treatment.