Treatment Of Chronic Pancreatitis Research Articles

Interventional radiological and endoscopic technologies in diagnosis and treatment of chronic pancreatitis

This review is devoted to internationally accepted diagnostic algorithms for complicated chronic pancreatitis (CP). In addition, the authors discuss interventional radiological and endoscopic diagnostic and therapeutic procedures, as well as their role in surgical approaches for this disease. Chronic pancreatitis is often diagnosed with severe symptoms following severe course of disease and complications. Imaging techniques, such as ultrasound, endoscopic ultrasound, CT, MRI/MR cholangiocreatography (MRCP), secretin-stimulated MRCP, are valuable to assess the pancreas in patients with initial manifestations of CP. Modern treatment of complicated CP includes transpapillary or transmural drainage of false cysts, shock wave lithotripsy and stenting for pancreatic duct strictures and/or stones, stenting for biliary hypertension, endovascular interventions for vascular complications and radical surgical treatment. Endoscopic methods are preferable regarding better short-term quality of life. Early surgical intervention (within 3 years after clinical manifestation) is effective to eliminate or significantly reduce pain and pancreatic insufficiency. Multidisciplinary team including surgeons, endoscopists and interventional radiologists should determine the most optimal diagnostic and treatment approach individually for each patient.

EVALUATING LACTOFERRIN AND CALPROTECTIN AS MARKERS OF INTESTINAL INFLAMMATION INCHRONIC PANCREATITIS.

The treatment of chronic pancreatitis does not consistently solve intestinal abnormalities, and despite the implementation of various therapeutic measures, patients often continue to experience persistent diarrhea. Therefore, it is imperative to recognize that diarrhea may stem from factors beyond pancreatic insufficiency, and intestinal inflammation emerges as a potential contributing factor. The aim of this study was to assess fecal lactoferrin and calprotectin levels as indicators of intestinal inflammation in patients with chronic pancreatitis experiencing persistent diarrhea. In this study, 23 male patients with chronic pancreatitis primarily attributed to alcohol consumption and presenting with diarrhea (classified as Bristol stool scale type 6 or 7), underwent a comprehensive evaluation of their clinical and nutritional status. Fecal lactoferrin and calprotectin levels were mea-sured utilizing immunoassay techniques. The average age of the participants was 54.8 years, 43.5% had diabetes, and 73.9% were smokers. Despite receiving enzyme replacement therapy and refraining from alcohol for over 4 years, all participants exhibited persistent diarrhea, accompanied by elevated calprotectin and lactoferrin levels indicative of ongoing intestinal inflammation. The findings of this study underscore that intestinal inflammation, as evidenced by elevated fecal biomarkers calprotectin and lactoferrin, may contribute to explaining the persistence of diarrhea in patients with chronic pancreatitis. • Exploration of intestinal inflammation in chronic pancreatitis patients with altered bowel habits. • Assessment of 23 patients using lactoferrin and calprotectin as intestinal inflammation biomarkers. • Intestinal inflammation was detected in all patients; positive correlation between both biomarkers. • Established connection between altered bowel habits and intestinal inflammation in chronic pancreatitis.

Nationwide Outcome of Tailored Surgery for Symptomatic Chronic Pancreatitis based on Pancreatic Morphology

Objective: To determine the nationwide use and outcome of tailored surgical treatment for symptomatic chronic pancreatitis (CP) as advised by recent guidelines. Summary background data: Randomized trials have shown that surgery is superior to endoscopy in patients with symptomatic CP, although endoscopy remains popular Recent guidelines advice to “tailor surgery” based on pancreatic morphology meaning that the least extensive procedure should be selected based on pancreatic morphology. However, nationwide, and multicenter studies On tailored surgery for symptomatic CP are lacking. Methods: Nationwide multicenter retrospective analysis of consecutive patients undergoing surgical treatment for symptomatic CP in all seven Dutch university medical centers (2010-2020). Outcomes included volume trend, major complications, 90-day mortality, postoperative opioid use and clinically relevant pain relief. Surgical treatment was tailored based on the size of the main pancreatic duct and pancreatic head (e.g. surgical drainage for a dilated pancreatic duct, and normal size pancreatic head). Results: Overall, 381 patients underwent surgery for CP: 127 surgical drainage procedures ( 33%; mostly extended lateral pancreaticojejunostomy), 129 duodenum-preserving pancreatic head resections (DPPHR, 34%, mostly Frey), and 125 formal pancreatic resections (33%, mostly distal pancreatectomy). The annual surgical volume increased slightly (Pearson r=0.744). Mortality (90-day) occurred in 6 patients (2%), and was non-significantly lower after surgical drainage (0%, 3%, 2%; P=0.139). Major complications (12%, 24%, 26%; P=0.012), postoperative pancreatic fistula grade B/C (0%, 3%, 22%; P=0.038), surgical reintervention (4%, 16%, 12%; P=0.006), and endocrine insufficiency ( 14%, 21%, 43%; P<0.001) occurred less often after surgical drainage. After a median follow-up of 11 months [IQR 3-23] good rates of clinically relevant pain relief ( 83%, 69%, 80%; P=0.082) were observed and 81% of opioid users had stopped using (83%, 78%, 84%, P=0.496). Conclusion: The use of surgery for symptomatic CP increased over the study period. Drainage procedures were associated with the best safety profile and excellent functional outcome, highlighting the importance of tailoring surgery based on pancreatic morphology.

Daily Pain Experiences in Chronic Pancreatitis: Identifying Pain Phenotypes.

Pain, the hallmark symptom of chronic pancreatitis (CP), remains difficult to assess. To capture the variability of pain that patients can experience day to day, this study used pain diaries to describe daily pain experiences and identify pain phenotypes. This study is a secondary data analysis from a pilot trial examining cognitive behavioral therapy for pain treatment in CP. Before treatment, patients completed an online daily pain diary using the Brief Pain Inventory for 7 days. Using indicators of pain magnitude, pain variability, pain synchrony along with least, worst, and average pain intensity levels, we identified pain patterns using K-means clustering. Of 30 patients in the pilot trial, a total of 27 patients (mean age of 49.8 years, 80% women) had complete data to include in this report. Four clusters were identified: cluster 1, lowest pain magnitude (n = 3); cluster 2, moderate pain magnitude and high pain variability (n = 4); cluster 3, moderate pain magnitude and low pain variability (n = 9); and cluster 4, highest pain magnitude and lowest pain variability (n = 11). Daily pain diaries offer a novel way of evaluating the dynamic pain experiences in CP. Although 4 distinct pain patterns were identified, further studies are needed to validate these findings.

Assessment of the efficacy of the combination of α-lipoic acid preparation and synbiotics in the protocol therapy of hypothyroidism combined with chronic pancreatitis

Hypothyroidism (Ht) is a common clinical condition with variable prevalence. This disease is often associated with chronic pancreatitis (CP). Consensus exists regarding the necessity to treat patients with Ht in comorbidity with CP to reduce the risk of complications and the frequency of exacerbations, to reduce the activity of the progression of the pathological process, and to improve the quality of life.
 Objective — to evaluate the effects of additional use of thioctic acid and synbiotics combination in the conventional treatment on the indicators of the functional state of thyroid gland (THG) and pancreas in patients with Ht in comorbidity with CP.
 Materials and methods. Investigation involved 107 patients with a comorbid course of Ht and CP, who were divided into 3 groups according to the complex treatment programs: the first group consisted of 32 subjects, who received protocol treatment (PT) of Ht and CP, the second included 36 patients (PT + α‑lipoic acid preparation (Dialipon Turbo), the third — 39 patients (PT + α‑lipoic acid preparation + synbiotic (Lactimak Forte). The groups were comparable by age and gender. The functional state of the pancreas was assessed using the level of fecal α‑elastase (enzyme immunoassay), pancreatic α‑amylase (immunochemical method), and the coprogram index in points. Thyroid function was assessed by the levels of thyrotropic hormone TSH, free triiodothyronine T3 and free thyroxine T4 (chemiluminescent immunoassay). The obtained data were processed with statistical methods.
 Results. The positive dynamics was established in all groups, but the degree of its expression differed. Thus, the level of fecal α‑elastase increased by 57.54% — in the 1st group, by 78.27% — in the 2nd group, by 89.94% — in the 3rd group; pancreatic α‑amylase decreased by 29.68% — in the 1st group, by 39.19% — in the 2nd group, by 42.44% — in the 3rd group; the total coprogram index decreased by 25.11% — in the 1st group, by 47.57% — in the 2nd group, by 84.91% — in the 3rd group. T3 dynamics was 13.9% in the 1st group, 48.69% in the 2nd group, 78.17% in the 3rd group. Dynamics of T4 — 11.3% in the 1st group, 29.98% — in the 2nd group, 35.37% — in the 3rd group. The dynamics of TSH was 19.66%, 31.81%, 69.41%, respectively.
 Conclusions. It has been proven that the use of the proposed treatment regimen including the combination of the drug α‑lipoic acid and the synbiotic Laktimak Forte promoted the improvement of pancreas functions and levels of thyroid hormones compared to those in the group of protocol treatment: the level of fecal α‑elastase increased by 89.94%; pancreatic α‑amylase — by 42.44%; coprogram index — by 84.91%; T3 — by 78.17%; T4 — by 35.37%; TSH — by 69.41% (p <0.01).

A Review of Recent Chinese Clinical Studies on Herbal Medicine Treatments for Chronic Pancreatitis

Objectives: This study summarizes current trends and results in clinical studies on herbal medicine treatments for chronic pancreatitis.Methods: Studies published from 2014 to 2023 were searched for on the China National Knowledge Infrastructure (CNKI), PubMed, and KMbase using the keywords “chronic pancreatitis”, “herbal medicine”, “herb”, “만성 췌장염”, and “한약”. The studies were analyzed according to year, study design, characteristics of the patients, and traditional Chinese medicine (TCM) intervention.Results: In total, 23 studies were selected. There were 21 randomized controlled trials and 2 case-control studies. The most common herbal prescriptions were Qingyi-tang (淸胰湯), <i>Radix Bupleuri</i> (柴胡), <i>Radix Paeoniae Alba</i> (白芍藥), <i>Radix Glycyrrhizae</i> (甘草), <i>Radix Scutellariae</i> (黃芩), and <i>Rhei Rhizoma</i> (大黃). In all the studies, herbal medicine treatments were effective in the treatment of chronic pancreatitis, and efficacy was assessed using clinical symptoms, physicochemical examination, radiological examination, and relapse.Conclusions: Herbal medicine treatment can be an effective treatment for chronic pancreatitis and has potential in clinical practice.

Reg family proteins contribute to inflammation and pancreatic stellate cells activation in chronic pancreatitis

Chronic pancreatitis (CP) is a disease characterized by the inflammation and destruction of pancreatic tissue, leading to the replacement of functional tissue with fibrotic tissue. The regenerating gene (Reg) family proteins have recently been implicated in the repair and regeneration of inflamed pancreatic tissue, though the exact mechanisms of their involvement in the pathogenesis of CP are not yet fully understood. To investigate the role of Reg family proteins in CP, we generated global knockout mice (Reg−/−) for Reg1-3 (Reg1,2,3a,3b,3d,3g) genes using the CRISPR/Cas9 system. We then investigated the effect of Reg family protein deficiency in a genetic model of CP (X-SPINK1) mice by knocking out Reg1-3 genes. We examined pancreatic morphology, inflammatory cytokines expression, and activation of pancreatic stellate cells (PSCs) at different ages. Reg−/− mice showed no abnormalities in general growth and pancreas development. Deficiency of Reg1-3 in CP mice led to a reduction in pancreatic parenchymal loss, decreased deposition of collagen, and reduced expression of proinflammatory cytokines. Additionally, Reg proteins were found to stimulate PSCs activation. Overall, our study suggests that Reg1-3 deficiency can lead to the remission of CP and Reg family proteins could be a potential therapeutic target for the treatment of CP.

Pancreatic Stellate Cells and the Targeted Therapeutic Strategies in Chronic Pancreatitis.

Chronic pancreatitis (CP) is a disease characterized by inflammatory recurrence that accompanies the development of pancreatic fibrosis. As the mystery of CP pathogenesis is gradually revealed, accumulating evidence suggests that the activation of pancreatic stellate cells (PSCs) and the appearance of a myofibroblast-like phenotype are the key gatekeepers in the development of CP. Targeting PSCs to prevent their activation and conversion to a myofibroblast-like phenotype, as well as increasing antioxidant capacity to counteract ongoing oxidative stress, are effective strategies for preventing or treating CP. Therefore, we reviewed the crosstalk between CP and pancreatic fibrosis, summarized the activation mechanisms of PSCs, and investigated potential CP therapeutic strategies targeting PSCs, including, but not limited to, anti-fibrosis therapy, antioxidant therapy, and gene therapy. Meanwhile, the above therapeutic strategies are selected in order to update the available phytopharmaceuticals as novel complementary or alternative approaches for the prevention and treatment of CP to clarify their potential mechanisms of action and their relevant molecular targets, aiming to provide the most comprehensive therapeutic treatment direction for CP and to bring new hope to CP patients.

Gut microbiota and pancreatic diseases: a microbiome-associated approach in the treatment of chronic pancreatitis

Intestinal microbiota is a factor that determines human health, maintains body homeostasis, and influences the development of pancreatic diseases (acute pancreatitis, chronic pancreatitis (CP), and cancer). Butyrate, acetate, propionate, and key short-chain fatty acids, which are synthesized by probiotic bacteria, have a significant effect on the functional pancreatic activity: anti-inflammatory effect, modulation of pancreatic β-cell function, regulation of pancreatic cell mass, and strengthening of the intestinal barrier function.
 It has been proven that the course of CP is associated with intestinal dysbiosis, bacterial overgrowth syndrome, a decrease in the levels of Firmicutes and Actinobacteria, and an increase in the levels of Proteobacteria phylum, Eubacterium rectale, Coprococcus, Sutterella, and Eubacterium ruminantium. Their predominance is related to exocrine pancreatic insufficiency, while Pseudomonas, Fusobacterium, and Ruminococcus gnavus are more common in CP patients without exocrine pancreatic insufficiency. Activation of pancreatic fibrogenesis is associated with an increase in Streptomyces, Turicibacter, Methylobacterium, Enterococcus, and Candidatus Paenicardiniummore.
 The mechanism of action of probiotics in pancreatic diseases is associated with improved functioning of the intestinal barrier, decreased BOS and the inflammatory process, and inhibition of the signaling pathway of oncogenesis. The microbiome-associated approach to treating CP is based on the additional administration of probiotics. The multicomponent probiotic Laktiale Multi can be the drug of choice.

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

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%.

Relief of symptoms of gastric and intestinal dyspepsia in chronic pancreatitis

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.

A CLINICAL PROSPECTIVE STUDY OF CHRONIC PANCREATITIS

Introduction: Chronic pancreatitis (CP) is a relentlessly progressive fibroinflammatory process, resulting in the destruction of endocrine and exocrine elements, which may eventually lead to pancreatic insufficiency. Although previous reports on the treatment of CP have yielded considerable data, our study hopes to give validation on managing CP patients conservatively with confidence. Aim: A prospective study of CP. Methods: This study was conducted in the Department of General Surgery, SVRRGGH, affiliated with Sri Venkateswara Medical College Tirupati. The materials for the study were collected from patients presenting to the surgery outpatient department and emergency room with the features of CP during the period of March 2020–April 2021 were included in the study. Results: The incidence is high in patients of age group 44.46±9.16, of which 63.3% were males and 36.7% were females. The most common presenting symptom was pain abdomen. All the data were statistically analyzed using software, namely SPSS 21.0 and Instat. Microsoft Word and Excel have been used to generate tables and graphs. Results on continuous measurements are presented on Mean±SD, and results on categorical measurements are presented in number (%). Conclusion: Conservative management shows 100% pain relief, 33.3% had steatorrhea, while surgical management shows 80% pain relief and 80% steatorrhea. Hence patients with CP can be treated effectively with conservative management.

Treatment of chronic pancreatitis by laparoscopic DuVal procedure: report of a pediatric case

Treatment of chronic pancreatitis by laparoscopic DuVal procedure: report of a pediatric case

2. Diagnosis and Treatment of Chronic Pancreatitis

2. Diagnosis and Treatment of Chronic Pancreatitis

Immune cells and immune cell-targeted therapy in chronic pancreatitis.

In recent years, studies have attempted to understand the immune cells and mechanisms underlying the pathogenesis of chronic pancreatitis (CP) by constructing a model of CP. Based on these studies, the innate immune response is a key factor in disease pathogenesis and inflammation severity. Novel mechanisms of crosstalk between immune and non-immune pancreatic cells, such as pancreatic stellate cells (PSC), have also been explored. Immune cells, immune responses, and signaling pathways in CP are important factors in the development and progression of pancreatitis. Based on these mechanisms, targeted therapy may provide a feasible scheme to stop or reverse the progression of the disease in the future and provide a new direction for the treatment of CP. This review summarizes the recent advances in research on immune mechanisms in CP and the new advances in treatment based on these mechanisms.

Gut microbiota affects pancreatic fibrotic progression through immune modulation in chronic pancreatitis

Chronic pancreatitis (CP) is characterized by chronic progressive pancreatic inflammation, which leads to the permanent damage of exocrine and endocrine cells. CP causes irreversible morphological and functional changes, and the clinical manifestations includes abdomen pain, steatorrhea and diabetes. CP induces changes in the composition of gut microbiota that could be used as potential biomarkers for pancreatic fibrosis evaluation. Gut microbiota has emerged as key regulator of immunomodulation and gut microbiota-induced immune activation has not been explored in CP. In current study, we profiled gut microbial signatures in mouse CP model, and found that higher proportion of Streptomyces, Turicibacter, Methylobacterium, Enterococcus and Candidatus_Paenicardiniummore were positively associated with the occurrence of pancreatic fibrosis. We then identified increased CD3+T cells and macrophage infiltration in mouse and human CP tissues by transcriptome sequencing data from GEO database. Subsequently, we demonstrated that fecal microbiota transplantation (FMT) from CP mouse (FMT-CP) exacerbated pancreatic fibrosis by increasing CD4+T cells and macrophage infiltration compared to fecal samples obtained from healthy mouse donor (FMT-HC). Our study describes the link between gut microbiota dysbiosis and immune activation in pancreatic fibrotic progression, and highlights the potential therapeutic roles of FMT and CP treatment.

Dynamics of clinical manifestations, functional state and structural changes of the pancreas, quality of life of patients with chronic pancreatitis in combination with chronic obstructive pulmonary disease under the influence of eradication of the syndrome of excessive bacterial growth in the small intestine

The lack of efficiency in the diagnosis and treatment of chronic pancreatitis (CP) is associated with a number of objective and subjective reasons, one of which is insufficient knowledge about the pathogenesis of the disease, especially when it is combined with other internal diseases, in particular, with chronic obstructive pulmonary disease (COPD). The frequent combination of COPD and CP is associated not only with the frequency of these diseases, but also with the common links of pathogenesis, and a significant place in the pathogenesis of both diseases is occupied by the syndrome of excessive bacterial growth in the small intestine (SIBO). Aim: to increase the effectiveness of the treatment of CP in combination with COPD based on the inclusion of rifaximin and probiotic Subalin in the complex therapy of concomitant diseases. Materials and methods. We examined 128 patients with CP in the stage of exacerbation in combination with COPD in the stage of mild exacerbation, which were divided into two groups: the main group and the comparison group. The basic treatment of CP was carried out according to the clinical recommendations of the Russian Gastroenterological Association. Patients of the main group, in addition to basic therapy, received rifaximin (Alfa Normix) for 10 days, and then Subalin-forte for 2 weeks. Patients in the comparison group received only basic therapy. Results. Due to the treatment with the inclusion of rifaximin and Subalin, there is a significant suppression of the phenomenon of “evasion” of the pancreatic-specific enzyme into the blood, an improvement in the exocrine function of the pancreas according to the results of the fecal elastase test and the response of the pancreas to food intake according to the dynamics of uroamylase flow rates and endogenous pancreozymin induction coefficients. Under the influence of the main treatment option, there is an increase in the frequency of normalization of the echogenicity of the pancreas and less often than with traditional therapy, an increase in the pancreas or part of it, blurring and unevenness of the contours persist. In addition, the indicators of ultrasonic histography of the pancreas are significantly improved, and a more pronounced positive dynamics of the clinical manifestations of COPD is observed. Thus, the eradication of SIBO provides a significant increase in the effectiveness of the treatment of patients with a combination of CP and COPD.

Nationwide Trends in Use and Outcome of Surgical Treatment in Chronic Pancreatitis

Nationwide Trends in Use and Outcome of Surgical Treatment in Chronic Pancreatitis

Effectiveness of Intestinal Lavage for the Inflammatory, Pro- and Antioxidant Processes Correction in the Treatment of Chronic Pancreatitis Therapeutic Exacerbation

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas with periods of exacerbation and remission. Frequent long-term exacerbations lead to the destruction of the soft tissue and a decrease in its functional properties. CP is manifested by an activation of inflammation, severe pain that reduces the quality of life, the development of exocrine and endocrine insufficiency and the development of polynutrient trophologic insufficiency (PTI), which requires adequate correction. The objective: to study the dynamics of inflammatory, pro- and antioxidant parameters under the influence of the use of the intestinal lavage method in patients with the therapeutic exacerbation of CP that occurred after acute pancreatitis (AP). Materials and methods. The study included 60 patients with CP after a history of AP. Patients were divided into two groups. I group included 38 patients who received a generally accepted complex of CP treatment. II group included 22 patients, whose treatment complex included a course of modified intestinal lavage in addition to the drug therapy. The effectiveness and duration of the procedures were determined by laboratory, anthropometric and instrumental parameters of CP and PTI in the patients with CP after AP history. The processes of pro- and antioxidant disorders were studied with the determination of the content of malonaldehyde, superoxide dismutase, catalase, and SH-groups. Results. The proposed method of intestinal lavage demonstrated that its use makes possible to increase the time of intestinal lavage due to the “pulsating” supply of liquid, provides a gentle effect of washing on the intestinal mucous membrane, and prevents additional traumatization of the intestine in case of the need to administer drugs. The use of a double circuit allows to administer drugs immediately after lavage without the probe removement, and in such way to prevent the mixing and possible side effects when using several drugs at the same time. Conclusions. The study demonstrated that the higher level of effectiveness of the proposed treatment complex with the inclusion of a course of intestinal lavage compared to the protocol complex for the management of patients with a therapeutic exacerbation of chronic pancreatitis (CP) after a history of acute pancreatitis (AP) was proved. The analysis of the level of C-reactive protein proved that this parameter can be a marker of the depth of intoxication and the severity of inflammation. The use of a course of intestinal lavage procedures in the generally accepted treatment of patients with CP after the history of AP led to a decrease in pain syndrome, improvement of anthropometric parameters, coprogram indicators and normalization of pro- and antioxidant changes.

The research progress of anti-inflammatory and anti-fibrosis treatment of chronic pancreatitis.

Chronic pancreatitis (CP) is a chronic progressive inflammatory disease of the pancreas, caused by multiple factors and accompanied by irreversible impairment of pancreatic internal and external secretory functions. Pathologically, atrophy of the pancreatic acini, tissue fibrosis or calcification, focal edema, inflammation, and necrosis are observed. Clinical manifestations include recurrent or persistent abdominal pain, diarrhea, emaciation, and diabetes. In addition, CP is prone to develop into pancreatic cancer(PC) due to persistent inflammation and fibrosis. The disease course is prolonged and the clinical prognosis is poor. Currently, clinical treatment of CP is still based on symptomatic treatment and there is a lack of effective etiological treatment. Encouragingly, experiments have shown that a variety of active substances have great potential in the etiological treatment of chronic pancreatitis. In this paper, we will review the pathogenesis of CP, as well as the research progress on anti-inflammatory and anti-fibrotic therapies, which will provide new ideas for the development of subsequent clinical studies and formulation of effective treatment programs, and help prevent CP from developing into pancreatic cancer and reduce the prevalence of PC as much as possible.