Treatment Of Chronic Pancreatitis Research Articles

A Macrophage Membrane-Polymer Hybrid Biomimetic Nanoplatform for Therapeutic Delivery of Somatostatin Peptide to Chronic Pancreatitis.

The clinical translation of therapeutic peptides is generally challenged by multiple issues involving absorption, distribution, metabolism and excretion. In this study, a macrophage membrane-coated poly(lactic-co-glycolic acid) (PLGA) nanodelivery system was developed to enhance the bioavailability of the somatostatin (SST) peptide, which faces the hurdles of short half-life and potential side effects in the treatment of chronic pancreatitis. Using a facile nanoprecipitation strategy, SST was loaded in the nanoparticles with an encapsulation efficiency (EE) and a loading efficiency (LE) of 73.68 ± 3.56% and 1.47 ± 0.07%, respectively. The final formulation of SST-loaded nanoparticles with the camouflage of macrophage membrane (MP-SST) showed a mean diameter of 151 ± 4 nm and an average zeta potential of -29.6 ± 0.3 mV, which were stable long term during storage. With an above 90% cell viability, a hemolysis level of about 2% (<5%) and a preference for being ingested by activated endothelial cells compared to macrophages, the membrane-polymer hybrid nanoparticle showed biocompatibility and targeting capability in vitro. After being intravenously administered to mice with chronic pancreatitis, the MP-SST increased the content of SST in the serum (123.6 ± 13.6 pg/mL) and pancreas (1144.9 ± 206.2 pg/g) compared to the treatment of (Dulbecco's phosphate-buffered saline) DPBS (61.7 ± 6.0 pg/mL in serum and 740.2 ± 172.4 pg/g in the pancreas). The recovery of SST by MP-SST downregulated the expressions of chronic pancreatitis-related factors and alleviated the histologic severity of the pancreas to the greatest extent compared to other treatment groups. This augmentation of SST therapeutic effects demonstrated the superiority of integrating the synthetic polymer with biological membranes in the design of nanoplatforms for advanced and smart peptide delivery. Other peptides like SST can also be delivered via the membrane-polymer hybrid nanosystem for the treatment of diseases, broadening and promoting the potential clinical applications of peptides as therapeutics.

Wirsungectomy for pancreatic hypertension in chronic pancreatitis

Background. Pain in chronic pancreatitis (CP) can occur as a consequence of mechanical factors— pancreatic ductal hypertension, interstitial pressure, inflammatory and neuropathic pathological changes in the pancreas. The purpose was to evaluate a novel modification of the classic Partington-Rochelle procedure via comparing functional results of conventional surgery group and wirsungectomy group. Materials and methods. A retrospective analysis of the case histories of patients with CP and an enlarged (≥4mm) main pancreatic duct was carried out for the period from 2003 to 2009, which underwent surgical treatment of CP. The SF-36 and EORTC QLQ-C30 questionnaires, and visual analogue scale of pain were used for the assessment. The first group included five patients with wirsungectomy with lateral pancreaticojejunostomy (PEA + WE); the second group consisted of 20 patients after the lateral pancreaticojejunostomy (PEA) only. Cross-tabulation analyses were performed to compare PEA and PEA + WE groups as well as those groups in different time points using a two-sided Student’s t-test. The significance level was set to p<0.05. Results. The groups were compared in terms of VAS and the EORTC QLQ-C30 questionnaire before and 2 years after surgery using Student’s t-test for unrelated values: statistically significant differences between the groups according to VAS as before (p=0.757) and after surgery (p=0.696) were not obtained. There were no significant differences (p > 0.05) between the PEA and PEA + WE groups before and after surgery according to the EORTC QLQ-C30 questionnaires, except for some items (p<0.05) Within the groups according to VAS and EORTC QLQ-C30 (pain severity), in the PEA group (p=0.000001, p=0.000109) and the PEA + WE group (p=0.018, p=0.017) after surgery, there was a statistically significant decrease in pain. Conclusions. Longitudinal pancreaticojejunostomy with wirsungectomy is justified in patients with long-term CP, severe fibrosis of the pancreas with multiple calcifications of the periphery pancreatic ducts to decompress pancreatic ducts, and parenchyma. In the long-term period after 2 years, the proposed method of longitudinal pancreaticojejunostomy with wirsungectomy in patients with CP with dilation of main pancreatic duct according to the VAS scale and EORTC QLQ questionnaires C30 and SF-36 is accompanied by a significant reduction in pain.

An Atypical Complication of Chronic Pancreatitis

An Atypical Complication of Chronic Pancreatitis

S1747 Iatrogenic Cushing’s From Celiac Plexus Blocks for Chronic Pancreatitis

Introduction: Celiac plexus blocks (CPB) and celiac plexus neurolysis (CPN) have been implemented to decrease opiate dependency and treat chronic pancreatitis and/or pain resulting from pancreatic malignancy. There are various approaches to facilitate CBP/CPN including percutaneous, surgical and endoscopic, guided as CT, fluoroscopy, US or EUS techniques. EUS is the latest development in CPB/CPN and the least commonly utilized method, however recent studies have shown high efficacy and minimal complications or risks. Despite various complications associated with different techniques, no case report or current literature has documented the development of Iatrogenic Cushing’s disease from use of steroids during CPB via any approach. Herein we report the first case of Iatrogenic Cushing’s disease from CPB in the treatment of chronic pancreatitis. Case Description/Methods: A 27 YO F presented to the ED with severe epigastric pain associated with nausea. She was diagnosed with chronic pancreatitis a year and a half prior. At that time, she underwent an EUS showing severe chronic pancreatitis with biopsies positive for benign pancreatic tissue, fibrotic stromal tissue and scattered eosinophilic infiltrates. Due to recurring pain a subsequent nerve block was repeated. She was prescribed hydromorphone 4 mg q3h as needed, methadone 30 mg BID and Pancrealipase, however a celiac plexus block was repeated due to refractory pain. Upon follow up, she endorsed a 10 lb weight gain, fatigue, acne, facial hair and fullness, dark abdominal striae and insomnia. She was suspected to have iatrogenic cushingoid features due to multiple celiac nerve blocks. A morning cortisol level was 0.3 ug/dL but a salivary cortisol level with within normal limits (< 0.010 ug/dL). She was referred to Endocrinology, who recommended withholding steroids for 3 to 6 months. Repeat testing with ACTH and DEXA suppression confirmed adrenal insufficiency. Five months later, the patient’s pain returned, and her methadone was increased. Repeat EGD/EUS showed pancreatic parenchymal abnormalities consisting of hyperechoic strands, hyperechoic foci and lobularity throughout the entire pancreas. Due to refractory pain, she was referred for a pancreatic transplant program. Discussion: EUS-guided CPB is an effective, minimally invasive modality in treating pain from abdominal malignancy and/or pancreatitis, however future studies are warranted to evaluate the agents used for chemical destruction, to avoid complications such as Iatrogenic Cushing’s disease.

Pancreatic enzyme treatment in chronic pancreatitis: Quality of management and adherence to guidelines-A cross-sectional observational study.

ObjectivesPancreatic exocrine insufficiency (PEI) is a common complication in patients with chronic pancreatitis (CP), leading to increased morbidity and mortality if not treated adequately. Pancreatic enzyme replacement therapy|pancreas enzyme replacement therapy (PERT) is the cornerstone in treatment of patients with PEI. In the present study, we use data from the Scandinavian Baltic Pancreatic Club database to examine adherence of PERT according to United European Gastroenterology evidence‐based guidelines treatment of CP.Patients and methodsPatients with definitive or probable CP according to M‐ANNHEIM diagnostic criteria were included. We collected information on exposures, exocrine function, intake of pancreatic enzymes, and markers of nutrition. Fecal elastase <200 μg/g was defined as a marker for PEI. Enzyme replacement therapy of 100,000 lipase units or more was defined as adequate treatment.ResultsWe included 1006 patients from 8 centers in five countries. Sixty‐four percent of the patients were correctly treated. Twenty‐five per cent of PEI patients were not taking enzymes at all, and 20% of PEI patients were undertreated with insufficient PERT doses according to the guidelines. Fourteen percent of patients with sufficient pancreatic function were receiving enzymes despite normal exocrine pancreatic function. There were center differences. Current smoking was associated with lack of treatment and alcohol abuse was associated with under‐treatment. There were no associations between “no treatment” or “under‐treatment” for underweight or vitamin D deficiency.ConclusionIn our CP expert centers, the adherence to guidelines for enzyme treatment is insufficient. Both patient factors and center differences have influence on treatment adherence.

Vitamin D: A Potential Star for Treating Chronic Pancreatitis

Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas. The incidence of CP is increasing worldwide but the effective therapies are lacking. Hence, it is necessary to identify economical and effective agents for the treatment of CP patients. Vitamin D (VD) and its analogues have been confirmed as pleiotropic regulators of cell proliferation, apoptosis, differentiation and autophagy. Clinical studies show that VD deficiency is prevalent in CP patients. However, the correlation between VD level and the risk of CP remains controversial. VD and its analogues have been demonstrated to inhibit pancreatic fibrosis by suppressing the activation of pancreatic stellate cells and the production of extracellular matrix. Limited clinical trials have shown that the supplement of VD can improve VD deficiency in patients with CP, suggesting a potential therapeutic value of VD in CP. However, the mechanisms by which VD and its analogues inhibit pancreatic fibrosis have not been fully elucidated. We are reviewing the current literature concerning the risk factors for developing CP, prevalence of VD deficiency in CP, mechanisms of VD action in PSC-mediated fibrogenesis during the development of CP and potential therapeutic applications of VD and its analogues in the treatment of CP.

St13 protects against disordered acinar cell arachidonic acid pathway in chronic pancreatitis

BackgroundEarly diagnosis and treatment of chronic pancreatitis (CP) are limited. In this study, St13, a co-chaperone protein, was investigated whether it constituted a novel regulatory target in CP. Meanwhile, we evaluated the value of micro-PET/CT in the early diagnosis of CP.MethodsData from healthy control individuals and patients with alcoholic CP (ACP) or non-ACP (nACP) were analysed. PRSS1 transgenic mice (PRSS1Tg) were treated with ethanol or caerulein to mimic the development of ACP or nACP, respectively. Pancreatic lipid metabolite profiling was performed in human and PRSS1Tg model mice. The potential functions of St13 were investigated by crossing PRSS1Tg mice with St13−/− mice via immunoprecipitation and lipid metabolomics. Micro-PET/CT was performed to evaluate pancreatic morphology and fibrosis in CP model.ResultsThe arachidonic acid (AA) pathway ranked the most commonly dysregulated lipid pathway in ACP and nACP in human and mice. Knockout of St13 exacerbated fatty replacement and fibrosis in CP model. Sdf2l1 was identified as a binding partner of St13 as it stabilizes the IRE1α-XBP1s signalling pathway, which regulates COX-2, an important component in AA metabolism. Micro-PET/CT with 68Ga-FAPI-04 was useful for evaluating pancreatic morphology and fibrosis in CP model mice 2 weeks after modelling.ConclusionSt13 is functionally activated in acinar cells and protects against the cellular characteristics of CP by binding Sdf2l1, regulating AA pathway. 68Ga-FAPI-04 PET/CT may be a very valuable approach for the early diagnosis of CP. These findings thus provide novel insights into both diagnosis and treatment of CP.

Surgical Outcomes and Trends for Chronic Pancreatitis: An Observational Cohort Study from a High-Volume Centre.

Surgery for chronic pancreatitis (CP) is considered as a last resort treatment. The present study aims to determine the short- and medium-term outcomes of surgical treatment for CP with a comparison between duodenum-preserving pancreatic head resection (DPPHR) and pancreatoduodenectomy (PD). The trends in surgical procedures were also examined. This was a retrospective cohort study of patients who underwent surgery for CP between 2000 and 2019 at the Karolinska University Hospital. One hundred and sixty-two patients were included. Surgery performed included drainage procedures (n = 2), DPPHR (n = 35), resections (n = 114, of these PD in n = 65) and other procedures (n = 11). Morbidity occurred in 17%, and the 90-day mortality was 1%. Complete or partial pain relief was achieved in 65% of patients. No significant difference in morbidity was observed between the DPPHR and PD groups: 17% vs. 20% (p = 0.728). Pain relief did not differ between the groups (62% for DPPHR vs. 73% for PD, p = 0.142). The frequency of performed DPPHR decreased, whereas the rate of PD remained unaltered. Surgical treatment for CP is safe and effective. DPPHR and PD are comparable regarding post-operative morbidity and are equally effective in achieving pain relief. Trends over time revealed PD as more commonly performed compared to DPPHR.

Optimal time for surgical treatment of chronic pancreatitis or optimal surgery?

Background. The majority of studies on the surgical treatment of chronic pancreatitis (CP) compare treatment outcomes by the type of the procedure. However, some studies, especially systematic reviews and meta-analyses, indicate the equality of different surgeries by their long-term results. During last 5–9 years, several studies showed advantages of early surgery in chronic pancreatitis, within three years after symptoms onset. Objective: to analyze the short- and long-term results of surgical treatment for chronic pancreatitis regarding timing and, accordingly, the neglect of the disease. Materials and methods. Retrospective analysis of data of 147 patients from 2001 to 2020, the main intervention was surgery aimed at the main manifestations of CP, such as pancreatic ductal and/or parenchymal hypertension. Patients who suffered from CP symptoms 3 years or more were included in the control group (late surgery), and those who noted symptoms of CP for less than 3 years were included in the study group (early surgery). All patients completed the EORTC QLQ-30, SF-36 questionnaires, as well as the questionnaire developed by the study authors, via telephone or mail, or during the visit. Results. According to all scales of the SF-36 questionnaire, except for Physical functioning, the group of early surgery prevails over the group of late surgery. The early surgery group had the best average scores on all functional scales of the EORTC QLQ-30 questionnaire compared to the late surgery group, except for the Cognitive functioning. Of the symptomatic scales, the early surgery group had the best averages on Pain and Diarrhea. The average Health/Quality of life scale was significantly better in the early surgery group. Conclusions. The quality of life, pain control, pancreatic function in patients operated within 3 years from the onset of CP symptoms were better compared to those with longer disease duration, with the same short-term results. The duration of the disease is a major factor for the success of surgical treatment of chronic pancreatitis in terms of long-term results. The early surgery is effective approach to obtain better long-term outcomes in chronic pancreatitis.

Modern aspects of diagnosis and treatment of chronic pancreatitis in children: experience of the center Center for the treatment of developmental anomalies and diseases of the hepatopancreatobiliary system in children

Chronic pancreatitis is one of the most pressing problems of pediatric gastroenterology and surgery of hepatopancreatobiliary organs. Diagnosis and treatment of this category of patients requires a comprehensive examination using modern highly sensitive research methods and the collegial participation of a surgeon, gastroenterologist and endocrinologist. Due to the fact that the algorithm for managing these patients is not regulated, patients often receive enzyme replacement therapy for a long time, with indications for surgical treatment. In addition, the non-specificity of complaints and clinical manifestations of chronic pancreatitis, the asymptomatic course and the initial detection of exo- and endocrine insufficiency lead to a later choice of the optimal treatment method and increase the risk of complications. The key to effective care for children with chronic pancreatitis is the staging and continuity in research and treatment. At the Center for the Treatment of Developmental Anomalies and Diseases of the Hepatopancreatobiliary System in Children on the basis of the Filatov Hospital, highly effective interventions are carried out for chronic pancreatitis in children, the purpose of which is to ensure an adequate outflow of pancreatic juice using longitudinal pancreaticojejunostomy, which, in addition to draining the pancreas, allows to achieve clinical remission and stop the progression pathological process, including diabetes mellitus. The article reflects the experience of diagnosis and treatment of chronic pancreatitis in children.

A brief review of clinical guidelines for the diagnosis and treatment of exocrine pancreatic insufficiency

In recent years, several consensus and guidelines for the diagnosis and treatment of chronic pancreatitis have been published. In 2017, the Russian and Pan-European (HaPanEU) consensus was published, in 2018 — the international consensus on minimal change pancreatitis, in 2020 — the clinical guidelines of the American College of Gastroenterology, in 2021 — the British clinical guidelines. Many of their provisions overlap. This review article analyzed the main provisions of the latest recommendations, taking into account the possibility of their adaptation to Russian clinical practice.

Outcome and Trends of Surgery for Chronic Pancreatitis – Experience of Two Decades from a High-volume Centre

Introduction: Surgery for chronic pancreatitis (CP) is considered mainly when medical and endoscopic therapy have failed to achieve sufficient pain relief or if there is a suspicion of malignancy. Pancreatic surgery has increasingly become safer and more efficient, however postoperative morbidity remains high in some centers. The present study evaluated the short- and medium-term outcomes of surgical treatment for CP at a high-volume center with an emphasis on comparison between duodenum-preserving pancreatic head resection (DPPHR) and pancreatoduodenectomy (PD).

News of European Pancreatology (based on the materials of the 53rd meeting of the European Pancreatic Club)

The 53rd meeting of the European Pancreatic Club (online) took place in Verona (Italy) on June 9–11, 2021. The meeting was attended by 690 delegates from 40 countries. More than 400 oral and poster presentations were presented.&#x0D; The results of advances in the diagnosis and treatment of chronic pancreatitis, as well as the crucial research directions, were summarized in a lecture by E. de-Madaria et al. (Italy). The main medical and social characteristics of chronic pancreatitis (CP): chronic disease; often manifests itself in pain, which is often disabling; leads to complications, including pancreatic cancer; diagnosis and treatment are complex. Despite this, the number of randomized controlled trials (RCTs) on CP is significantly less than on acute pancreatitis, and in recent years, the annual number of studies on CP has even decreased. Problems to be solved: we do not have antifibrotic drugs, a “gold standard” for diagnosis, and we do not even have good methods for diagnosing early CP. The main etiological CP options are alcoholic and idiopathic ones. A more detailed analysis showed that toxic CP (alcoholic and smoking-induced) account for 46% of cases of the disease, idiopathic CP — 24%, genetically predisposed CP — 7%, obstructive CP — 7%, autoimmune CP — 2%, CP of other etiology — 12% of cases. We have made progress in the study of autoimmune pancreatitis, however, the frequency of pancreatic cancer due to autoimmune CP, features of the disease in children, increased accuracy of pancreas imaging and the effectiveness of treatment require further study in RCTs.&#x0D; Lithotripsy, endoscopy, and surgery are used to treat CP with dilated pancreatic ducts. There were 3 RCTs that showed the advantages of surgical treatment over endoscopic one (long-term pain relief, fewer complications, higher efficiency), but lithotripsy and endoscopy were not compared.&#x0D; “Small ducts disease” is treated by the blockade of the solar plexus and/or nn. splanchnici, V-shaped excision of the pancreas, pancreatectomy with autotransplantation of the islets of Langerhans (only in specialized centers). The effectiveness of these techniques requires further study. The main techniques for diagnosing exocrine pancreatic insufficiency (EPI) are: probe (laborious), fecal elastase test (low sensitivity in mild EPI), tests for assessing trophological status (low specificity), breath tests (not available everywhere and laborious).&#x0D; Thus, we need an more RCTs (international efforts), definition of early CP; we need to better understand the relationship between genetic and environmental factors, advance in understanding of the autoimmune pancreatitis, and understanding the role of endoscopy and lithotripsy in pain management; it is necessary to develop new techniques of treating pain in the “small ducts disease”; we need easy-to-perform, accurate and widespread tests to diagnose EPI.&#x0D; The article analyzes the results of studies on the diagnosis and treatment of pancreatitis, cysts and pancreatic tumors.

Anterior Cingulate Cortex Mediates Hyperalgesia and Anxiety Induced by Chronic Pancreatitis in Rats

Central sensitization is essential in maintaining chronic pain induced by chronic pancreatitis (CP), but cortical modulation of painful CP remains elusive. Here, we examined the role of the anterior cingulate cortex (ACC) in the pathogenesis of abdominal hyperalgesia in a rat model of CP induced by intraductal administration of trinitrobenzene sulfonic acid (TNBS). TNBS treatment resulted in long-term abdominal hyperalgesia and anxiety in rats. Morphological data indicated that painful CP induced a significant increase in FOS-expressing neurons in the nucleus tractus solitarii (NTS) and ACC, and some FOS-expressing neurons in the NTS projected to the ACC. In addition, a larger portion of ascending fibers from the NTS innervated pyramidal neurons, the neural subpopulation primarily expressing FOS under the condition of painful CP, rather than GABAergic neurons within the ACC. CP rats showed increased expression of vesicular glutamate transporter 1, and increased membrane trafficking and phosphorylation of the N-methyl-D-aspartate receptor (NMDAR) subunit NR2B and the α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPAR) subunit GluR1 within the ACC. Microinjection of NMDAR and AMPAR antagonists into the ACC to block excitatory synaptic transmission significantly attenuated abdominal hyperalgesia in CP rats, which was similar to the analgesic effect of endomorphins injected into the ACC. Specifically inhibiting the excitability of ACC pyramidal cells via chemogenetics reduced both hyperalgesia and comorbid anxiety, whereas activating these neurons via optogenetics failed to aggravate hyperalgesia and anxiety in CP rats. Taken together, these findings provide neurocircuit, biochemical, and behavioral evidence for involvement of the ACC in hyperalgesia and anxiety in CP rats, as well as novel insights into the cortical modulation of painful CP, and highlights the ACC as a potential target for neuromodulatory interventions in the treatment of painful CP.

The role of extracorporeal shock wave lithotripsy in the treatment of chronic pancreatitis.

Pain is the most frequent symptom in chronic pancreatitis (CP) and has an important impact on quality of life. One of its major pathophysiological mechanisms is ductal hypertension, caused by main pancreatic duct stones and/or strictures. In this article, we focus on extracorporeal shock wave lithotripsy (ESWL) as a treatment for main pancreatic duct stones, which have been reported in >50% of CP patients. ESWL uses acoustic pulses to generate compressive stress on the stones, resulting in their gradual fragmentation. In patients with radiopaque obstructive main pancreatic duct (MPD) stones larger than 5 mm, located in the pancreas head or body, ESWL improves ductal clearance, thereby relieving pain and improving quality of life. In case of insufficient ductal clearance or the presence of an MPD stricture, ESWL can be followed by endoscopic retrograde cholangiopancreatography (ERCP) to increase success rate. Alternatively, direct pancreaticoscopy with intracorporeal lithotripsy or surgery can be performed.

Determination of the Length of Pancreatic Ductotomy by Pancreaticoscopy During Frey's Procedure for Chronic Pancreatitis.

To study the impact of pancreaticoscopy during Frey's procedure for treating chronic pancreatitis (CP). Excision of the central part of the head of the pancreas along with longitudinal pancreaticotomy (Frey's procedure) is widely performed for the treatment of CP. However, there is no reliable method to determine the necessary length of longitudinal pancreaticotomy during surgery for CP. Thirty-five consecutive patients with CP were scheduled for Frey's procedure with intraoperative pancreaticoscopy. The length of the longitudinal pancreaticotomy was tailored by pancreaticoscopy in the following manner: (1) it did not extend beyond the neck in case of a uniformly dilated main duct with patent branch duct confluences and a clear lumen; (2) in case of an obstructed main duct or branch duct confluence of any cause, the main duct was opened to include the most distal obstruction. All patients underwent Frey's procedure and intraoperative pancreaticoscopy. Based on the pancreaticoscopy findings, pancreaticotomy over the body of the gland was not necessary in 34% of the patients. A short (4-6 cm) ductotomy extension over the pancreatic body was required in 14% of the patients. Full-length pancreaticotomy was required in 52% of the patients. The median operative time was 145 minutes, and the median blood loss was 70 mL. Four patients (11.4%) experienced postoperative complications. There were no 90-day postoperative mortality or hospital readmission rates. At the median follow-up of 19 months, 31 patients (88.5%) had no pain attacks requiring medication. Intraoperative pancreaticoscopy helps to determine the length of longitudinal pancreaticotomy and reduce pancreatic trauma during Frey's procedure for treating CP.

Surgical treatment in patients with chronic pancreatitis in a multidisciplinary hospital

A rational personalized program of surgical treatment of patients with various clinical and morphological forms of chronic pancreatitis is substantiated, integrating modern diagnostic and minimally invasive technologies. Examination results and treatment of 354 patients with chronic pancreatitis were analyzed. Patients were divided into three groups according to the modified Marseille-Rome Classification of Chronic pancreatitis (1988). Calcifying chronic pancreatitis was detected in 119 patients, obstructive in 81, and inflammatory in 154. Modern methods of diagnosis and treatment of chronic pancreatitis allowed the modification of the classification by allocating subgroups for each disease form. The justified use of the entire range of modern surgical technologies, taking into account the morphological changes of the pancreas, allows the maximum correction of complications of chronic pancreatitis with minimal complications and good quality of life in the long-term. The choice of surgical aid in patients with chronic pancreatitis is established to primarily depend on the form and variant of the disease course. The main criteria for choosing a surgical aid should be the state of the pancreatic ductal system, the degree and nature of changes in its parenchyma, and the presence of a cystic or inflammatory component during the surgical decision making. Important adjustments in the stage of surgical interventions are made due to mechanical jaundice, portal hypertension, decompensated duodenal stenosis, and concomitant somatic pathology in patients. Subgroups of patients with identified main chronic pancreatitis form, according to its modified classification, allows the determination of the surgical intervention volume, type, and access for each specific patient.

Клинико-патогенетические аспекты хронического панкреатита в сочетании с вегетативной дисфункцией

Актуальность. В статье проанализированы особенности состояния вегетативной нервной системы у больных хроническим панкреатитом (ХП). Проведенные исследования показали, что наличие вегетативной дисфункции (ВД) осложняет течение хронического панкреатита. Все органы и системы нашего тела находятся под постоянным контролем вегетативной нервной системы. Проблема хронического панкреатита остается одной из наиболее актуальных проблем в современной гастроэнтерологии. Несмотря на внедрение новых методов, наблюдается низкая эффективность лечения ХП, что, вероятно, обусловлено недостаточностью знаний об определенных механизмах патогенеза, в частности о роли ВД в развитии и прогрессировании ХП. Итак, особенности состояния вегетативной нервной системы при хроническом панкреатите представляют значительный научный интерес. Цель исследования: изучить степень вегетативных нарушений и их клиническое течение у больных с хроническим панкреатитом. Материалы и методы. Обследовано 45 пациентов с ХП, проходивших лечение в дневном стационаре и гастроэнтерологическом отделении Тернопольской городской клинической больницы № 2. Диагноз «хронический панкреатит» выставляли на основе клинического протокола, принятого в соответствии с приказом № 638 МЗ Украины от 10.09.2014 г. Общеклинические и биохимические обследования проводили больным ХП в фазе обострения и нестойкой ремиссии (10–14 день пребывания в условиях дневного стационара). Результаты. По данным опросника Вейна, у 91,1 % (n = 41) больных ХП обнаружены признаки вегетативной дисфункции, которые сопровождались наиболее выраженными диспеп­тическим ((3,2 ± 1,0) балла) и болевым ((2,9 ± 1,3) балла) синдромами по данным гастроэнтерологического опросника (GSRS). Наличие вегетативной дисфункции у больных ХП сопровождалось повышением реактивной (среднее значение — (45,0 ± 5,7)) и личной (среднее значение — (43,0 ± 5,2)) тревожности, а также ростом нейротизма (среднее значение — (14,7 ± 2,4)) у 75,6 % больных. У больных ХП с ВД по индексу Кердо констатировано преобладание состояния ваготонии (56 %) над симпатикотонией (31 %) при уровне эйтонии 13 %. По результатам клиноортостатической пробы у 13 % пациентов с ХП установлена нормальная реакция гемодинамики на ее проведение, у 6,5 % — гиперсимпатикотонический и гипердиастолический варианты, у 74 % — асимпатикотонический, что указывает на истощение компенсаторных механизмов регуляции вегетативного тонуса. Выводы. По оценке данных исследования, установлено негативное влияние вегетативной дисфункции на течение хронического панкреатита.

Impact of surgery for chronic pancreatitis on the risk of pancreatic cancer: Untying the Gordian knot.

Pancreatic ductal adenocarcinoma is an aggressive tumor with poor long-term outcomes. Chronic pancreatitis (CP) is considered a risk factor for the development of pancreatic cancer (PC). Persistent pancreatic inflammation and activation of pancreatic stellate cells play a crucial role in the pathogenesis of CP-related PC by activating the oncogene pathway. While genetic mutations increase the possibility of recurrent and persistent pancreatic inflammation, they are not directly associated with the development of PC. Recent studies suggest that early surgical intervention for CP might have a protective role in the development of CP-related PC. Hence, the physician faces the clinical question of whether early surgical intervention should be recommended in patients with CP to prevent the development of PC. However, the varying relative risk of PC in different subsets of CP underlines the complex gene-environment interactions in the disease pathogenesis. Hence, it is essential to stratify the risk of PC in each individual patient. This review focuses on the complex relationship between CP and PC and the impact of surgical intervention on PC risk. The proposed risk stratification based on the genetic and environmental factors could guide future research and select patients for prophylactic surgery.

Features of bacterial overgrowth syndrome and its treatment in chronic pancreatitis

Features of bacterial overgrowth syndrome and its treatment in chronic pancreatitis