scholarly journals The effectiveness of systemic enzyme therapy in complex treatment chronic pancreatitis in old age

2021 ◽  
Vol 11 (6) ◽  
pp. 209-216
Author(s):  
N. A. Shevchenko ◽  
L. S. Babinets
Keyword(s):  
Chronic Pancreatitis ◽  
Elderly Patients ◽  
Pancreatic Insufficiency ◽  
Colorimetric Method ◽  
Control Group ◽  
Enzyme Therapy ◽  
Complex Treatment ◽  
Functional Changes ◽  
Enzyme Replacement ◽  
Group I

Relevance. The variety of functional changes in internal organs characteristicofgeriatricage necessitates the search for drugs that can exert a multifaceted effect on various links in the pathogenesis of chronic pancreatitis (CP) in comorbidity with the most common diseases of the elderly. Purpose. Investigation of the effectiveness of the inclusion of a systemic enzyme therapy drug in the complex treatment of chronic pancreatitis in elderly patients. Materials and methods. We examined 77 patients with CP over the age of 66 years, the average age (71.3 ± 1.4) g. Group I of patients with CP (23 patients) - took aconventional therapeutic complex (MC) for three months: pantoprazole 40 mg on an empty stomach according to requirement, continuous enzyme replacement therapy with pure pancreatin in an adequate dose with each meal, prokinetics / or antispasmodics if necessary. Group II consisted of 34 patients with CP (MC + W), in addition to LK, the drug of systemic enzyme therapy (SET) Wobenzym, 5 tablets, was taken. three times a day for three months. The control group consisted of 20 patients without signs of pathology of the digestive system. The parameters of lipid metabolism were determined by the enzymatic-colorimetric method. The assessment of the depth of exocrine pancreatic insufficiency (PI) was determined by the level of fecal α-elastase (FαE) by enzyme-linked immunosorbentassay using standard BIOSERVELASTASE 1-ELISA kits. Statistical analysis was performed using Excel and the statistical package Statistica v. 5.0. Results. Additional inclusion of the drug SET (Wobenzym) in the generally accepted MC promoted a significant improvement in lipid profile parameters in elderly patients with CP, as well as a reliable correction of the excretory function of the P by the level of FαE (from the level of moderate to mild insufficiency). Conclusions. 1) The inclusion of Wobenzym in the general treatment complex contributed toa decrease in the levels of TC, βLP, TG and LDLP by 15.4%, 19.8%, 32.0% and 33.9%, respectively (p <0.001), as well as an increase in the level of HDLP by 21.7% and a decrease in AF (by 41.3%) (p <0.001); 2) under the influence of treatment with the use of Wobenzym, a significant increase in the level of FαE (by 42.6%) was found relative to this indicator to treatment (p <0.001), which significantly exceeded the results (by 15.8%) in the MC group, which were not statistically significant (p> 0.05).

scholarly journals СORRECTION OF MALNUTRITION IN PATIENTS WITH CHRONIC PANCREATITIS

2019 ◽  
Vol 9 (1) ◽  
pp. 70-80 ◽  
Author(s):  
N. S. Gavrilina ◽  
L. Yu. Ilchenko ◽  
G. A. Sedova ◽  
I. G. Fedorov ◽  
I. G. Nikitin
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Alcoholic Pancreatitis ◽  
Chronic Obstructive ◽  
High Dose ◽  
Chronic Alcoholic Pancreatitis ◽  
Chronic Alcoholic ◽  
Enzyme Replacement ◽  
Group I

Aim:To estimate the frequency of occurrence malnutrition and efficacy its correction in chronic pancreatitis (CP).Materials and methods:148 patients were examined. Group I included 71 people with chronic alcoholic pancreatitis (CAP); group II — 77 patients with chronic obstructive pancreatitis (COP). Trophological status (TS) was investigated by criteria of V.M. Luft. Lymphocytes, pancreatic amylase, lipase, total protein, albumin, urine diastase and faecal elastase-1 were investigated before and after treatment. Two treatment options were used: combination therapy (CT, (Mezym-forte 10500 USP/day and pharmaconutrient Ensure 2 200 ml/day)) and high-dose pancreatic enzyme replacement therapy ((HD PERT), Kreon 120000 USP/day) for 10 weeks. 62 patients received HD PERT: 24 patients with CAP and 38 patients with COP; CT — 86 patients: 47 and 39, respectively.Results:The prevalence of malnutrition in patients with CP was 92% (n=136). Lymphopenia was determined in 44%, hypoproteinemia-in 11,5%, hypoalbuminemia-in 54%. 12 (8%) patients did not have malnutrition. In the group CAP: mild malnutrion was established in44, moderate — in 20, severe — 2, eutrophia — 6; in the group COP: mild malnutrion — in 33, moderate — in 37, severe — 0, eutrophia — 6. Aftertreatment in the group CAP: malnutrion moderate — in 7, mild — 58, eutrophia — 7, in the COP: malnutrion moderate — 37, mind — 31, eutrophy — 8.Conclusions:Malnutrition is frequent symptom complex in patients with CP. The severity of malnutrition is more severy in CAP. The most effective treatment malnutrition was CT in patients with CAP. HD PERT is indicated to correct exocrine pancreatic insufficiency.

scholarly journals A Case of Chronic Pancreatic Insufficiency Due to Valproic Acid in a Child

2001 ◽  
Vol 15 (2) ◽  
pp. 127-130 ◽  
Author(s):  
Mary Anne Cooper ◽  
Aubrey Groll
Keyword(s):  
Valproic Acid ◽  
Weight Loss ◽  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Exocrine Pancreatic Insufficiency ◽  
Radiological Evaluation ◽  
Enzyme Replacement

A 14-year-old child treated with valproic acid over several years for a seizure disorder developed abdominal pain with radiological evidence of acute pancreatitis. The association with valproic acid was not recognized, and the child continued to take the drug. The patient eventually developed steatorrhea and weight loss that improved with pancreatic enzyme replacement. Radiological evaluation showed an atrophic pancreas. Without evidence of other etiological factors, valproic acid by itself appeared to be the cause of chronic pancreatitis with exocrine pancreatic insufficiency in this patient.

Effect of leptin on the gallbladder in patients with metabolic syndrome

2016 ◽  
Vol 94 (4) ◽  
pp. 285-289 ◽  
Author(s):  
Natalia G. Virstyuk ◽  
N. R. Senyutovich
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
International Diabetes Federation ◽  
Resistance Index ◽  
High Density Lipoproteins ◽  
Control Group ◽  
Blood Levels ◽  
Model Assessment ◽  
Functional Changes ◽  
Group I

The study involved 58 patients with chronic noncalculous cholecystitis (CNC) divided into two groups. Group I included 30 CNC patients with metabolic syndrome (MS), group II 28 CNC patients without MS. The control group consisted of 20 healthy people. MS was diagnosed according to International Diabetes Federation guidelines (2005). The following anthropometric parameters were determined: body mass index (BMI), waist to hip ratio, blood lipid profile (total cholesterol, triglycerides, high density lipoproteins (HDL), and low density lipoproteins (LDL)). Leptin and insulin levels were measured using commercial ELISA kits «Leptin ELISA» and «Insulin ELISA» (DRG International, Inc., USA) respectively. Insulin resistance index HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) was calculated. It was shown that leptin level in CNC patients with MS was 2.61 times that in healthy subjects (p <0.001) and 2.47 times higher than in CNC patients without MS (p <0.001). Significant direct correlations between leptin blood levels andBMI, HOMA-IR index, triglycerides, and cholesterol were documented. The relationships between blood levels of leptin and the thickness of the gallbladder (GB) wall, the amount of cholesterol crystals in bile, and decreased bile release rate from GB which suggests effect of leptin on the structural and functional changes in GB.

scholarly journals Morphologic and functional changes in the retina and sclera induced by form deprivation high myopia in guinea pigs

2019 ◽  
Author(s):  
yingxin zi ◽  
Yu Deng ◽  
Jingru Zhao ◽  
Meiqi Ji ◽  
Yali Qin ◽  
...  
Keyword(s):  
Axial Length ◽  
Guinea Pigs ◽  
High Myopia ◽  
Light And Electron Microscopy ◽  
Anterior Chamber Depth ◽  
Control Group ◽  
Group Iii ◽  
Functional Changes ◽  
Group I ◽  
Group Ii

Abstract Background Our aim was to study the morphologic and functional changes in the retina and sclera induced by form deprivation high myopia (FDHM) in guinea pigs and explore the possible mechanisms FDHM formation. Methods Forty 3-weeks-old guinea pigs were randomized into the blank control (Group I, 20 cases) and model groups (20 cases). In the model group, the right eyes of the guinea pigs were sutured 8 weeks to induce FDHM (Group II) and the left eyes were considered a self-control group (Group III). The diopters were measured with retinoscopy. The anterior chamber depth (AC), lens thickness (L), vitreous depth (V) and axial length (AL) were measured using ultrasonometry A. Retinal and scleral morphology and ultrastructural features were observed with light and electron microscopy. The content of malondialdehyde (MDA) and the activity of superoxide dismutase (SOD) in the retina and sclera were detected with a chemical colorimetric assay. Results After remaining stitched for eight weeks, the diopters of Group II changed from (+3.59±0.33) D to (-7.96±0.55) D, and these values were significantly higher than those of Group I (+0.89±0.32) D and Group III (-0.55±0.49) D. The vitreous chamber depth (4.12±0.13) mm and axial length (8.93±0.22) mm of Group II were significantly longer than that of Group I [(3.71±0.23) mm and (7.95±0.37) mm, respectively] and Group III [(3.93±0.04) mm and (8.01±0.15) mm, respectively] (P < 0.05). With the prolongation of form deprivation, the retina and scleral tissue became thinner, the ganglion cell and inner and outer nuclear layers of the retina became decreased, and the arrangement was disordered. In Group II, the activity of SOD was significantly lower than that in Group I and Group III, and the content of MDA was significantly higher in Group II than in Group I and Group III. The differences were statistically significant (P < 0.05). Conclusions These findings suggested that in the FDHM guinea pigs model, the diopter, the vitreous chamber depth, and axial length increased significantly with prolongation of monocular FD time, and morphological structural changes in the retina and sclera were observed. Oxygen free radicals might participate in the formation of FDHM.

scholarly journals Pancreatology: debunked myths

2020 ◽  
Vol 48 (3) ◽  
pp. 44-53
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva
Keyword(s):  
Chronic Pancreatitis ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Overweight And Obesity ◽  
Evidence Based ◽  
Enzyme Preparations ◽  
Enzyme Replacement ◽  
European Guidelines ◽  
Relieve Pain

Enzyme replacement therapy is not always effective enough upon exocrine pancreatic insufficiency. One of the main reasons is myths — doctors’ misconceptions about the indications and rules of replacement therapy. In particular, there is an outdated opinion about the effectiveness of tablet enzyme preparations used for the relief of pancreatic pain. However, a number of evidence-based studies have proved that enzyme preparations are not effective enough to relieve pain in chronic pancreatitis, and thus should not be used for this purpose. This statement is recorded in the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis, as well as in the recommendations of the American College of Gastroenterology. In addition, tablet preparations are characterized by asynchronism of the passage of the chyme and the tablet along the digestive tract. The second myth is that drugs without an acid-resistant coat start hydrolyzing the components of the chyme in the stomach, which ensures higher efficiency as compared to Creon. But in the absence of a coat, enzymes are inactivated in the acidic environment of the stomach and cannot have any effect at all. The third myth is that enzyme preparations always cause constipation. In fact, constipation occurs in no more than 10% of cases. They are usually associated with an overdose of the drug, concomitant pathology or insufficient compliance. The fourth myth is that prescribing the doses of enzyme preparations indicated in the European Guidelines causes addiction. It is crucial to know that such doses do not exceed 10% of the pancreas’s own capacities, therefore, they cannot significantly affect these capabilities, which is also demonstrated by evidence-based studies. The fifth myth is that patients gain weight because of enzyme preparations, and they should not be prescribed upon overweight and obesity. Numerous data firmly show that pancreatic insufficiency often occurs in such cases, and enzyme preparations are required. The sixth myth is that a drug with a different composition can be produced under the usual established product name. For example, NEO is added to the name to “mask” a drug with a new composition. Doctors should carefully monitor the composition of such drugs. The seventh myth is that a minimicrospherical preparation (Creon) is as effective as microspherical preparation. However, this statement turned out to be a myth as well. Minimicrospherical preparations are proved to be significantly more effective in clinical practice. Thus, the above-mentioned myths, like many others, are based on insufficient knowledge in the field of pancreatology.

scholarly journals Enzyme replacement therapy, life quality and expectancy of patients with chronic pancreatitis and exocrine pancreatic insufficiency

2018 ◽  
Vol 41 (3) ◽  
pp. 10-16
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
А. Y. Klochkov ◽  
G. М. Lukashevich ◽  
P. G. Fomenko ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Life Quality ◽  
Exocrine Pancreatic Insufficiency ◽  
Enzyme Preparations ◽  
Enzyme Replacement ◽  
Enteric Coated ◽  
Adequate Dosage

The article reviews the evidence-based studies devoted to the evaluation of the efficacy and safety of enzyme replacement therapy in patients with chronic pancreatitis with exocrine pancreatic insufficiency. Particular attention is paid to the effect of replacement therapy on the life quality and expectancy of patients. It has been proven that the correct prescription of enzyme preparations (minimicrosphere enteric-coated preparation, adequate dosage) improves the quality and prolongs the life of patients.

scholarly journals COMPARING THE ENZYME REPLACEMENT THERAPY COST IN POST PANCREATECTOMY PATIENTS DUE TO PANCREATIC TUMOR AND CHRONIC PANCREATITIS

2016 ◽  
Vol 53 (2) ◽  
pp. 94-97 ◽  
Author(s):  
Anna Victoria FRAGOSO ◽  
Martha Regina PEDROSO ◽  
Paulo HERMAN ◽  
André Luis MONTAGNINI
Keyword(s):  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Gastrointestinal Surgery ◽  
Exocrine Pancreatic Insufficiency ◽  
Intractable Pain ◽  
Enzyme Replacement ◽  
Significant Difference

ABSTRACT Background - Among late postoperative complications of pancreatectomy are the exocrine and endocrine pancreatic insufficiencies. The presence of exocrine pancreatic insufficiency imposes, as standard treatment, pancreatic enzyme replacement. Patients with chronic pancreatitis, with intractable pain or any complications with surgical treatment, are likely to present exocrine pancreatic insufficiency or have this condition worsened requiring adequate dose of pancreatic enzymes. Objective - The aim of this study is to compare the required dose of pancreatic enzyme and the enzyme replacement cost in post pancreatectomy patients with and without chronic pancreatitis. Methods - Observational cross-sectional study. In the first half of 2015 patients treated at the clinic of the Department of Gastrointestinal Surgery at Hospital das Clínicas, Universidade de São Paulo, Brazil, who underwent pancreatectomy for at least 6 months and in use of enzyme replacement therapy were included in this series. The study was approved by the Research Ethics Committee. The patients were divided into two groups according to the presence or absence of chronic pancreatitis prior to pancreatic surgery. For this study, P<0.05 was considered statistically significant. Results - The annual cost of the treatment was R$ 2150.5 ± 729.39; R$ 2118.18 ± 731.02 in patients without pancreatitis and R$ 2217.74 ± 736.30 in patients with pancreatitis. Conclusion - There was no statistically significant difference in the cost of treatment of enzyme replacement post pancreatectomy in patients with or without chronic pancreatitis prior to surgical indication.

scholarly journals Chronic pancreatitis: review and update of etiology, risk factors, and management

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 607 ◽  
Author(s):  
Angela Pham ◽  
Christopher Forsmark
Keyword(s):  
Chronic Pancreatitis ◽  
Islet Cells ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Exocrine Insufficiency ◽  
Disease Etiology ◽  
Enzyme Replacement ◽  
Endocrine Insufficiency ◽  
Pancreatic Enzyme Replacement Therapy ◽  
Pancreatic Exocrine

Chronic pancreatitis is a syndrome involving inflammation, fibrosis, and loss of acinar and islet cells which can manifest in unrelenting abdominal pain, malnutrition, and exocrine and endocrine insufficiency. The Toxic-Metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and Severe Acute Pancreatitis, Obstructive (TIGAR-O) classification system categorizes known causes and factors that contribute to chronic pancreatitis. Although determining disease etiology provides a framework for focused and specific treatments, chronic pancreatitis remains a challenging condition to treat owing to the often refractory, centrally mediated pain and the lack of consensus regarding when endoscopic therapy and surgery are indicated. Further complications incurred include both exocrine and endocrine pancreatic insufficiency, pseudocyst formation, bile duct obstruction, and pancreatic cancer. Medical treatment of chronic pancreatitis involves controlling pain, addressing malnutrition via the treatment of vitamin and mineral deficiencies and recognizing the risk of osteoporosis, and administering appropriate pancreatic enzyme supplementation and diabetic agents. Cornerstones in treatment include the recognition of pancreatic exocrine insufficiency and administration of pancreatic enzyme replacement therapy, support to cease smoking and alcohol consumption, consultation with a dietitian, and a systematic follow-up to assure optimal treatment effect.

scholarly journals COMBINATION OF O BESITY AND MALNUTRITION AT A PATIENT WITH CHRONIC ALCOHOLIC PANCREATITIS (CASE REPORT)

2018 ◽  
Vol 8 (6) ◽  
pp. 475-479 ◽  
Author(s):  
N. S. Gavrilina ◽  
L. Yu. Ilchenko ◽  
I. G. Fedorov ◽  
I. G. Nikitin
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Alcoholic Pancreatitis ◽  
Anthropometric Parameters ◽  
Chronic Alcoholic Pancreatitis ◽  
Chronic Alcoholic ◽  
Enzyme Replacement ◽  
Clinical Description ◽  
Positive Effect

The article contains a clinical description of the case of combination of such two opposite states as obesity and malnutrition in a patient with chronic pancreatitis. The patient was hospitalized with exacerbation of chronic pancreatitis and alcohol abuse. The examination revealed exocrine pancreatic insufficiency and mild malnutrition. The patient was prescribed enzyme replacement therapy and additional oral sip feeding with a positive effect. After 10 weeks of exocrine pancreatic insufficiency were stopped, but malnutrition remained and required a longer course of treatment. The relevance of this problem, the main difficulties of diagnosis were presented in the article. All patients need to measure anthropometric parameters, BMI, lymphocytes, total protein, albumin. Using only BMI leads to hypodiagnosis of malnutrition in patients with chronic pancreatitis.

scholarly journals Dynamics of vitamin D level in patients with chronic pancreatitis on the background of enzyme replacement therapy

2019 ◽  
pp. 156-160
Author(s):  
T. V. Bideyeva ◽  
D. N. Andreyev ◽  
Yu. A. Kucheryavy ◽  
I. V. Maev
Keyword(s):  
Vitamin D ◽  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Past History ◽  
Pancreatic Insufficiency ◽  
Nutrient Status ◽  
Enzyme Replacement ◽  
Vitamin D Levels

According to the latest data, the risk of vitamin D deficiency in patients with chronic pancreatitis (CP) and associated exocrine pancreatic insufficiency (EPI) is higher than in the general population. The aim of the present study was to evaluate the dynamics of vitamin D level in patients with CP with EPI against the background of long-term enzyme replacement therapy (ERT) with the use of microencapsulated pancreatin preparations. The study included 58 CP patients, who were divided into two groups depending on the results of laboratory assessment of nutrient status parameters. The 1st group consisted of the patients with the signs of EPI (according to the data of low values of the elastase test) without deviations in the nutritive status. The 2nd group consisted of CP patients with EPI and low values of stool elastase-1 and abnormal nutrient status. According to the results of the study, the serum level of vitamin D in the 1st group was 36.05 (95% CI 32.8397–38.9603) ng/ml, and in the 2nd group - 10.6 (95% CI 32.8397– 38.9603) ng/ml. A reliable inverse correlation between the past history duration and vitamin D level (r = -0.5644; 95% CI -0.8162 – -0.1324, p = 0.0147) was revealed, as well as a reliable direct correlation between elastase and vitamin D levels in the 2nd group (r = 0.8296; 95% CI 0.592–0.9345, p < 0.0001). Long-term ERT (8-12 months) resulted in a significant increase of vitamin D level in the 2nd group of patients from 10.6 (95% CI 32.8397–38.9603) ng/ml to 17.1 (95% CI 12.0166-23.6232) ng/ml (p < 0.0003).

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