scholarly journals 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

2022 ◽  
pp. 28-34
Author(s):  
B. O. Kulevich ◽  
A. Yu. Razumovsky ◽  
V. V. Kholostova ◽  
Z. B. Mitupov ◽  
A. I. Khavkin ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Clinical Manifestations ◽  
Treatment Method ◽  
Pathological Process ◽  
Diagnosis And Treatment ◽  
Developmental Anomalies ◽  
Enzyme Replacement ◽  
Effective Interventions ◽  
Endocrine Insufficiency ◽  
Long Time

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.

scholarly journals The substantiation of chronic pancreatitis surgical treatment method selection

2007 ◽  
Vol 6 (3) ◽  
pp. 43-50
Author(s):  
V. A. Koubyshkin ◽  
I. A. Kozlov ◽  
N. I. Yashina ◽  
T. V. Shevchenko
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Gastric Resection ◽  
Clinical Manifestations ◽  
Pancreatic Head ◽  
Pain Syndrome ◽  
Treatment Method ◽  
Pancreas Head ◽  
Resection Of The Pancreas

The experience of surgical treatment of 154 patients having chronic pancreatitis with preferential injury of the pancreas head which underwent different operative interventions: isolated resection of pancreatic head ( based upon Berger surgery - 24, Frey surgery - 39), pancreatoduodenal resection ( with gastric resection - 22, with preserved pylorus - 43) and drainage surgeries - 26 is presented in the article. The surgery of isolated resection of pancreatic head has less number of nearest unfavorable results compared with pancretoduodenal resection with preserved pylorus. Proximal resection of the pancreas the variants of which are different isolated resection of pancreatic head is superior upon surgeries with full or partly resection of the duodenum due to fast normalization of the motor-evacuation function, less rate of the intestinal reflux and portion character of duodenal evacuation. In the follow-up period after pancreatoduodenal resection, atrophic processes occur in distal areas of the pancreas which are followed by clinical manifestations of exo- and endocrinous insufficiency. The surgery of longitudinal pancreatic jejunostomy does not avoid pathologic changes in the organ head and pain syndrome.

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 Management of Pain, Exocrine and Endocrine Insufficiency in Chronic Pancreatitis

2020 ◽  
Vol 25 (1) ◽  
pp. 5-10
Author(s):  
Tae Joo Jeon
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Pancreatitis ◽  
Medical Treatment ◽  
Pancreatic Enzyme ◽  
World Health ◽  
Severe Malnutrition ◽  
Enzyme Replacement ◽  
First Choice ◽  
Endocrine Insufficiency ◽  
Life Style Changes

Chronic pancreatitis is the progressive and inflammatory disease which will result in the irreversible destruction and fibrosis of the pancreas. These processes cause chronic pain and pancreatic dysfunctions such as exocrine and endocrine insufficiency. Medical treatment for chronic pancreatitis would be reviewed in this article. Abdominal pain should be accessed by using multidimensional approach including pain intensity, pattern, impact on daily function and quality of life. Abstinence from alcohol and smoking should be strong recommendation. The guideline for analgesic therapy follows the principles of the “pain relief ladder” by World Health Organization. The pancreatic enzyme replacement should be considered when exocrine insufficiency is suspected. Enteric-coated microspheres or mini-microspheres of <2 mm in size with a minimum lipase dose of 40,000–50,000 United States Pharmacopeia are the recommended preparations. These preparations should be taken with main meals. Increasing the oral enzyme dose and the addition of a proton pump inhibitor could be considered in cases of unsatisfactory clinical response. Diabetes mellitus secondary to chronic pancreatitis is classified as Type IIIc diabetes mellitus. Optimal pharmacological treatment has not been established yet but should promote life-style changes, which may improve glucose control and avoid hypoglycemia. In patients with severe malnutrition, insulin therapy is recommended as a first choice. Treatment for chronic pancreatitis can include medication, therapeutic endoscopy, interventional radiology, and surgery. Among them, medical treatment is the most important and should be well understood.

Rare Clinical Case of Cryopyrin-Associated Periodic Syndrome Presented with Ankylosing Spondylitis: A Case Report

2021 ◽  
Vol 17 ◽  
Author(s):  
Anna A. Zayaeva ◽  
Lyudmila V. Sokolova ◽  
Denis V. Shaduro ◽  
Andrey V. Petrov ◽  
Shanmugaraj Kulanthaivel ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Clinical Case ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Treatment Method ◽  
Genetically Engineered ◽  
Periodic Syndrome ◽  
Biological Drugs ◽  
Nlrp3 Gene ◽  
Long Time

Background: Cryopyrin-Associated Periodic Syndrome (CAPS) is a variety of clinical variants of autoinflammatory diseases. The pathology is based on a mutation in the NLRP3 gene encoding the cryopyrin protein, which leads to the uncontrolled production of interleukin-1β. Particular attention should be paid to the rarity of this disease and the lack of clinical knowledge about it in therapeutic and rheumatological practice, which leads to an erroneous diagnosis and the appointment of ineffective treatment for a long time, leading to the progression of the disease and disability of the patient. Case Presentation: This article describes a clinical case of this disease. The first manifestations of the disease in a woman appeared from the age of 2 years, in the form of a rash and fever. Since school age, there have been signs of arthritis. By the age of 24, sensorineural hearing loss and pain in the spine were evident. The disease occurred under the clinical manifestations of spondyloarthritis. Its treatment with anti-inflammatory therapy did not give a stable result. Conclusion: From the analysis, we can conclude that patient M. from early childhood suffers from a severe Neonatal-onset Multisystem Inflammatory Disease of a genetic nature. For a long time, the patient was diagnosed with ankylosing spondylitis, and appropriate treatment was carried out without significant success. The correct diagnosis of CAPS was made only in 2018. This patient has conditions of both CAPS and AS together, which is a very rare association in rheumatological practice. The only treatment method that could stop the manifestations of the disease and prevent life-threatening kidney damage (amyloidosis) is the use of genetically engineered biological drugs, i.e., IL-1β inhibitors. The only drug of this group registered in Russia is canakinumab (Ilaris ®). From the moment of diagnosis to the present day, the patient is treated with the genetically engineered drug canakinumab (Ilaris ®) at a dose of 150 mg once every 8 weeks. 6 months after taking the drug, the patient went into complete clinical and laboratory remission.

scholarly journals Enzymatic diagnosis of chronic pancreatitis

1986 ◽  
Vol 67 (6) ◽  
pp. 438-441
Author(s):  
V. V. Lukyanov ◽  
S. I. Rapoport ◽  
I. V. Lukyanov
Keyword(s):  
Chronic Pancreatitis ◽  
Digestive System ◽  
Clinical Manifestations ◽  
Initial Point ◽  
Pathological Process ◽  
Preliminary Diagnosis ◽  
Urgent Task ◽  
Pancreas Function

Chronic pancreatitis in the structure of diseases of the digestive system makes up from 5.1 to 9%. Severity of clinical manifestations and outcomes of this disease, frequent involvement of other organs and systems in the pathological process make diagnosis of chronic pancreatitis a very urgent task. Till now the anamnesis is the initial point of examination of the patient and further diagnosis. In a number of cases it allows to make a preliminary diagnosis without using complicated methods of pancreas function examination. In recent years radiological, gastroduodenoscopic, angiography and echography of pancreas are often used for recognition of chronic pancreatitis.

scholarly journals Etiological significance of the hepatitis C virus among other infectious factors of chronic pancreatitis

2019 ◽  
Vol 42 (1) ◽  
pp. 41-45
Author(s):  
O.R. Shayhen ◽  
L.S. Babinets
Keyword(s):  
Chronic Pancreatitis ◽  
Endocrine Cells ◽  
Inflammatory Process ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Pancreatic Tissue ◽  
Endocrine Insufficiency ◽  
Pancreatic Endocrine Cells ◽  
Selection Of

The article presents a review of modern literature data on the role of various etiological factors in the development of chronic recurrent pancreatitis. Much attention is paid to infectious agents (viruses of epidemic parotiditis, hepatitis B and C, enteroviruses, adenoviruses, mycoplasmas, salmonellae) in the formation of the inflammatory process in the pancreatic tissue. The features of the pathogenesis of chronic pancreatitis associated with viral infection B and C are considered; it has been shown that the lesion of the pancreas is caused by the replication of viruses directly in the cells of this organ, immunopathological changes in the liver, and concomitant immunological disorders. The probability of developing diabetes mellitus, as one of the clinical manifestations of viral replication in pancreatic endocrine cells, is underlined. The clinical manifestations of exocrine and endocrine insufficiency of the pancreas during infection with various viruses, including Coxsackie B and enteroviruses, are described in detail; the features of the course of diabetes caused by infection of these pathogens are listed. The peculiarities of chronic pancreatitis in HIV-infected and AIDS patients, in patients with parasitic pathology (opisthorchiasis, clonorchosis, ascariasis, giardiasis) are considered; the role of helicobacteria in the development of a chronic inflammatory process in pancreatic tissue is characterized. It has been suggested that a given organ may be simultaneously affected by several infectious factors; the importance of identifying pathogens of infectious diseases for the timely formulation of the correct diagnosis and the selection of adequate therapy is emphasized.

scholarly journals Evidence-based pancreatology: what do we know about chronic pancreatitis by 2020?

2020 ◽  
Vol 47 (2) ◽  
pp. 19-31
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
G. M. Lukashevich ◽  
P. G. Fomenko ◽  
E. V. Berezhnaya ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Clinical Manifestations ◽  
Genetic Mutations ◽  
Enzyme Preparations ◽  
Enzyme Replacement ◽  
Pancreatic Steatosis

The article reveals the achievements of modern pancreatology in the field of pathogenesis, dynamics of development and treatment of chronic pancreatitis (CP). Data of genetic studies describing the most diverse genetic mutations predisposing to the appearance of CP are considered. Genetic mutations causing not only СP, but also pancreatic cancer are analyzed. Risk factors of autoimmune pancreatitis development are mentioned; features of accompanying kidney affection are described. СP conceptual model including the phase of early СP is presented. The provisions of the International Consensus on Early CP are given, the criteria for diagnosing this stage of СP using both clinical/functional criteria and visualizing research methods are listed. Pathophysiological features of pancreatic fibrogenesis are considered. The results of studies describing the peculiarities of the appearance of exocrine pancreatic insufficiency (EPI), the feasibility of determining fecal elastase-1 as a screening of EPI are analyzed. Peculiarities of EPI occurrence in osteopenia, cardiovascular disease are considered. The nuances of pancreatic enzyme replacement therapy (PERT) in the pancreatic steatosis, obesity are described, as well as its impact on the quality of life of patients with CP and EPI. Advantages of using the enteric-coated minimicrospheres and possibility of controlling the clinical manifestations of EPI, increasing body weight, improving quality of life and its duration of PERT are listed. Optimal doses of enzyme preparations during PERT are considered, results of randomized studies proving the efficacy of minimicrospherical preparations are given.

scholarly journals Clinical and pharmacological approaches to the management of exocrine pancreatic insufficiency in chronic pancreatitis

2021 ◽  
pp. 58-67
Author(s):  
V. N. Drozdov ◽  
E. V. Shikh ◽  
A. A. Astapovskiy ◽  
Yu. V. Kotlyachkova ◽  
L. E. Dobrovolskaya ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Fibrous Tissue ◽  
Pancreatic Enzyme ◽  
The United States ◽  
Exocrine Insufficiency ◽  
Enzyme Replacement ◽  
Endocrine Insufficiency

Chronic pancreatitis is a multifactorial disease in which repeated episodes of inflammation of the pancreas contribute to the development of fibrous tissue, leading to chronic pain, as well as exocrine and endocrine insufficiency. The incidence and prevalence of chronic pancreatitis in the world are growing, as evidenced by current statistics. In addition, the annual costs associated with the treatment of exocrine and endocrine insufficiency are also increasing. In the United States alone, the annual cost of treating these complications is $ 75.1 million. Exocrine insufficiency is one of the most frequent complications, which is characterized by a deficiency of pancreatic enzymes, leading to the development of malabsorption syndrome (impaired absorption of nutrients, vitamins and minerals). Due to the increased incidence and deterioration of the quality of life associated with this condition, the goal of treatment is to compensate for the deficiency of exocrine enzymes with oral pancreatic enzyme replacement therapy. The core of this therapy is to deliver activated, unbroken enzymes directly to the small intestine during a meal. Many studies have shown that prescribing enzyme replacement therapy improves symptoms associated with exocrine insufficiency, reduces the progression of osteopenia, and improves survival in such patients. The use of pancreatin contributes to the correction of exocrine insufficiency in patients with chronic pancreatitis. The data presented in the article indicate that the drug is a safe and effective agent, meets all modern standards and requirements, and can be used to correct enzymatic pancreatic insufficiency.

scholarly journals The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy

2017 ◽  
Vol 89 (8) ◽  
pp. 80-87 ◽  
Author(s):  
I E Khatkov ◽  
I V Maev ◽  
D S Bordin ◽  
Yu A Kucheryavyi ◽  
S R Abdulkhakov ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Diagnosis And Treatment ◽  
Ministry Of Health ◽  
Saint Petersburg ◽  
Clinical Hospital ◽  
Enzyme Replacement ◽  
Medical Academy ◽  
Medical University

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children’s Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

Gottron’s carcinoid papillomatosis of skin (features of clinical course, diagnosis and treatment, own clinical observation)

2021 ◽  
pp. 15-20
Author(s):  
T.О. Lytynska ◽  
O.V. Demchenko
Keyword(s):  
Clinical Observation ◽  
Clinical Course ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Pathological Process ◽  
Current Data ◽  
Diagnosis And Treatment ◽  
Rational Approach ◽  
Significant Regression ◽  
Long Course

Objective — to study the features of the clinical course, diagnosis and rational approach to the treatment of Gottron’s carcinoid papillomatosis of skin.Materials and methods. The article presents current data on the clinical course, pathomorphological criteria, diagnosis and treatment of Gottron’s carcinoid papillomatosis of skin. The authors’ own clinical observation is given.Results and discussion. Gottron’s carcinoid papillomatosis of skin is dermatosis that is quite rare in medical practice. The disease is characterized by a long course with a permanent progression of the pathological process. In the vast majority of patients, this pathology develops against the background of other chronic dermatoses such as psoriasis, eczema, lichen planus, pemphigus. In addition, these patients are diagnosed with concomitant multiorgan somatic pathology, which causes not only severe course and recurrence of this dermatosis, but also requires a comprehensive approach to the treatment of these patients, taking into account the identified somatic pathology.Conclusions. Gottron’s carcinoid papillomatosis of the skin is characterized by a long course against the background of permanent progression of the pathological process.Treatment of patients with Gottron’s carcinoid papillomatosis should be comprehensive and individualized, taking into account the severity of dermatosis and concomitant pathology, which is predominantly multiorgan in nature and in some cases causes severe dermatosis and resistance to traditional therapy. This clinical case indicates a significant regression of clinical manifestations of dermatosis in patients with long­term disease, provided the correct diagnosis and adequate therapy.

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