Functional state of pancreas in patients with chronic pancreatitis

Аim of research is to study the functional state of the pancreas in patients with various forms of chronic pancreatitis. Materials and methods. Complex examination of 210 patients with various forms of chronic pancreatitis (І, n=26 — obstructive, ІІ, n=56 — calcifying, ІІІ, n=78 — fibrous-parenchymal, ІV, n=50 — chronic pancreatitis complicated by pseudocyst) was carried out. Activity of enzymes (amylase, lipase, trypsin, phospholipase A) in serum, duodenal and ductal pancreatic contents was determined by common clinical techniques. In addition, content of bicarbonates was determined in duodenal and ductal contents. Exocrine pancreatic function was assessed by fecal elastase-1 level, endocrine function — by glycosylated hemoglobin level. Results of study. Increased activity of enzymes was determined (amylase, lipase, trypsin, phospholipase A) in the serum of patients of all groups: amylase activity (61.6%), trypsin (85.9%) by 3.5 times and phospholipase A (84, 6%) — by 2.3 times in comparison with the control group (p <0,001). Most often, α-amylase activity increased in patients of I and IV groups (with the same frequency of 70.0%) due to the process exacerbation or obstacle for the pancreatic juice outflow; increased trypsin activity was more frequent in III group of patients (91,0%). According to the fecal elastase test, the highest degree of pancreatic parenchymal involvement was detected in II and III groups of patients. Fecal elastase test showed increased level of enzymes in the duodenal and ductal pancreatic contents, increased level of bicarbonates, and decrease in the exocrine pancreatic function. Inhibition of basal pancreatic secretion and increase of debit-hour of pancreatic enzymes in duodenal contents after stimulation of the pancreas was states, which corresponds to the intraoperatively obtained data. Conclusions. It was found out that functional activity of the pancreas was preserved in 83.3% of patients, which coincides with literature data on changes in the indices of pancreatic functional activity upon 90.0% lesion of its parenchyma.