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 Quality of Life Assessment after Pancreatic Enzyme Replacement Therapy in Chronic Pancreatitis

2003 ◽  
Vol 17 (10) ◽  
pp. 597-603 ◽  
Author(s):  
László Czakó ◽  
Tamás Takács ◽  
Peter Hegyi ◽  
László Prónai ◽  
Zsolt Tulassay ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Enzyme ◽  
Enzyme Replacement ◽  
Pancreatic Enzyme Replacement Therapy ◽  
Group 1

GOALS: To evaluate the quality of life (QoL) of patients with chronic pancreatitis before and after pancreatic enzyme replacement therapy in a prospective, multicentre, follow-up study.STUDY: Two groups of patients were evaluated. Group 1 consisted of 31 patients with newly diagnosed chronic pancreatitis who had never been treated with pancreatic enzyme preparations. Group 2 consisted of 39 patients whose disease was diagnosed on average 3.4 years before the start of the study. The latter group of patients had undergone pancreatic enzyme replacement therapy, but during follow-up this treatment proved to be insufficient. The dose of pancreatic enzyme replacement therapy was tailored in accordance with the degree of pancreatic exocrine insufficiency measured by means of exocrine pancreatic function tests. A modified European Organizaton for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) was used to assess QoL.RESULTS: The social functioning and financial strain were significantly better, while the levels of hope and confidence were significantly reduced in group 1 compared with group 2. A significant gain in body weight and a significantly reduced defecation rate were found in both groups one month after the beginning of the pancreatic enzyme replacement therapy when compared with the pretreatment values. The prevalence of general and disease-specific symptoms and the intensity of pain were reduced in both groups after one month of enzyme substitution therapy. The working ability, the financial strain and the overall QoL scores were improved significantly in both groups, while the cognitive functioning score was found to be significantly improved during the follow-up only in group 1. The overall increase in the QoL score correlated significantly with the increase in body weight and the decrease in defecation number in both groups.CONCLUSIONS: Pancreatic enzyme replacement therapy in patients with chronic pancreatitis not only reduced the extent of steatorrhea and pain, but also significantly improved a variety of other symptoms and the patient’s QoL. Individually tailored enzyme replacement therapy improved the QoL not only in the untreated chronic pancreatitis patients, but also in the inadequately treated group. This study demonstrated that the EORTC QLQ-C30 questionnaire, with the addition of two further questions about steatorrhea, is a useful tool for the evaluation of QoL in patients with chronic pancreatitis.

Strengthening the pharmacological potential of drug therapy in treatment of patients with chronic pancreatitis by using therapeutic physical factors

2020 ◽  
pp. 8-14
Author(s):  
R. M. Mallaeva ◽  
A. N. Makhinko ◽  
M. B. Uzdenov
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Drug Therapy ◽  
Clinical Manifestations ◽  
Medical Rehabilitation ◽  
Control Group ◽  
Physical Factors ◽  
Standard Drug ◽  
Pharmacological Potential

The purpose of the study is to improve rehabilitation treatment of patients with chronic pancreatitis (CP) at inpatient stage by strengthening pharmacological potential of drug therapy due to inclusion of therapeutic physical factors (TPF) in therapeutic programs. Materials and methods. 159 patients with acute CP were observed. By simple randomization, 4 groups were formed: the control group (MG, 39 people) received standard drug therapy; 1st comparison group (GC1; 38 people) additionally received TPF; GC2 (40 people) in addition to treatment in GC1 had drinking mineral water «Slavyanovskaya»; in main group (42 people) in addition to the treatment in GC2 got preformed peloidotherapy on the cervical-collar zone. All the patients underwent the evaluation of clinical score and quality of life before and after medical rehabilitation. Results. In MG, clinical symptomatology leveling was by 78,2% (p<0,01), in GC1 — by 71,5% (p<0,01), GC2 — by 62,3% (p<0,01), CG — by 57,2% (p<0,01) on average immediately after the treatment, which was in a clear correlation with indicators of quality of life. In the long term (in 6 and 12 months), the advantage of combination therapy was noted with the same validity, the preservation of the achieved positive result was mostly noted in the MG: after 6 months the improvement in physical health compared to the initial values was noted by 34,4% (p<0,01), after 12 months — by 24,0% (p<0,05); mental — by 32,3% (p<0,01) and 22,5% (p<0,05), respectively. In both comparison groups, positive dynamics was 10–12% lower, and in the control group, after 6 months, there was only a tendency to improve quality of life indicators. Conclusion. The inclusion of TPF in the programs of the inpatient stage of medical rehabilitation of patients with chronic pancreatitis by strengthening the pharmacological potential of drug therapy contributes to the leveling of clinical manifestations (abdominal pain, dyspepsia and diarrhea), the result of which is an improvement in the quality of life of this category of patients.

scholarly journals State of the Art in Exocrine Pancreatic Insufficiency

Medicina ◽  
2020 ◽  
Vol 56 (10) ◽  
pp. 523
Author(s):  
Carmelo Diéguez-Castillo ◽  
Cristina Jiménez-Luna ◽  
Jose Prados ◽  
José Luis Martín-Ruiz ◽  
Octavio Caba
Keyword(s):  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Bacterial Overgrowth ◽  
Exocrine Pancreatic Insufficiency ◽  
Enzyme Replacement ◽  
Non Invasive ◽  
Invasive Test ◽  
Pancreatic Enzyme Replacement Therapy ◽  
Risk Patients

Exocrine pancreatic insufficiency (EPI) is defined as the maldigestion of foods due to inadequate pancreatic secretion, which can be caused by alterations in its stimulation, production, transport, or interaction with nutrients at duodenal level. The most frequent causes are chronic pancreatitis in adults and cystic fibrosis in children. The prevalence of EPI is high, varying according to its etiology, but it is considered to be underdiagnosed and undertreated. Its importance lies in the quality of life impairment that results from the malabsorption and malnutrition and in the increased morbidity and mortality, being associated with osteoporosis and cardiovascular events. The diagnosis is based on a set of symptoms, indicators of malnutrition, and an indirect non-invasive test in at-risk patients. The treatment of choice combines non-restrictive dietary measures with pancreatic enzyme replacement therapy to correct the associated symptoms and improve the nutritional status of patients. Non-responders require the adjustment of pancreatic enzyme therapy, the association of proton pump inhibitors, and/or the evaluation of alternative diagnoses such as bacterial overgrowth. This review offers an in-depth overview of EPI in order to support the proper management of this entity based on updated and integrated knowledge of its etiopathogenesis, prevalence, diagnosis, and treatment.

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.

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 Pharmacological potential strengthening of drug therapy in treating patients with chronic pancreatitis by using therapeutic physical factors

2021 ◽  
Vol 19 (5) ◽  
pp. 293-298
Author(s):  
Raziyat M. Mallaeva ◽  
Anna N. Makhinko ◽  
Marat B. Uzdenov
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Drug Therapy ◽  
Clinical Manifestations ◽  
Medical Rehabilitation ◽  
Control Group ◽  
Physical Factors ◽  
Standard Drug ◽  
Pharmacological Potential

Background. The steady increase in the incidence of chronic pancreatitis, its aggressive course in recent years, as well as the insufficient therapeutic effect of standard techniques determine the relevance of the search for new approaches to the treatment and medical rehabilitation of this category of patients. Aims. To improve rehabilitation treatment of patients with chronic pancreatitis (CP) at inpatient stage by strengthening pharmacological potential of drug therapy due to inclusion of therapeutic physical factors (TPF) in therapeutic programs. Materials and methods. 159 patients with acute CP were observed. By simple randomization, 4 groups were formed: the control group (MG; n=39) received standard drug therapy; 1st comparison group (GC1; n=38) additionally received TPF; (GC2, n=40) in addition to treatment in GC1 had drinking mineral water "Slavyanovskaya"; in main group (n=42) in addition to the treatment in GC2 got preformed peloidotherapy on the cervical-collar zone. All the patients underwent the evaluation of clinical score and quality of life before and after medical rehabilitation. Results. In MG, clinical symptomatology leveling was by 78.2% (р 0.01), in GC1 by 71.5% (р 0.01), GC2 by 62.3% (р 0.01), CG by 57.2% (р 0.01) on average immediately after the treatment, which was in a clear correlation with indicators of quality of life. In the long term (in 6 and 12 months), the advantage of combination therapy was noted with the same validity, the preservation of the achieved positive result was mostly noted in the MG: after 6 months the improvement in physical health compared to the initial values was noted by 34.4% (р 0.01), after 12 months by 24.0% (р 0.05); mental by 32.3% (р 0.01) and 22.5% (р 0.05), respectively. In both comparison groups, positive dynamics was 1012% lower, and in the control group, after 6 months, there was only a tendency to improve quality of life indicators. Conclusion. The inclusion of TPF in the programs of the inpatient stage of medical rehabilitation of patients with chronic pancreatitis by strengthening the pharmacological potential of drug therapy contributes to the leveling of clinical manifestations (abdominal pain, dyspepsia and diarrhea), the result of which is an improvement in the quality of life of this category of patients.

scholarly journals Clinical course and approaches to the therapy of chronic pancreatitis in patients with comorbid pathology

2017 ◽  
Vol 36 (2) ◽  
pp. 45-48
Author(s):  
Т. А. Ruzhentsova
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Cardiovascular Diseases ◽  
Enzyme Replacement Therapy ◽  
Cardiovascular System ◽  
Replacement Therapy ◽  
Clinical Course ◽  
Enzyme Replacement

The features of pathogenesis, clinical course and diagnostics of chronic pancreatitis combined with diseases of the cardiovascular system are discussed in the article. Results of the author’s own research on the effectiveness of influence of enzyme replacement therapy on the course of pancreatitis and comorbid pathology are presented. Significant positive dynamics of both manifestations of chronic pancreatitis and cardiovascular diseases, laboratory and instrumental examinations, improvement of patients’ quality of life upon the prescription of pancreatin are noted.

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.

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