scholarly journals Lactulose: a kaleidoscope of pleiotropic effects (literature review and own data)

2020 ◽  
Vol 47 (2) ◽  
pp. 89-99
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
G. M. Lukashevich
Keyword(s):  
Hepatic Encephalopathy ◽  
Pancreatic Insufficiency ◽  
Gallstone Disease ◽  
Bacterial Overgrowth ◽  
Sweet Taste ◽  
Exocrine Pancreatic Insufficiency ◽  
Therapeutic Effects ◽  
Overgrowth Syndrome ◽  
First Choice ◽  
Depth Analysis

The article presents in-depth analysis of literature data on the multifaceted effects of lactulose and the opportunities for its practical use. History of the study of lactulose therapeutic effects is described. Currently, lactulose as a medicine is registered in more than 100 states. Indications are constipation and hepatic encephalopathy, in some countries — treatment of salmonella carriage. However, the prospects and possibilities for the clinical use of lactulose are very broad. In 2005, lactulose was officially recognized as the first choice for chronic constipation from the point of view of evidence-based medicine. Mechanism of lactulose action in case of constipation is analyzed; literature data on its safety in pregnant women, children and the elderly are presented. Lactulose is superior to other treatment options for hepatic encephalopathy. It has been successfully used for any stage of severity of this condition, including latent encephalopathy and hepatic coma. The effectiveness and safety of lactulose in hepatic encephalopathy is confirmed by a large number of high-evidential studies. Possible indications are: as a prebiotic for the treatment of bacterial overgrowth syndrome, primary and secondary prevention of gallstone disease, for the elimination of endotoxemia in hepatorenal syndrome, exocrine pancreatic insufficiency, hypercholesterolemia. Despite its sweet taste, lactulose is not contraindicated, but, on the contrary, is useful in diabetes. Contraindications to treatment with lactulose are limited. The article also presents authors’ own data demonstrating the effectiveness of Medulak in a prebiotic dose in the treatment of chronic pancreatitis with exocrine pancreatic insufficiency combined with bacterial overgrowth syndrome.

scholarly journals Evidence-based pancreatology 2018 (review of research results on diseases and exocrine pancreatic insufficiency)

2019 ◽  
Vol 43 (2) ◽  
pp. 4-14
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
A. Ye. Klochkov ◽  
G. M. Lukashevich ◽  
P. G. Fomenko ◽  
...  
Keyword(s):  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Bacterial Overgrowth ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Tumors ◽  
Research Results ◽  
Enzyme Replacement ◽  
Pancreatic Pathology

The article presents a detailed review of the research results in the field of pancreatology published in 2018. Certain parts of the review are devoted to the pathogenesis, diagnostics, course of pancreatitis, its treatment, as well as autoimmune, hereditary pancreatitis, pancreatic pathology in children, as well as treatment. In studying the pathogenesis of pancreatitis, attention is paid to genetic markers of pancreatitis along with a role of bacterial overgrowth syndrome in the small intestine, both in terms of worsening of the course of pancreatitis and the lack of effectiveness of enzyme replacement therapy. The study of the role of alcohol abuse and smoking in the pathogenesis of pancreatic pathology is still in progress. Diagnostics is going on. Endosonography remains the most informative method. A number of studies have been devoted to the studying of exocrine and endocrine pancreatic insufficiency both upon pancreatitis, pancreatic tumors, and in functional dyspepsia and HIV infection. Autoimmune pancreatitis is increasingly being diagnosed, a number of studies are devoted to its diagnostics and treatment. Pancreatic diseases in children develop mainly on the background of genetic predisposition, while functional pancreatic insufficiency occurs in adult patients. The study of the peculiarities of the effect of enzyme replacement therapy continues. The immediate and remote results of the surgical treatment of pancreatic pathology are assessed.

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.

Prevalence and nutritional impact of small intestinal bacterial overgrowth (SIBO) and exocrine pancreatic insufficiency (EPI) in gastrectomized patients

Pancreatology ◽  
2017 ◽  
Vol 17 (3) ◽  
pp. S119-S120
Author(s):  
Ángeles Pérez Aísa ◽  
Leticia Mongil Poce ◽  
Julia Alcaide ◽  
Isabel Méndez Sánchez ◽  
Robin Rivera Irigoin ◽  
...  
Keyword(s):  
Pancreatic Insufficiency ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Exocrine Pancreatic Insufficiency ◽  
Intestinal Bacterial Overgrowth ◽  
Small Intestinal

scholarly journals Excessive Bacterial Growth Syndrome and Exocrine Pancreatic Insufficiency in Chronic Pancreatitis

2020 ◽  
Vol 16 (30) ◽  
pp. 56-64
Author(s):  
A.I. Levchenko ◽  
◽  
Yu.V. Osipenko ◽  
Yu.A. Kucheryavy ◽  
D.S. Bordin ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Clinical Symptoms ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Bacterial Overgrowth ◽  
Exocrine Pancreatic Insufficiency ◽  
Diagnostic Methods ◽  
Narcotic Analgesics ◽  
Potential Risk Factors ◽  
Fat Soluble Vitamins

Bacterial overgrowth syndrome (BOS) is characterized by clinical symptoms similar to those of exocrine pancreatic insufficiency (EPI) in chronic pancreatitis (CP). This phenomenon complicates differential diagnosis, especially when BOS and CP combined with EPI. BOS can contribute to the development of malabsorption and impaired digestion. As a result, it occurs diarrhea, steatorrhea, the lack of fat-soluble vitamins, as well as bloating and weight loss can be noticed. Pancreatic enzyme deficiency, alcohol abuse, use of narcotic analgesics to relieve abdominal pain, and proton pump inhibitors (PPIS) that cause drug hypochlohydria are predictors of the weakening of the gastroduodenal antibacterial barrier, and therefore potential risk factors for the development of BOS in CP, especially complicated by EPI. The lack of standard protocols and unified diagnostic methods does not provide the complete picture of the incidence of BOS in CP, and the available data are contradictory and heterogeneous. However, the verification of BOS in CP and way to correct it requires further research. Standardization of research methods and interpretation of results will allow implementing more specific and targeted treatment

scholarly journals News of European pancreatology (by materials of the 51st Meeting of the European Pancreatic Club)

2019 ◽  
Vol 45 (4) ◽  
pp. 6-16
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
G. M. Lukashevich ◽  
A. Ye. Klochkov ◽  
P. G. Fomenko ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Pancreatic Insufficiency ◽  
Bacterial Overgrowth ◽  
Basic Research ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Tumors ◽  
Modern Theory ◽  
Genetic Characteristics ◽  
Randomized Controlled Studies

This article presents an overview of the results of practical and basic research in the field of pancreatology, which were presented during the 51st Meeting of the European Pancreatic Club (2019). Achievements of leading European pancreatologists in the study of the etiology, pathogenesis, diagnosis, treatment of pancreatitis, pancreatic tumors are briefly described. The article presents clinical features of acute and chronic pancreatitis, depending on the variety of concomitant pathology, genetic characteristics, bad habits, drugs taken. New opportunities for the differential diagnosis of chronic pancreatitis and pancreatic cancer using miRNA are considered, as well as the feasibility of determining the soluble urokinase-type plasminogen activator receptor (suPAR) in order to differentiate benign and malignant pancreatic tumors. Approaches to the diagnosis of abdominal pain, use of computed tomography for the diagnosis of sarcopenia are described. Results of basic research analyzing the mechanisms of pancreatic cancer development are presented. Modern theory on the role of microbiota and syndrome of bacterial overgrowth in the pancreatic oncogenesis processes is revealed. Pathogenetic features of the formation of exocrine pancreatic insufficiency and effectiveness of its correction via enzyme replacement therapy with the use of modern drugs are emphasized. Results of randomized controlled studies that proved effectiveness and safety of microtablet preparation in correction of exocrine pancreatic insufficiency in patients undergoing pancreatoduodenectomy are presented.  

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