Imaging of Fibrosis in Chronic Pancreatitis

Chronic pancreatitis (CP) describes long-standing inflammation of the pancreas, which leads to irreversible and progressive inflammation of the pancreas with fibrosis. CP also leads to abdominal pain, malnutrition, and permanent impairment of exocrine/endocrine functions. However, it is difficult to assess CP pathologically, and imaging modalities therefore play an important role in the diagnosis and assessment of CP. There are four modalities typically used to assess CP. Pancreatic duct features are assessed with magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). However, ERCP is a rather invasive diagnostic modality for CP, and can result in adverse events such as post-ERCP pancreatitis. Computed tomography (CT) is often the most appropriate initial imaging modality for patients with suspected CP, and has high diagnostic specificity. However, CT findings typically only appear in advanced stages of CP, and it is difficult to detect early CP. Endoscopic ultrasonography (EUS) provides superior spatial resolution compared with other imaging modalities such as CT and magnetic resonance imaging (MRI), and is considered the most reliable and efficient diagnostic modality for pancreatic diseases. The EUS-based Rosemont classification plays an important role in diagnosing CP in clinical practice. Evaluation of tissue stiffness can be another option to assess the diagnosis and progression of CP, and MRI and EUS can be used to assess CP not only with imaging, but also with elasticity measurement. MR and EUS elastography are expected to provide new alternative diagnostic tools for assessment of fibrosis in CP, which is difficult to evaluate pathologically.

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

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.

Possibilities of life quality correction of patients with chronic pancreatitis in postoperative hypothyroidis

Aim: to study the quality of life and the emotional state of patients with chronic pancreatitis on the background of postoperative hypothyroidism and the possibility of effective rehabilitation.Materials and methods. 270 patients with chronic pancreatitis were examined, among which 40 patients with primary postoperative hypothyroidism, who made up group 1, group 2 included 30 patients without thyroid pathology. Patients underwent a blood test according to the main biochemical parameters, hormonal blood count, ultrasound of the thyroid gland, hepatobiliary and duodenal zone. The study of quality of life and psychoemotional state by tests.Results In patients with chronic pacreatitis in combination with postoperative hypothyroidism among diseases of the hepatoduodenal zone, chronic non-calculous cholecystitis and non-alcoholic fatty liver disease were identified that are clinically characterized by abdominal pain syndrome according to the GSRS questionnaire. Patients revealed mild depressive state, high levels of personal and situational anxiety. The quality of life of patients was reduced both in physical and in psychological components, due to indicators of role-playing physical and emotional functioning. Against the background of treatment with a combination of succinate-containing drugs, the severity of depression, situational and personal anxiety decreased, and role functioning due to physical and emotional state, social functioning increased.Conclusions: The use of combination therapy with sodium levothyroxine and ethylmethylhydroxypyridine succinate in patients with comorbid pathology during postoperative hypothyroidism improves the clinical picture, psychoemotional balance and quality of life.

Features of diagnosis and treatment of acute and chronic pancreatitis with primary hyperparathyroidism

Aim: To identify a connection between acute and chronic pancreatitis and primary hyperparathyroidism on the base of clinical cases. To consider the features of the diagnosis and treatment of acute and chronic pancreatitis with primary hyperparathyroidism.Materials and methods: Over the past 10 years, there have been observed 3 cases of pancreatitis with primary hyperparathyroidism. Two patients were diagnosed with chronic pancreatitis, one patient was diagnosed with acute destructive pancreatitis. Patients were undergoing surgery, parathyroidectomy was performed.Results: Primary hyperparathyroidism is rarely associated with the occurrence of acute or chronic pancreatitis, but hypercalcemia plays an important role in the pathogenesis of these diseases. Pancreatitis usually occurs in the late stage of hyperparathyroidism, which explains the low prevalence of this association in developed countries, where primary hyperparathyroidism is diagnosed at an early stage of the disease.Conclusion: These clinical cases of radical surgical treatment of parathyroid adenoma associated with severe concomitant pathology testifies to the effectiveness of the surgical method in some cases. It is necessary to take into account severe concomitant pathology and diagnose and correct it in time.

Is it necessary to correct the intestinal microbiota disorders in chronic pancreatitis?

The frequency of intestinal microbiota disorders in patients with chronic pancreatitis (CP) is extremely high and can reach 97%. The bacterial overgrowth syndrome (SIBO) and the syndrome of increased epithelial permeability (SPEP), developing against the background of excretory insufficiency of the pancreas, affect the severity of the clinical picture of the disease, reduce the effectiveness of enzyme replacement therapy and generally contribute to the further progression of CP.The article presents a modern view on the mechanisms of the formation of SIBO and SPEP in CP. There is their aggravating effect on the course of the disease and the aggravation of disorders of the digestive and absorption processes that accompany them is shown and analyzed in the article.For decontamination of conditionally pathogenic and pathogenic flora, increasing the number and metabolic activity of indigenous microflora in patients with CP, the use of a non-absorbable broad-spectrum antibiotic rifaximin is effective. In order to restore the barrier function of the gastrointestinal mucosa, the drug of choice is rebamipid, a universal cytoprotector that affects all three levels of epithelial tissue protection (preepithelial, epithelial and subepithelial).Conclusion. CP is characterized by the complexity of its etiology and pathogenesis. Bacterial factors, in particular, SIBO and SPEP, play an essential role in the development of inflammatory changes in the pancreas. In the complex therapy of CP, it is advisable to take measures aimed at correcting disorders of the intestinal microbiota.

A brief review of clinical guidelines for the diagnosis and treatment of exocrine pancreatic insufficiency

In recent years, several consensus and guidelines for the diagnosis and treatment of chronic pancreatitis have been published. In 2017, the Russian and Pan-European (HaPanEU) consensus was published, in 2018 — the international consensus on minimal change pancreatitis, in 2020 — the clinical guidelines of the American College of Gastroenterology, in 2021 — the British clinical guidelines. Many of their provisions overlap. This review article analyzed the main provisions of the latest recommendations, taking into account the possibility of their adaptation to Russian clinical practice.