The Russian consensus on diagnosis and treatment of chronic pancreatitis: points of debate

Cover Page


Cite item

Full Text

Abstract

The most controversial provisions of the Russian Consensus on Diagnosis and Treatment of Chronic Pancreatitis (hereinafter, the Consensus) are presented. The debate has been initiated by the Russian Pancreatic Club and performed with the use of the Delphi system, based on interdisciplinary approach with participation of leading gastroenterologists, surgeons and pediatricians. This paper is the first in the series of the Consensus-related publications. Here we discuss the most controversial issues of Chapter 5 "Treatment of acute episodes" and Chapter 8 "Strategies of pain syndrome management". While discussing the conventional recommendation of a period of starvation for patients with clinical symptom of exacerbation of chronic pancreatitis, it was noted that for a long time it had been virtually the only way to provide functional rest for the pancreas. However, patients with chronic pancreatitis are frequently in malnutrition, therefore, starving may aggravate nutritional deficit that significantly affects the prognosis; therefore, early nutritional support is indicated. To alleviate functional strain of the pancreas, it is reasonable to use enteral nutrition elemental and semi-elemental formulas. The transition from formulas to conventional nutrition should be accompanied by administration of adequate pancreatin doses. The role of pancreatic enzymes, spasmolytics and proton pump inhibitors in the management of pain syndrome was also controversial.

About the authors

I. E. Khat'kov

Moscow Clinical Scientific and Practical Center, Moscow Healthcare Department, Moscow; Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow

Email: fake@neicon.ru
Khat'kov Igor' E. – MD, PhD, Professor, Director, Head of Chair of Faculty Surgery No. 22, President of the Russian Pancreatic Club Russian Federation

I. V. Maev

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow

Email: fake@neicon.ru
Maev Igor' V. – MD, PhD, Professor, Member-Correspondent of Russian Academy of Sciences, Prorector on Educational Work, Head of Chair of Internal Diseases Propedeutics and Gastroenterology Russian Federation

D. S. Bordin

Moscow Clinical Scientific and Practical Center, Moscow Healthcare Department, Moscow

Author for correspondence.
Email: d.bordin@mknc.ru

Bordin Dmitriy S. – MD, PhD, Head of Department of Pancreatic, Biliary and Upper Gastrointestinal Tract Diseases, Scientific Secretary of the Russian Pancreatic Club.

86 Shosse Entuziastov, Moscow, 111123, Russian Federation. Tel.: +7 (495) 304 95 51. E-mail: d.bordin@mknc.ru Russian Federation

Yu. A. Kucheryavyy

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow

Email: fake@neicon.ru
Kucheryavyy Yuriy A. – MD, PhD, Assosiate Professor, Chair of Internal Diseases Propedeutics and Gastroenterology Russian Federation

V. B. Grinevich

Kirov Military Medical Academy, Saint Petersburg

Email: fake@neicon.ru

Grinevich Vladimir B. – MD, PhD, Head of Chair of Internal Disease No. 2 (Postgraduate Medical Training).

In The name of the Russian Expert Consensus Panel for Diagnosis and Treatment of Chronic Pancreatitis

Russian Federation

References

  1. Linstone H, Turoff M, editors. The Delphi method: Techniques and applications. Available from: www.is.njit.edu/pubs/delphibook/
  2. Бордин ДС. Рекомендации Научного общества гастроэнтерологов России по диагностике и лечению хронического панкреатита (приняты 11-м съездом НОГР 2 марта 2011 года на заседании Российского панкреатического клуба). Экспериментальная и клиническая гастроэнтерология. 2011;(7):122-9.
  3. Toskes PP. Update on diagnosis and management of chronic pancreatitis. Curr Gastroenterol Rep. 1999;1(2):145-53.
  4. Afghani E, Sinha A, Singh VK. An overview of the diagnosis and management of nutrition in chronic pancreatitis. Nutr Clin Pract. 2014;29(3):295-311. doi: 10.1177/0884533614529996.
  5. Dominguez-Munoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-22.
  6. Hart PA, Bechtold ML, Marshall JB, Choud-hary A, Puli SR, Roy PK. Prophylactic antibiotics in necrotizing pancreatitis: a meta-analy-sis. South Med J. 2008;101(11):1126-31. doi: 10.1097/SMJ.0b013e31817ecbda.
  7. D'Haese JG, Ceyhan GO, Demir IE, Tieftrunk E, Friess H. Treatment options in painful chronic pancreatitis: a systematic review. HPB (Oxford). 2014;16(6):512-21. doi: 10.1111/hpb.12173.
  8. Frulloni L, Falconi M, Gabbrielli A, Gaia E, Graziani R, Pezzilli R, Uomo G, Andriulli A, Balzano G, Benini L, Calculli L, Campra D, Capurso G, Cavestro GM, De Angelis C, Ghez-zo L, Manfredi R, Malesci A, Mariani A, Mutig-nani M, Ventrucci M, Zamboni G, Amodio A, Vantini I; Italian Association for the Study of the Pancreas (AISP), Bassi C, Delle Fave G, Frulloni L, Vantini I, Falconi M, Frulloni L, Gabbrielli A, Graziani R, Pezzilli R, Capur-so IV, Cavestro GM, De Angelis C, Falconi M, Gaia E, Ghezzo L, Gabbrielli A, Graziani R, Manfredi R, Malesci A, Mariani A, Mutig-nani M, Pezzilli R, Uomo G, Ventrucci M, Zamboni G, Vantini I, Magarini F, Albarello L, Alfieri S, Amodio A, Andriulli A, Anti M, Ar-cidiacono P, Baiocchi L, Balzano G, Benini L, Berretti D, Boraschi P, Buscarini E, Calculli L, Carroccio A, Campra D, Celebrano MR, Capurso G, Casadei R, Cavestro GM, Chilovi F, Conigliaro R, Dall'Oglio L, De Angelis C, De Boni M, De Pretis G, Di Priolo S, Di Sebastia-no PL, Doglietto GB, Falconi M, Filauro M, Frieri G, Frulloni L, Fuini A, Gaia E, Ghezzo L, Gabbrielli A, Graziani R, Loriga P, Macarri G, Manes G, Manfredi R, Malesci A, Mariani A, Massucco P, Milani S, Mutignani M, Pasqua-li C, Pederzoli P, Pezzilli R, Pietrangeli M, Roc-ca R, Russello D, Siquini W, Traina M, Uomo G, Veneroni L, Ventrucci M, Zilli M, Zamboni G. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis. 2010;42 Suppl 6:S381-406. doi: 10.1016/S1590-8658(10)60682-2.
  9. Chronic Pancreatitis German Society of Digestive and Metabolic Diseases (DGVS), Hoff-meister A, Mayerle J, Beglinger C, Buchler MW, Bufler P, Dathe K, Folsch UR, Friess H, Izbic-ki J, Kahl S, Klar E, Keller J, Knoefel WT, Layer P, Loehr M, Meier R, Riemann JF, Runzi M, Schmid RM, Schreyer A, Tribl B, Werner J, Witt H, Mossner J, Lerch MM. S3-Consensus guidelines on definition, etiology, diagnosis and medical, endoscopic and surgical management of chronic pancreatitis German Society of Digestive and Metabolic Diseases (DGVS). Z Gastro- enterol. 2012;50(11):1176-224. doi: 10.1055/s-0032-1325479.
  10. Brown A, Hughes M, Tenner S, Banks PA. Does pancreatic enzyme supplementation reduce pain in patients with chronic pancreatitis: a meta-analysis. Am J Gastroenterol. 1997;92(11):2032-5.
  11. Whitcomb DC, Lehman GA, Vasileva G, Mal-ecka-Panas E, Gubergrits N, Shen Y, Sand-er-Struckmeier S, Caras S. Pancrelipase de-layed-release capsules (CREON) for exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery: A double-blind randomized trial. Am J Gastroenterol. 2010;105(10):2276-86. doi: 10.1038/ajg.2010.201.
  12. Shafiq N, Rana S, Bhasin D, Pandhi P, Srivas-tava P, Sehmby SS, Kumar R, Malhotra S. Pancreatic enzymes for chronic pancreatitis. Co-chrane Database Syst Rev. 2009;(4):CD006302. doi: 10.1002/14651858.CD006302.pub2.
  13. Lerch MM, Bachmann KA, Izbicki JR. New guidelines on chronic pancreatitis: interdisciplinary treatment strategies. Chirurg. 2013;84(2):99-105. doi: 10.1007/s00104-012-2373-z.
  14. Mayerle J, Hoffmeister A, Werner J, Witt H, Lerch MM, Mossner J. Chronic pancreatitis definition, etiology, investigation and treatment. Dtsch Arztebl Int. 2013;110(22):387-93. doi: 10.3238/arztebl.2013.0387.
  15. de-Madaria E, Abad-Gonzalez A, Apari-cio JR, Aparisi L, Boadas J, Boix E, de-Las-Heras G, Dominguez-Munoz E, Farre A, Fernandez-Cruz L, Gomez L, Iglesias-Garcia J, Garcia-Malpartida K, Guarner L, Larino-Noia J, Lluis F, Lopez A, Molero X, Moreno-Perez O, Navarro S, Palazon JM, Perez-Mateo M, Sa-bater L, Sastre Y, Vaquero EC, Martinez J. The Spanish Pancreatic Club's recommendations for the diagnosis and treatment of chronic pancreatitis: part 2 (treatment). Pancreatology. 2013;13(1):18-28. doi: 10.1016/j.pan.2012.11.310.
  16. Ивашкин ВТ, Маев ИВ, Охлобыстин АВ, Кучерявый ЮА, Трухманов АС, Шептулин АА, Шифрин ОС, Лапина ТЛ, Осипенко МФ, Си-маненков ВИ, Хлынов ИБ, Алексеенко СА, Алексеева ОП, Чикунова МВ. Рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению хронического панкреатита. Роаийский журнал гастроэнтерологии, гепатологии, колопрок-тологии. 2014;24(4):70-97.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2016 Khat'kov I.E., Maev I.V., Bordin D.S., Kucheryavyy Y.A., Grinevich V.B.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies