PATHOGENETIC RATIONALE FOR COMBINATION THERAPY OF PATIENTS WITH CHRONIC PANCREATITIS

Cover Page


Cite item

Full Text

Abstract

Background: Chronic pancreatitis is characterized by an imbalance of pro-inflammatory and anti-inflammatory cytokines, reflecting the presence of chronic systemic inflammation. The functional state of microbial-tissue complex of the intestine determines the severity of chronic systemic inflammation. Restoration of normal microbial-tissue complex functioning of the intestine reduces the severity of inflammatory changes in the pancreas.
Aim: To study clinical efficacy of combination of chronic pancreatitis through correction of the functional state of intestinal microbial-tissue complex.
Materials and methods: The analyzed patient sample included 117 patients with uncomplicated chronic pancreatitis and moderate pain syndrome, moderate exocrine and endocrine, with their mean age of 43.9 ± 11.6 years (men, 40.9 ± 13.5 years and women, 48.6 ± 11.7 years). Patients with chronic pancreatitis were divided into 2 groups, with the Results: After combination therapy of chronic pancreatitis with the agent for correction of the functional state of intestinal microbial-tissue complex, there was a significant (p < 0.05) reduction in the representation of pathogenic and conditionally pathogenic microflora, with a significant increase in the primary intestinal flora, as well as a decrease in cytokines TNF-α (74.32 ± 11.22 ng/ml before treatment, 31.34 ± 8.92 ng/ml after treatment) and IL-1β (25.32 ± 4.36 ng/ml before treatment, 10.52 ± 3.52 ng/ml after treatment), a significant decrease in cortisol (456.53 ± 68.99 nmol/ml before treatment, 382.61 ± 60.24 nmol/ml after treatment). The significant improvement of metabolic abnormalities was associated with positive clinical dynamics and improvement of quality of life.
Conclusion: Treatment strategies in chronic pancreatitis should include agents restoring the functioning of intestinal microbial-tissue complex and positively affecting metabolic and hormonal milieu.

About the authors

V. B. Grinevich

S.M. Kirov Military Medical Academy, Saint Petersburg

Author for correspondence.
Email: doctorsas@rambler.ru
Grinevich Vladimir Borisovich – MD, PhD, Head of Chair of Internal Disease No. 2 (Postgraduate Medical Training) Russian Federation

E. I. Sas

S.M. Kirov Military Medical Academy, Saint Petersburg

Email: doctorsas@rambler.ru
Sas Evgeniy Ivanovich – MD, PhD, Professor, Chair of Internal Disease No. 2 (Postgraduate Medical Training) Russian Federation

Yu. A. Kravchuk

S.M. Kirov Military Medical Academy, Saint Petersburg

Email: doctorsas@rambler.ru
Kravchuk Yuriy Alekseevich – PhD, Professor, Chair of Internal Disease No. 2 (Postgraduate Medical Training) Russian Federation

N. N. Shcherbina

S.M. Kirov Military Medical Academy, Saint Petersburg

Email: doctorsas@rambler.ru
Shcherbina Nikolay Nikolaevich – PhD, Associate Professor, Chair of Internal Disease No. 2 (Postgraduate Medical Training) Russian Federation

References

  1. Буклис ЭР, Ивашкин ВТ. Хронический панкреатит: этиология, патофизиология и консервативная терапия. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2006;16(6):79–86.
  2. Ammann RW. Diagnosis and management of chronic pancreatitis: current knowledge. Swiss Med Wkly. 2006;136(11–12):166–74.
  3. Banks PA. Classification and diagnosis of chronic pancreatitis. J Gastroenterol. 2007;42 Suppl 17:148–51.
  4. Seicean A, Tantău M, Grigorescu M, Mocan T, Seicean R, Pop T. Mortality risk factors in chronic pancreatitis. J Gastrointestin Liver Dis. 2006;15(1):21–6.
  5. Larsson SC, Permert J, Håkansson N, Näslund I, Bergkvist L, Wolk A. Overall obesity, abdominal adiposity, diabetes and cigarette smoking in relation to the risk of pancreatic cancer in two Swedish population-based cohorts. Br J Cancer. 2005;93(11):1310–5.
  6. Lindley KJ. Chronic pancreatitis. Indian J Pediatr. 2006;73(10):907–12.
  7. Lévy P, Barthet M, Mollard BR, Amouretti M, Marion-Audibert AM, Dyard F. Estimation of the prevalence and incidence of chronic pan creatitis and its complications. Gastroenterol Clin Biol. 2006;30(6–7):838–44.
  8. Ивашкин ВТ, Шифрин ОС, Соколина ИА. Хро нический панкреатит, стеатоз поджелудоч ной железы и стеатопанкреатит. М.: Литтер ра; 2014. 240 с.
  9. Malmstrøm ML, Hansen MB, Andersen AM, Ersbøll AK, Nielsen OH, Jørgensen LN, Novovic S. Cytokines and organ failure in acute pancreatitis: inflammatory response in acute pancreatitis. Pancreas. 2012;41(2):271–7. doi: 10.1097/ MPA.0b013e3182240552.
  10. Cani PD, Possemiers S, Van de Wiele T, Guiot Y, Everard A, Rottier O, Geurts L, Naslain D, Neyrinck A, Lambert DM, Muccioli GG, Delzenne NM. Changes in gut microbiota control inflammation in obese mice through a mechanism involving GLP-2-driven improvement of gut permeability. Gut. 2009;58(8):1091–103. doi: 10.1136/gut.2008.165886.
  11. Schnelldorfer T, Lewin DN, Adams DB. Reoperative surgery for chronic pancreatitis: is it safe? World J Surg. 2006;30(7):1321–8.
  12. Tsukumo DM, Carvalho BM, Carvalho-Filho MA, Saad MJ. Translational research into gut microbiota: new horizons in obesity treatment. Arq Bras Endocrinol Metabol. 2009;53(2):139–44.
  13. DiMagno MJ, Dimagno EP. Chronic pancreatitis. Curr Opin Gastroenterol. 2006;22(5): 487–97.
  14. Membrez M, Blancher F, Jaquet M, Bibilo ni R, Cani PD, Burcelin RG, Corthesy I, Macé K, Chou CJ. Gut microbiota modulation with nor floxacin and ampicillin enhances glucose tol erance in mice. FASEB J. 2008;22(7):2416–26. doi: 10.1096/fj.07-102723.
  15. Behrman SW, Mulloy M. Total pancreatectomy for the treatment of chronic pancreatitis: indications, outcomes, and recommendations. Am Surg. 2006;72(4):297–302.
  16. Domínguez-Muñoz JE, Iglesias-García J, Iglesias-Rey M, Vilariño-Insua M. Optimising the therapy of exocrine pancreatic insufficiency by the association of a proton pump inhibitor to enteric coated pancreatic extracts. Gut. 2006;55(7):1056–7.
  17. Маев ИВ, Кучерявый ЮА, Оганесян ТС, Москалева АБ, Трошина ИВ, Устинова НН, Куликовская НС. Фармакоэкономическая эффективность заместительной терапии различными препаратами панкреатина у больных хроническим панкреатитом с экзокринной панкреатической недостаточностью. Фарматека. 2010;(15):98–104.
  18. Маев ИВ, Свиридова АВ, Кучерявый ЮА, Гончаренко АЮ, Самсонов АА, Оганесян ТС, Устинова НН, Казюлин АН, Трошина ИВ, Москалева АБ. Длительная заместительная ферментная терапия различными препаратами панкреатина у больных хроническим панкреатитом с экзокринной недостаточностью поджелудочной железы. Фарматека. 2011;(2):32–9.
  19. Шифрин ОС, Ивашкин ВТ. Роль ферментных препаратов в лечении пациентов с болевой формой хронического панкреатита. Клинические перспективы гастроэнтерологии, гепатологии. 2009;(3):3–8.
  20. Белоусова ЕА, Никитина НВ, Цодиков ГВ. Оптимизация схем лечения хронического панкреатита ферментными препаратами. Фарматека. 2008;(13):103–9.
  21. Мишуровская ТС, Белоусова ЕА. Возможно сти применения гиосцина бутилбромида (Бускопан) в лечении больных хроническим панкреатитом. Фарматека. 2009;(13):45–9.
  22. Tytgat GN. Hyoscine butylbromide – a review on its parenteral use in acute abdominal spasm and as an aid in abdominal diagnostic and therapeutic procedures. Curr Med Res Opin. 2008;24(11):3159–73. doi: 10.1185/03007990802472700.
  23. Jindal RD, Keshavan MS. Critical role of M3 muscarinic receptor in insulin secretion: implications for psychopharmacology. J Clin Psychopharmacol. 2006;26(5):449–50.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2015 Grinevich V.B., Sas E.I., Kravchuk Y.A., Shcherbina N.N.

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