Aim:To estimate the frequency of occurrence malnutrition and efficacy its correction in chronic pancreatitis (CP).Materials and methods:148 patients were examined. Group I included 71 people with chronic alcoholic pancreatitis (CAP); group II — 77 patients with chronic obstructive pancreatitis (COP). Trophological status (TS) was investigated by criteria of V.M. Luft. Lymphocytes, pancreatic amylase, lipase, total protein, albumin, urine diastase and faecal elastase-1 were investigated before and after treatment. Two treatment options were used: combination therapy (CT, (Mezym-forte 10500 USP/day and pharmaconutrient Ensure 2 200 ml/day)) and high-dose pancreatic enzyme replacement therapy ((HD PERT), Kreon 120000 USP/day) for 10 weeks. 62 patients received HD PERT: 24 patients with CAP and 38 patients with COP; CT — 86 patients: 47 and 39, respectively.Results:The prevalence of malnutrition in patients with CP was 92% (n=136). Lymphopenia was determined in 44%, hypoproteinemia-in 11,5%, hypoalbuminemia-in 54%. 12 (8%) patients did not have malnutrition. In the group CAP: mild malnutrion was established in44, moderate — in 20, severe — 2, eutrophia — 6; in the group COP: mild malnutrion — in 33, moderate — in 37, severe — 0, eutrophia — 6. Aftertreatment in the group CAP: malnutrion moderate — in 7, mild — 58, eutrophia — 7, in the COP: malnutrion moderate — 37, mind — 31, eutrophy — 8.Conclusions:Malnutrition is frequent symptom complex in patients with CP. The severity of malnutrition is more severy in CAP. The most effective treatment malnutrition was CT in patients with CAP. HD PERT is indicated to correct exocrine pancreatic insufficiency.
The lecture contains current data on prevalence of malnutrition among patients with chronic pancreatitis. We discuss the main pathogenetic mechanisms, clinical variants, diagnostic approaches and treatment methods of malnutrition.
Eating disorder with its two extreme manifestations — obesity and trophological insufficiency (TI) — is one of the common problems of modern society. TI is often diagnosed in patients with chronic pancreatitis (CP); it occurs due to a limited amount of food intake, malabsorption, diabetes mellitus, and chronic alcoholism. TI severity correlates with severity of malabsorption and depletion of nutrients degree. However, TI verification in patients with CP is difficult due to the lack of uniform diagnostic recommendations. Anthropometric technique, laboratory (determination of the level of lymphocytes, albumin) and instrumental (computed tomography, X-ray absorptiometry, magnetic resonance imaging) diagnostics are usually used. The article presents a case report of combination of such two opposite states as obesity and malnutrition in a patient with CP. The patient was hospitalized with CP exacerbation and alcohol abuse. Examination revealed exocrine pancreatic insufficiency and mild malnutrition. Enzyme replacement therapy and additional oral sip feeding with a positive effect were prescribed. Exocrine pancreatic insufficiency stopped after 10 weeks of treatment, but malnutrition remained and required a longer course of treatment. Relevance of this problem, main difficulties of diagnosis are presented in the article. Anthropometric indices, body mass index, lymphocytes, total protein, albumin need to be measured in all patients. Using only body mass index leads to hypodiagnosis of malnutrition in patients with CP.
Background: Malnutrition is among the predictors of unfavorable outcome of chronic pancreatitis (CP). Our previous study has shown that the malnutrition prevalence in CP patients was 92%; body mass index (BMI) ≤ 19 kg/m2 was found only in 15.5%.Aim: To identify clinical variants of nutrition status in CP patients. Materials and methods: We have analyzed the data from the first step of an open-label randomized prospective study on 148 patients (80 male) with CP of various etiologies, aged from 22 to 82 years (mean age, 51.8 ± 13.2 years). According to TIGAR-O, the patients were allocated into two groups: the first group with chronic alcoholic pancreatitis (CAP) included 71 patients (57 male and 14 female, mean age 46.3 ± 11.2 years), the second one with chronic obstructive pancreatitis (COP) consisted of 77 patients (29 male and 48 female; mean age 56.81 ± 3 years). Exocrine pancreatic function was assessed by fecal elastase 1 levels. Nutritional status was determined by V.M. Luft classification based on comparison of various anthropometrical parameters, as well as on some laboratory parameters (hemoglobin, total protein, albumin levels, lymphocyte counts, etc.). The anthropometrical and laboratory parameters, as well as smoking and alcohol overconsumption were included into the correlational analysis.Results: In the CAP group, the number of smoking patients was 2.5-fold higher than that in the COP group (р < 0.001). The smokers had a lower BMI (р = 0.002) and lower pre-albumin levels (р = 0.04), compared to the non-smokers. There were associations between: the number of cigarettes per day and the daily amount of alcohol (r = 0.55), the smoking index and thickness of the skin/fat fold over the triceps muscle of the arm (r = -0.4), severity of chronic alcohol abuse and malnutrition grade (r = -0.5), duration of excess alcohol consumption and thickness of the skin/fat fold over the triceps (r = -0.4), hemoglobin levels and malnutrition grade (r = 0.5), hemoglobin level and shoulder circumference (r = 0.47), blood cholesterol level and shoulder circumference (r = 0.37), low density lipoprotein level and shoulder circumference (r = 0.41). Four basic clinical types of nutrition status could be identified: malnutrition of various grades (66%), overweight/obesity without malnutrition (3%), sarcopenic obesity with some malnutrition (26%), euthrophic type (5%). In the patients with malnutrition without sarcopenia, the etiology of CP had no effect on the prevalence of malnutrition. Low albumin levels were found in 54% (80/98) of the patients with pancreatic exocrine insufficiency and malnutrition, indicating a risk of sarcopenia. Sarcopenic obesity with malnutrition was most prevalent in COP (24 vs. 14 patients with CAP) and at higher age (56.8 vs. 46.3 years, respectively, р < 0.001).Conclusion: Smoking, chronic alcohol abuse, low hemoglobin levels are associated (negative correlation) with the development of malnutrition in CP patients. The most prevalent clinical types of nutrition status in CP patients are characterized by various degrees of malnutrition, as well as by malnutrition with sarcopenic obesity.
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