The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy

Khatkov, Igor; Маев, И. В.; Bordin, D.S.; Kucheryavyi, Yu A; Абдулхаков, С. Р.; Алексеенко, С. А.; Алиева, Э И; Alikhanov, R.; Бакулин, И. Г.; Baranovsky, A. Yu.; Белобородова, Е. В.; Belousova, Elena; Buriev, I. M.; Bystrovskaya, E. V.; Vertyankin, S. V.; Винокурова, Л. В.; Gal'perin, E I; Горелов, А В; Гриневич, В. Б.; Данилов, Михаил Владимирович; Дарвин, В. В.; Дубцова, Е А; Dyuzheva, T. G.; Егоров, В И; Ефанов, Михаил; Zakharova, Natalia; Загайнов, В. Е.; Vt, Ivashkin; Izrailov, R.; Korochanskaya, N. V.; Корниенко, Е. А.; Коробка, В. Л.; Kokhanenko, N. Yu.; Livzan, M. А.; Лоранская, И. Д.; Nikolskaya, K.А.; Mf, Osipenko; Okhlobystin, Alexey; Пасечников, В. Д.; Plotnikova, E. Yu.; Polyakova, S.; Саблин, О. А.; Симаненков, В. И.; Урсова, Н. И.; Tsvirkun, V.; Цуканов, В. В.; Шабунин, А. В.

doi:10.17116/terarkh201789880-87

Cited by 9 publications

(7 citation statements)

References 34 publications

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“…After the completion of PERT, a significant tendency towards an increase in BMI in patients was noted in both groups. In group I, this indicator increased from 21 22.0 (95% CI 19.97-24.08) kg/m 2 . At the same time, the duration of PERT (months) significantly correlated with the dynamics of the patient's body weight (r=0.4679; 95% CI 0.2384-0.6479, p=0.0002).…”

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confidence: 87%

“…Мальдигестия является типичным исходом ХП любой этиологии с длительным анамнезом, ведущим к прогрессированию мальнутриции [5,8]. Компенсация абсолютного дефицита панкреатических ферментов (ЗФТ) является единственно возможным путем коррекции панкреатической недостаточности и профилактики нутритивной недостаточности, что является базисом улучшения качества жизни больных ХП с ВНПЖ [14,16,22]. Однако многие пациенты с ХП в силу комплекса причин не получают адекватной ЗФТ и имеют редуцированный по калоражу и эссенциальным факторам пи-тания рацион, позволяющий минимизировать клинические маркеры мальабсорбции [5,7].…”

Section: îáñóAeäåíèåunclassified

“…Однако многие пациенты с ХП в силу комплекса причин не получают адекватной ЗФТ и имеют редуцированный по калоражу и эссенциальным факторам пи-тания рацион, позволяющий минимизировать клинические маркеры мальабсорбции [5,7]. Одной из ключевых причин недостаточной эффективности ЗФТ, а как следствие и прогрессирующей нутритивной недостаточности является неадекватное дозирование ферментных препаратов (использование низких доз) и неправильный выбор препаратов с использованием неэффективных форм панкреатина первых поколений в таблетированной форме [14,22,23]. Продемонстрированный в данном исследовании нативный эффект ЗФТ без таргетной или полипозиционной нутритивной поддержки лишний раз доказывает состоятельность ключевых положений международных и национальных консенсусов, ярко демонстрируя на национальном уровне легитимность реализации современных подходов к компенсации недостаточности функции ПЖ [14,16,22].…”

Section: îáñóAeäåíèåunclassified

“…Одной из ключевых причин недостаточной эффективности ЗФТ, а как следствие и прогрессирующей нутритивной недостаточности является неадекватное дозирование ферментных препаратов (использование низких доз) и неправильный выбор препаратов с использованием неэффективных форм панкреатина первых поколений в таблетированной форме [14,22,23]. Продемонстрированный в данном исследовании нативный эффект ЗФТ без таргетной или полипозиционной нутритивной поддержки лишний раз доказывает состоятельность ключевых положений международных и национальных консенсусов, ярко демонстрируя на национальном уровне легитимность реализации современных подходов к компенсации недостаточности функции ПЖ [14,16,22]. Полученные нами данные об эффективности ЗФТ в рамках коррекции показателей нутритивного статуса пациентов с ХП подтверждаются рядом иностранных работ [24][25][26].…”

Section: îáñóAeäåíèåunclassified

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The effectiveness of pancreatic enzyme replacement therapy using microencapsulated pancreatin preparations in the correction of nutritional status in patients with chronic pancreatitis: a prospective observational study

Bideeva

Маев

Kucheryavy

et al. 2020

Terapevticheskii arkhiv

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Aim. The goal is to evaluate the effectiveness of pancreatic enzyme replacement therapy (PERT) using microencapsulated pancreatin preparations for the correction of nutritional status in patients with chronic pancreatitis (CP) and associated exocrine pancreatic insufficiency (EPI). Materials and methods. The study included 58 patients with CP who were divided into two groups depending on the results of a laboratory assessment of indicators of nutritional status: group I (n=30) consisted of patients with CP and signs of EPI (according to low elastase test values) without deviations in nutritional status; Group II (n=28) consisted of patients with CP with a EPI and an abnormal nutritional status. In both groups, patients during the entire observation period (8-12 months) received PERT using microencapsulated pancreatin preparations at a dose adjusted for the severity of permanent residence permit. Before and after the PERT course, the dynamics of anthropometric [body weight, body mass index (BMI)] and laboratory indicators of nutritional status (total protein, albumin, vitamins D and B12, transferrin, iron and magnesium) were evaluated. Results. After the completion of PERT, a significant tendency towards an increase in BMI in patients was noted in both groups. In group I, this indicator increased from 21.45 [95% confidence interval (CI) 19.80-23.92] kg/m2 to 22.15 (95% CI 20.31-23.86) kg/m2, and in II group - from 19.22 (95% CI 18.33-21.99) kg/m2 to 22.0 (95% CI 19.97-24.08) kg/m2. At the same time, the duration of PERT (months) significantly correlated with the dynamics of the patient’s body weight (r=0.4679; 95% CI 0.2384-0.6479, p=0.0002). When assessing laboratory markers of nutritional status after PERT, a general tendency was found to increase the levels of total protein, albumin, vitamin D, magnesium, transferrin, and iron in both groups, however, statistically significant differences in the dynamics were observed mainly in group II patients. So, the level of total protein in group II increased from 69.05 (95% CI 65.6717-70.9000) g/l to 72.8 (95% CI 71.1358-74.9000) g/l, vitamin D - from 10.6 (95% CI 32.8397-38.9603) ng/ml to 17.1 (95% CI 12.0166-23.6232) ng/ml, magnesium - from 0.72 ( 95% CI 0.6892-0.7825) mmol/L to 0.795 (95% CI 0.7692-0.8800) mmol/L, and transferrin from 2.91 (95% CI 2.1800-3.3656 ) g/l to 2.92 (95% CI 2.4000-3.5200) g/l. Conclusion. A prospective observational study demonstrated the effectiveness of PERT using microencapsulated pancreatin preparations in the correction of nutritional status in patients with CP.

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confidence: 87%

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The effectiveness of pancreatic enzyme replacement therapy using microencapsulated pancreatin preparations in the correction of nutritional status in patients with chronic pancreatitis: a prospective observational study

Bideeva

Маев

Kucheryavy

et al. 2020

Terapevticheskii arkhiv

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“…ЭНПЖ характеризуется снижением активности ферментов ПЖЖ в просвете тонкой кишки, что вызывает нарушение процессов пищеварения [45].…”

Section: ýêçîêðèííàÿ íåäîñòàòî÷íîñòü ïîäAeåëóäî÷íîé Aeåëåçû (ýíïAe)unclassified

Pancreatic diseases and inflammatory bowel diseases: a random or regular combination?

Ахмедов

Гаус

2020

Terapevticheskii arkhiv

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Pathology of the pancreas in inflammatory bowel disease (IBD) is more common than in the general population and includes a wide range of manifestations from asymptomatic to severe disorders. Acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, exocrine pancreatic insufficiency, increased pancreatic enzymes and structural duct anomalies are often associated with IBD. They can be either a manifestation of IBD itself or develop independently.

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Possibilities of the early diagnosis and prognosis of complicated clinical forms of chronic pancreatitis

Tarasenko

Васильевич²,

Natalskiy

et al. 2021

I.P. Pavlov Russian Medical Biological Herald

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AIM: This study aimed to improve the methods for the diagnosis of complicated clinical forms of chronic pancreatitis (CP) by evaluating the clinical significance of the polymorphisms of the genes of cationic trypsinogen (PRSS1), pancreatic secretory trypsin inhibitor (SPINK1), transmembrane regulator of cystic fibrosis (CFTR), and alcohol dehydrogenase (ADH) in patients with complicated and uncomplicated forms of CP. MATERIALS AND METHODS: The study was carried out on the clinical base of the Department of Hospital Surgery, Ryazan State Medical University, Center for Surgery of Liver, Pancreas, and Biliary Tract in Ryazan in 20142019. A total of 108 patients of both genders aged 2565 years were examined. Of these patients, 38 were surgically treated for complicated CP, 20 had complicated CP without surgery, and 50 had uncomplicated CP (control group). A comparative clinical study with the control group of patients was performed, and the genotype was simultaneously determined on days 1 and 10 under controlled laboratory parameters. DNA was isolated from the leukocytes of the whole blood by using a DNA-expressing blood reagent (OOO NPF Litekh, Russia) for further analysis. RESULTS: No polymorphism of cationic trypsinogen PRSS1 gene and cystic fibrosis-2 CFTR2 gene was found. The predictive value of these polymorphisms was insignificant. For the polymorphism of CFTR1 cystic fibrosis-1 gene, the odds ratio was 0.444, but this finding was not significant. Among patients with the complicated clinical forms of CP, mutations were observed in the PRSS1 cationic trypsinogen gene (c2 = 6.453, p = 0.012) and ADH (c2=14.176, p = 0.001). Conversely, they were not detected in the CFTR-1 gene (c2 = 0.873, p = 0.351), CFTR-2 (c2 was not determined), and SPINK1 (c2 = 0.873, p = 0.351). The polymorphisms of the ADH and PRSS1 genes of cationic trypsinogen were associated with more evident structural changes in the parenchyma and ductal system of the pancreas. They also had a higher likelihood of complications, severe disease course, and a lower efficiency of conservative treatment. The polymorphism of the ADH gene increased the risk of the development of the cystic form of CP (c2 = 5.898, p = 0.016). CONCLUSION: The polymorphism of ADH and cationic trypsinogen genes should be determined and used for the complex diagnosis of CP to specify indications for the surgical treatment of patients with CP.

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The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy

Cited by 9 publications

References 34 publications

The effectiveness of pancreatic enzyme replacement therapy using microencapsulated pancreatin preparations in the correction of nutritional status in patients with chronic pancreatitis: a prospective observational study

The effectiveness of pancreatic enzyme replacement therapy using microencapsulated pancreatin preparations in the correction of nutritional status in patients with chronic pancreatitis: a prospective observational study

Pancreatic diseases and inflammatory bowel diseases: a random or regular combination?

Possibilities of the early diagnosis and prognosis of complicated clinical forms of chronic pancreatitis

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