External secretory insufficiency of the pancreas. Chronic pancreatitis: exocrine insufficiency and its correction

14.02.2021

Description:

As the inflammatory process progresses in the pancreas in patients with chronic pancreatitis, the glandular (secretory) tissue of the organ is gradually replaced by connective, or scar tissue. As a result, the number of secretory (acinar) cells in the pancreas decreases, which, under physiological conditions, in response to the intake of food into the lumen of the duodenum, secrete a secret rich in digestive enzymes and alkali (pancreatic juice) into the intestine.

It contains the entire spectrum of enzymes capable of digesting proteins, fats, carbohydrates, but only lipase, an enzyme that breaks down fat into fatty acids and soaps in the presence of bile, does not have significant “understudies” in the digestive tract. Therefore, in conditions of a decrease in the number of secretory cells, a situation becomes more likely when the amount of juice released into the lumen of the duodenum is insufficient for the process of digestion and subsequent absorption, primarily fats and fat-soluble vitamins, and only then proteins, carbohydrates.

This condition is called exocrine pancreatic insufficiency. Further progression of inflammatory-cicatricial changes in the pancreas can lead to the addition of disorders of the endocrine function of the organ with development.

Symptoms:

The most typical manifestation of exocrine pancreatic insufficiency is poor tolerance to fatty foods, especially fried and smoked foods. As a result, the appearance after its consumption of a feeling of heaviness in the abdomen and abundant mushy "fatty" stools, the so-called pancreatic (fat excretion with feces). The frequency of bowel movements usually does not exceed 3-6 times a day. A fairly simple and easily identifiable criterion for increased "fat content" of feces is its ability to leave marks on the toilet, which are poorly washed off with water.

Perhaps the appearance of bloating and colicky pain in it. Limiting the intake of fatty foods, the intake of digestive enzymes (see below) helps to reduce the severity of these symptoms and even their disappearance.

Manifestations of a deficiency of fat-soluble vitamins in the body can be pain in the bones, their increased fragility and a tendency to convulsive muscle contractions (hypovitaminosis D), disorders in the blood coagulation system in the form of bleeding (hypovitaminosis K), disorders of twilight vision, or "night blindness", increased (hypovitaminosis A), susceptibility to infections, decreased libido, potency (hypovitaminosis E).

Pallor of the skin, palpitations, fatigue, decreased performance and other signs of B12 deficiency can be observed due to a violation of the absorption of the corresponding vitamin from food due to a lack of pancreatic proteases (enzymes that break down proteins). Decrease in body weight, as a result of insufficient intake of nutrients, indicates a pronounced exocrine pancreatic insufficiency.

Causes of occurrence:

Syndrome of primary exocrine pancreatic insufficiency (PE) is caused by a decrease in the mass of the functioning exocrine pancreatic parenchyma as a result of fibrosis, or a violation of the outflow of pancreatic secret into the duodenum (duodenum) due to blockage of the excretory ducts of the pancreas by calculus, tumor, thick and viscous secret. This is also characteristic of the later stages of CP (absolute primary pancreatic insufficiency) or, as a rule, pathology of the major duodenal papilla (relative primary exocrine insufficiency). Secondary mechanisms for the development of exocrine pancreatic insufficiency include cases when a sufficient amount of pancreatic enzymes enters the duodenum, which do not adequately participate in digestion due to insufficient activation, inactivation, and segregation disorders. The development of exocrine pancreatic insufficiency in patients after is based on several mechanisms, both primary and secondary.

Treatment:

For treatment appoint:

An integral component of the treatment of manifestations of exocrine pancreatic insufficiency is the correction of the regimen and diet. Among the main components of dietary and regime recommendations:
frequent (intervals no more than 4 hours) fractional (small) meals
avoid excessive food intake, especially in the evening and at night
limiting the consumption of fats, primarily from animals that have undergone heat treatment (roasting, smoking)
complete abstinence from alcohol

As for specific food products, their composition is quite individual and is selected jointly by the patient and the doctor, often empirically. Considering the important role of nutrition in the correction of manifestations of exocrine pancreatic insufficiency, the patient must first coordinate all issues related to the expansion of the diet and / or changes in the regimen with his attending physician.

In conditions of limited intake of fatty and, often, protein foods, carbohydrates come to the fore in providing the patient with energy. Of course, preference should be given not to refined carbohydrates (sweets), but to vegetables, fruits and cereals, as the main natural sources of not only plant fiber, but also the most important vitamins and microelements. However, not all patients with exocrine pancreatic insufficiency tolerate plant foods equally well. In some patients, while taking such useful and necessary products as beans, peas, various types of cabbage, eggplants, cereal flour products, etc., gas formation in the digestive tract increases, which negatively affects their well-being.

A possible alternative to them can be the regular consumption of food products containing high-quality fermented wheat bran "Rekitsen-RD" enriched with a vitamin and mineral complex. Their use in the diet of patients with exocrine pancreatic insufficiency will not only ensure the supply of sufficient energy to the body, but will also solve the existing problem of overcoming the deficiency of vitamins and micronutrients. In addition, such products are able to "unload" the pancreas, which will positively affect its functional activity.

The key drugs in the treatment of exocrine pancreatic insufficiency are digestive enzymes (pancreatin, mezim-forte, panzinorm-forte, creon, etc.). Between themselves, they differ only in the amount of lipase contained in them and additional ingredients (gastric enzymes).

These drugs must be taken with meals. The number of tablets or capsules per intake can vary widely from 1 to 3-4, depending on the volume and composition of the food. To the greatest extent, enzyme preparations are indicated when eating foods rich in fats, to a lesser extent, proteins.

The emphasis on the consumption of carbohydrate foods reduces the need for digestive enzymes, since the importance of the pancreas in their digestion is much less than proteins and, especially, fats. To increase the digestive capacity of digestive enzymes, they are taken with proton pump blockers (omeprazole, pantoprazole, lansoprazole, rabeprazole, esomeprazole), which create an alkaline reaction in the upper digestive tract, thereby favoring the action of enzymes.

A simple criterion for eliminating manifestations of exocrine pancreatic insufficiency with digestive enzymes is the disappearance of diarrhea and the normalization of body weight, as well as the disappearance of pancreatic steatorrhea according to the clinical analysis of feces and a decrease (normalization - less than 7 g) in fat content in feces per day.

This condition is called exocrine pancreatic insufficiency. Further progression of inflammatory-cicatricial changes in the pancreas can lead to the addition of endocrine dysfunction of the organ with the development of diabetes mellitus.

Clinical manifestations

The most typical manifestation of exocrine pancreatic insufficiency is poor tolerance to fatty foods, especially fried and smoked foods. As a result, the appearance after its consumption of a feeling of heaviness in the abdomen and abundant mushy "fatty" stools, the so-called pancreatic steatorrhea (fat excretion with feces). The frequency of bowel movements usually does not exceed 3-6 times a day. A fairly simple and easily identifiable criterion for increased "fat content" of feces is its ability to leave marks on the toilet, which are poorly washed off with water.

Manifestations of a deficiency of fat-soluble vitamins in the body can be pain in the bones, their increased fragility and a tendency to convulsive muscle contractions (hypovitaminosis D), disorders in the blood coagulation system in the form of bleeding (hypovitaminosis K), disorders of twilight vision, or "night blindness", increased dry skin (hypovitaminosis A), susceptibility to infections, decreased libido, potency (hypovitaminosis E).

Pallor of the skin, shortness of breath, palpitations, fatigue, decreased performance and other signs of B12-deficiency anemia can be observed due to a violation of the absorption of the corresponding vitamin from food due to a lack of pancreatic proteases (enzymes that break down proteins). Decrease in body weight, as a result of insufficient intake of nutrients, indicates a pronounced exocrine pancreatic insufficiency.

11. The concept of liver failure. Etiology, general manifestations.

ETIOLOGY : Most often it develops in the primary pore-

this organ: viruses (Botkin's disease), tumor, echinococcus, circus

rose. Quite often, liver failure develops in violation of

outflow of bile, due to compression or obstruction of the biliary tract. Maybe

poisoning with hepatotropic poisons, especially carbon tetrachloride,

chloroform, ether, benzene, mushroom poison. Often, liver damage is

due to changes outside this organ - shock of various etiologies, sepsis,

heart failure, collagenoses.

PATHOGENESIS: The pathogenesis is based on the phenomena of cytolysis of hepatic

cells. As a result of the action of all the above factors in the first

turn increases the permeability of the membranes of liver cells. Therefore, from outside

the cytoplasm of the liver cells receives sodium and water ions. Cells on-

thump. At the same time, cell organelles also increase in volume, especially

mitochondria and lysosomes. Due to swelling of mitochondria and decrease

ATP formation is aggravated by disorders of the permeability of cell membranes

bran, and edema increases, and as a result of increased membrane permeability

lysosomes and their subsequent rupture, a large amount enters the cytoplasm

the presence of enzymes, especially proteolytic ones, which, by lysing cells, form the phenomena of necrosis of hepatic cells. In connection with the violation of the functions of hepatocytes in liver failure, metabolic disorders come to the fore (see question 12)

The number of patients with organ pathology is only increasing every year; this is often associated with an increased growth of diseases due to exocrine pancreatic insufficiency.

Symptoms

Typical manifestations of insufficient organ functioning are associated with disturbances in the process of digestion of food. A person does not tolerate the use of fatty, fried and spicy foods.

After its adoption, there are complaints of heaviness in the epigastric region. The stool becomes unformed, plentiful, the color is faded, discolored and is poorly washed off the toilet. This is due to the presence of fat in the stool (steatorrhea). The frequency of bowel movements increases and can reach up to 6 times a day.

Moreover, the food is unable to be completely digested, the stool becomes mushy. The intestines are swollen from an excess of gases, painful colic is present.

The patient's body weight decreases, appetite disappears, weakness and decreased activity appear. Due to the low intake of fat-soluble vitamins, pain in the joints and bones occurs and osteoporosis develops, convulsive muscle contractions often join.

A lack of vitamin K leads to a decrease in blood clotting, vitamin A - increases dryness of the skin, and an insufficient amount of vitamin E increases the risk of infection, reduces libido and potency.

The patient looks pale and tired. There is shortness of breath, palpitations, fatigue.

Causes

The following mechanisms serve as the basis for the development of this state:

Violation in the development of the pancreas and the immaturity of the organ.
Destruction of acinar cells, which leads to a decrease in the production of enzymes.
Difficulty in the release of pancreatic juice into the duodenum.
Insufficient activity of enzymes due to low levels of enterokinase and bile.
The lack of protein nutrition leads to a violation of the synthesis of enzymes.
Dyskenesia of the small intestine and duodenum.

Absolute insufficiency

There are primary or absolute pancreatic insufficiency. It develops due to a decrease in the mass of the active tissue of the pancreas and is quite rare in practice.

Congenital diseases accompany absolute insufficiency:

gland hypoplasia,
hereditary pancreatitis,
cystic fibrosis,
anomalies of the pancreatic ducts,
lipase deficiency.

It can also be acquired diseases - acute and chronic pancreatitis.
Relative insufficiency

Secondary or relative exocrine pancreatic insufficiency is due to accelerated transit of intestinal contents. In this condition, the pancreas is not damaged, its functions are preserved, but for certain reasons, the enzymes do not perform their task.

What causes relative deficiency of the gland:

If the mucous membrane of the small intestine is damaged, the production of cholecystokinin and secretin is disrupted.
Decrease in intraduodenal pH less than 5.5, which inactivates enzymes.
A disorder of intestinal motility, which is why there is a violation when mixing enzymes with a food lump.
An overgrowth of bacteria in the small intestine leads to the destruction of enzymes.
Lack of bile and enterokinase.

Pancreatic insufficiency in children

Children's organism, as well as in adults, is prone to the development of diseases of the pancreas. The appearance and course of the disease is slightly different in the clinical picture.

Cystic fibrosis (cystic fibrosis)

In children, the occurrence of pancreatitis is associated with anatomical or structural anomalies of a congenital or genetic nature. The most common form of cystic fibrosis is a monogenic autosomal recessive disease.

The reason is a mutation in the gene responsible for the composition and function of the protein. This gene is located in the epithelial cells that line the excretory ducts of the pancreas, small intestine, bronchi, lungs, and genitourinary system. The task is to regulate the electrolyte exchange between the apical cells in which this gene is located and the intercellular fluid.

With cystic fibrosis, all organs and systems of the body are affected, which gives an unfavorable prognosis and a rather complicated course of the disease. The severity of the disease increases the damage to the respiratory and digestive systems. Severe exocrine pancreatic insufficiency is characteristic.

Clinical manifestations: steatorrhea, frequent bronchitis, pneumonia, atrophic gastritis, enterocolitis. Criteria for diagnosis, in addition to clinical indicators, chlorine in sweat fluid and gene analysis. Treatment involves large doses of pancreatic drugs, anabolic steroid drugs, diet, and vitamins.

Shwachman's syndrome

Another, no less complex Shwachman syndrome (Shwachman-Diamond), is congenital. It is expressed by lipase deficiency, that is, there is a lack of an enzyme that helps to digest, dissolve and divide fats into fractions.

In the process of embryonic development of the organism, a violation occurs during the laying of the pancreas, which leads to its hypoplasia (underdevelopment). Hematological shift is expressed by neutropenia, anemia and thrombocytopenia. In children with Shwachman's syndrome, there is a lack of growth, damage to the femoral head and knee joints, hypoplasia of the phalanges of the fingers, and a narrow chest.

Clinical manifestations: steatorrhea, diabetes mellitus, recurrent respiratory infections, otitis media, sinusitis, skin infections.

Treatment is with substitution therapy, pancreatic drugs, and sometimes antibiotics.

Acute pancreatitis develops in children very rarely, however, as well as chronic.

Chronic duodenitis is characterized by damage to the mucous membrane of the small intestine, its atrophy, which leads to a violation of the production of cholecystokinin and secretin, enzymes that regulate the production of pancreatic juice.

Deficiency also occurs due to inflammatory and ulcerative lesions of the stomach and duodenum, with increased acidification in the intestine, enzymes lose their activity, the process of digestion and assimilation of food suffers.

Deficiency is also caused by diseases of the liver and the bile duct system.

Causes of pancreatitis in children:

Anomalies in the development of the pancreas and its ducts.
Cholelithiasis (a growing number of diseases).
Duodenal obstruction.
Abdominal injuries, infections.
Intestinal diseases.

Therapy for exocrine insufficiency

There is no doubt that, along with diet, modern enzyme preparations, antisecretory and painkillers should be used for successful treatment.

In the treatment of exocrine pancreatic insufficiency, agents that contain pancreatin and pancrealipases are used. Mandatory components of medicines:

Lipase - breaks down fats.
Protease - proteins.
Amylase - breaks down carbohydrates.

The splitting goes to elementary particles, which then allows them to be transported through the intestinal mucosa into the circulatory system. The nutrition of the body improves, the material for building cells is supplied.

Effective drugs that contain pancreatic enzymes are activated in the duodenum. The drug lowers the pressure inside the pancreatic ducts, thereby stopping the pain.

All medicines are made in a shell that protects the enzymes from the damaging effects of hydrochloric acid in the stomach.

A positive effect in the treatment of exocrine pancreatic insufficiency is provided by multivitamin complexes with microelements, probiotic and choleretic agents.

Treatment with enzyme preparations is contraindicated in obstructive jaundice, patients with acute hepatitis and intestinal obstruction.

Diet

Treatment of insufficiency of the gland can not be carried out without observing the diet. Requirements for food: the most sparing mechanically and chemically. Subject to restriction: fats, spices, fried foods. Carbonated drinks are excluded. Reduce the intake of carbohydrates, whole milk. The patient should eat fractionally, in small portions.

Treatment becomes more productive during fasting days. Fasting for therapeutic purposes should be carried out from 1 to 3 days. It is necessary to take a large amount of liquid: pure water, weakly brewed tea, rosehip decoctions, compote, chamomile infusion, mineral water.

Compliance with the daily regimen, eating by the hour, treatment with medications give a positive effect, improve the patient's well-being. General strengthening activities improve the quality of life: walks, moderate physical education, therapeutic and relaxing baths.

Useful video about the pancreas

Pancreatic insufficiency is a condition of the body when it produces an insufficiency of enzymes to maintain the normal process of digestion. The disease is divided into several types, each of which has its own symptoms, causes of development and methods of treatment. The subsequent plan of therapy and stabilization of the patient's condition is based on determining the type of insufficiency.

Varieties of the disease and the main causes of its formation

Lack of pancreatic enzymes occurs in one in four people. Conventionally, doctors divide all types of insufficiency into 4 types:

enzymatic;
endocrine;
exocrine;
exocrine.

As for the main causes of the disease, doctors believe that an unbalanced diet is to blame in 80% of cases. Many people abuse fatty and salty foods. It loads the organ, which leads to the appearance of pancreatic changes and changes in the production of certain enzymes. Other causes of pancreatic insufficiency include:

hereditary predisposition to the development of this disease;
low hemoglobin level;
lack of vitamins and minerals;
inadequate intake and absorption of protein;
exposure to strong viruses.

Acute and chronic pancreatitis can also provoke pancreatic insufficiency. B-group vitamins are important for digestion. Without them, the liver, pancreas and other organs stop producing the necessary enzymes. If the amount of bile decreases, then the digestive process will be difficult. If pancreatic insufficiency is observed, the listed groups of vitamins are included in the diet. The most difficult thing is for people with a hereditary predisposition to pancreatic dysfunction. Proper nutrition and an active lifestyle will help to avoid them. The only way out is to undergo periodic medical examinations.

pancreatic insufficiency

“The pancreas was enlarged. Was not at one doctor. I even drank hormones. Then I decided not to go to the doctors so often. A month ago I quit smoking, began to actively go in for sports, eat more or less correctly. And most importantly, she began to drink Monastic Tea (I heard about it in Malakhov's program). And yesterday I went for a planned ultrasound, and they say to me: “Why did you decide to see a doctor at all - you don’t have any pathologies.” The pancreas is of normal size and hormones are normal!!! I was overwhelmed with happiness!
Svetlana Nikitina, 35 years old.
Nizhny Novgorod

Protein molecules and compounds are involved in the process of digestion of food. If a person has a lack of them, then pancreatic enzyme deficiency is formed. This disease is formed under the influence of drugs, certain types of infections, dysbacteriosis and congenital abnormalities in the structure of the organ. Its main symptoms include:

severe colic;
general weakness;
liquid stool;
increased gas formation;
nausea;
weight reduction;
appetite problems.

Enzymatic insufficiency of the pancreas is detected as a result of a blood test. Check the glucose content in the body. This way you can determine the amount of insulin produced. An important role in the study is played by the analysis of fecal masses. If it contains fat, then the patient suffers from insufficiency. It is treated with a high-calorie diet and taking medications containing enzymes necessary for digestion.

Exocrine insufficiency

This disease is characterized by insufficient production of enzymes necessary for processing nutrients from food. Exocrine pancreatic insufficiency is characterized by a gradual decrease in the number of cells that produce certain secrets. The first sign diseases - sensitivity to fatty and spicy foods. The body cannot digest it normally, so there are problems in the digestive tract. A person feels a constant heaviness in the stomach. Also, the patient is faced with the following manifestations of the disease:

pain in the bones;
loose and greasy stools;
convulsions;
rapid heartbeat.

Changes in blood counts. Against the background of poor digestibility, other anomalies develop. The main reason for the development of this disease is considered to be a reduction in the volume of the parenchyma. The disease is observed with the outflow of secretions into the duodenum. The treatment of certain diseases can provoke insufficient production of enzymes that process substances from food. Treatment of the disease is to normalize nutrition. Food is taken in small portions. It is necessary to exclude fatty, spicy and very salty foods from the diet.

endocrine insufficiency

Endocrine insufficiency in some sources is called intrasecretory. It is associated with a violation of the production of insulin, glucagon and lipocaine. These violations harm not only the digestive system, but the whole body. The main reason for the development of this form of the disease is damage to the areas of the pancreas that are responsible for the production of hormones. The disease is manifested by vomiting, fever, diarrhea and an increased amount of feces.

Treatment of the disease consists in the patient following a strict diet. The patient needs to monitor the level of sugar. To do this, not only foods containing sucrose are removed from the menu, but also those that cause sharp jumps in blood glucose levels. Preference is given to low GI foods. When they are used, the pancreas works less.

exocrine insufficiency

My friend persuaded me to try Monastic Tea. She had pancreatitis - and imagine, he was gone! Even her doctor was surprised. My diagnosis is inflammation of the pancreas. I have been suffering with this for a long time. Pills, droppers, hospitals have been the norm for me for the last 5 years. And it’s only been two weeks since I started drinking “Monastic Tea”, and I already felt much better. I hope to surprise my doctor at the next appointment.
Elena Shugaeva, 47 years old
St. Petersburg

This type of disease is characterized by insufficient production of juices for the digestive process. It is manifested mainly by flatulence, impaired stool and nausea. It does not arise spontaneously. It is preceded by the appearance of various anomalies in the work of organs. Problems with the stomach, the presence of foci of inflammation on the gland itself, malnutrition and problems with the functioning of the gallbladder lead to exocrine insufficiency.

If you have been diagnosed with this, then it is imperative to check your blood sugar levels. With an elevated sugar level, the patient is prescribed a strict diet. Also add vitamins to the diet AT and With groups. To improve digestion, doctors prescribe medications containing certain beneficial groups of enzymes to the patient.

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Syndrome of exocrine insufficiency

The syndrome of exocrine pancreatic insufficiency develops over time in almost all etiological forms of pancreatitis. It is caused by a decrease in the mass of the functioning exocrine parenchyma of the pancreas as a result of its atrophy and fibrosis, a violation of the outflow of pancreatic secretions into the duodenum with a blockage of the excretory ducts, as well as the development of dystrophic and atrophic changes in the mucous membrane of the duodenum. Insufficiency of the excretory function of the pancreas leads to a syndrome of malabsorption and trophological insufficiency. Persistent diarrhea with copious loose stools cause dehydration, with severe exocrine pancreatic insufficiency, dysbiotic disorders naturally develop, aggravating the course of the underlying disease.

Violation of carbohydrate metabolism

Violation of carbohydrate metabolism of varying severity in patients with pancreatitis is due to the fact that with OP and CP, not only the exocrine part of the gland suffers, but also the islets of Langerhans that produce insulin and glucagon. It should be borne in mind that the development of carbohydrate metabolism disorders can be facilitated not only by an absolute insulin deficiency due to destruction and sclerosis of the endocrine apparatus, but also by constitutional tissue insulin resistance, which occurs in a population in 10–12% of cases (much more often among obese individuals). The relationship between obesity and pancreatitis is also interesting in the aspect that initial obesity aggravates the course of pancreatitis and further prognosis. In other words, as the degree of obesity increases, the risk of developing complications of CP increases.

The development of endocrine insufficiency in CP can lead to paracrine effects of other hormones: sex, hormones of the hypothalamus and pituitary gland, adrenal glands, thyroid and parathyroid glands.

Pancreatogenic diabetes should not be associated with type 1 diabetes, in which more than 90% of 3-cells undergo destruction as a result of an autoimmune process. In CP, the degree of damage to the endocrine apparatus of the pancreas is usually less pronounced, residual insulin production is preserved. rare occurrence of ketoacidotic and hyperosmolar conditions, rare progression of microangiopathy.Another feature of diabetes in CP is the good tolerance of hyperglycemia up to 200 mg% (11.5 mmol / l).

Clinical manifestations of carbohydrate metabolism disorders in patients with CP are quite common (25%), especially with a long history of CP, in patients who have undergone massive pancreatic necrosis, in patients after pancreatic resection or pancreatectomy. Impaired carbohydrate tolerance can be detected in a much larger number of patients already at an early stage of CP. It is important to remember that it is carbohydrate metabolism disorders that occupy one of the leading positions in the causes of a decrease in the quality of life of patients with CP. The syndrome of endocrine disorders manifests itself in two variants - hyperinsulinism and pancreatogenic diabetes mellitus.

To eliminate endocrine insufficiency in OP or exacerbation of CP, fractional doses of simple insulin are used, the daily requirement most often does not exceed 20-30 IU, depending on the nature of the diet, the amount of glucose administered, the patient's physical activity and the initial level of glycemia. It is extremely dangerous to lower blood glucose levels below 80 mg% (4.5 mmol / l) due to the risk of hypoglycemia. During the period of remission of the disease with the stabilization of diabetes, you can try to transfer the patient to oral hypoglycemic drugs.

There is evidence that in patients with secondary diabetes mellitus against the background of CP, an improvement in carbohydrate metabolism (stabilization of the concentration of glucose in the blood plasma and the content of glycosylated hemoglobin) was noted with the appointment of replacement therapy with pancreatic enzymes. This allowed some authors to propose polyenzyme replacement therapy as an adjuvant treatment for pancreatogenic diabetes mellitus.

A promising direction in the treatment of severe diabetes mellitus is transplantation of donor islets or islet cells. A glorious problem with donor islet cell transplantation is that B-cells have limited (if any) proliferative potential, and experimental studies attempting to propagate B-cells in culture have been unsuccessful. Based on the phenomenon of insular neogenesis, there is a widespread opinion in the literature about the existence of progenitor cells in the pancreas.

Islet neogenesis has been experimentally induced in various models and has been described in pregnancy. A protein that stimulates islet neogenesis, the islet neogenesis associated protein (INGAP), has been isolated. The protein has been cloned, but it is still not known which of the pancreatic parenchyma cells is considered a potential precursor of islet cells.

This issue is being actively discussed. Some authors consider the ductal epithelium as a potential source of progenitor cells, based on the well-known fact of the close embryonic relationship between the islet and ductal epithelium and the results of individual experimental studies. Other authors consider the islet itself to be a zone of potential localization of progenitor cells.

The data obtained allow us to count on the emergence in the near future of methods applicable to wide practice for specific stimulation of pancreatic cells in order to transform them into functionally active β-cells. This approach can also be applied to transplanted islet cells, eliminating the need to transplant a large number of islets.

Pancreas cancer

In many diseases characterized by chronic inflammation (chronic gastritis, ulcerative colitis, Crohn's disease, Bsrrett's esophagus, etc.), the risk of developing malignant neoplasms is high. The most likely cause is cell proliferation and/or genome damage caused by inflammation. This relationship also exists in relation to pancreatic cancer, which develops against the background of CP.

The first report indicating a high risk of developing pancreatic cancer in CP patients was made by Rocca et al. in 1987. This relationship was further evaluated in a multicentre study by Lowenfels et al. The results were very impressive - approximately 4% of patients with CP develop pancreatic cancer within 20 years from the onset of the disease, which is 15-16 times higher than the incidence of pancreatic cancer in the general population. In all subsequent studies, this relationship was invariably confirmed with a slight variation in the data obtained within 0.8–8.3%.

To date, it has been unequivocally determined that the risk of developing pancreatic cancer significantly depends on the etiology of CP. In tropical pancreatitis, pancreatic cancer develops 100 times more often than in people without pancreatitis. In hereditary CP, there is also a high risk of developing pancreatic cancer: by the age of 70, pancreatic cancer develops in 40% of patients, reaching a total frequency of 53%. The frequency may be determined by the early age of clinical manifestation of CP and the long course of the disease.

In the last decade, the pathogenesis of cystic fibrosis has been deciphered. It was found that some CFTR mutations can lead to the development of CP, while the classical picture of cystic fibrosis does not develop, which significantly increases the life expectancy of patients. On the other hand, the improvement of therapeutic approaches has made it possible to significantly extend the life of patients with an advanced clinical picture of cystic fibrosis up to 50 years or more.

These patients have a high risk of developing pancreatic cancer. In other target organs (lungs, biliary tract) in patients with cystic fibrosis, no increase in the frequency of malignant tumors was noted, which suggests the organ-specificity of the oncological process.

The described complications and outcomes of pancreatitis largely determine both the clinical picture, the prognosis of the disease and the quality of life of patients, and the tactics of treatment. Despite the fact that most complications of CP require treatment in a surgical clinic, a significant part of them can be stopped by conservative measures under the joint supervision of gastroenterologists and surgeons. The severity of a number of complications requiring surgical treatment determines the need for the earliest possible diagnosis, therefore, the knowledge of the therapeutic profile of the features of the clinical picture by doctors can contribute to their timely detection, surgical treatment and a significant improvement in prognosis.

Maev I.V., Kucheryavy Yu.A.