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Chronic pancreatitis (CP) is characterized by disorders of the exocrine and endocrine functions of the pancreas. One of the manifestations of trophic insufficiency in patients with CP is endogenous and exogenous hypovitaminosis, in particular, ascorbic acid (vitamin C) deficiency. Unlike most animals, humans are unable to synthesize vitamin C endogenously due to the lack of the enzyme L-gulonolactone oxidase, which is necessary for the last step of ascorbic acid biosynthesis. Development of a mathematical prognostic model for predicting hypovitaminosis of ascorbic acid in patients with CP based on established predictive factors is an urgent task today. The objective: to develop a formula for predicting ascorbic acid deficiency in patients with CP based on established predictive factors. Materials and methods. 112 patients with CP and 30 practically healthy individuals were included in the study. During the study, the main clinical indicators affecting the course of CP were determined for the patients. Univariate regression analysis was performed to identify factors that could potentially affect ascorbic acid levels. A multivariate regression analysis was also performed, resulting in a multiple regression formula that identified a cohort of patients potentially with low ascorbic acid levels. Results. During the univariate correlation analysis, such indicators were established as the age of the patient with CP (R=-0.457) (р<0.05), the duration of CP (R=-0.478) (р<0.05), the functional capacity of the pancreas according to the point index of the coprogram (R=-0.372) (р<0.05), as well as the structural and morphological functional state of the pancreas according to ultrasound criteria expressed in points (R=-0.398) (р<0.05), total protein (R=0.370) (р<0.05), erythrocyte level (R=0.377) (р<0.05), ALT (R=-0.403) (р<0.05) and AST (R=-0.391) (p<0.05), which are predictors of vitamin deficiency for patients with CP. A multivariate regression analysis was performed to create a formula for predicting the level of ascorbic acid. Conclusions. The presence of ascorbic acid hypovitaminosis in patients with CP (p<0.001) indicates the need to study the level of this indicator for timely diagnosis and the appointment of appropriate treatment. For the personalized prediction of ascorbic acid deficiency in patients with CP the formulas are proposed that take into account the parameters of the course of CP, available for determination in the practice of primary care doctors: age of patients, duration of the disease, level of erythrocytes, quantitative value of ultrasound criteria, determination of coprogram criteria expressed in points. [ABSTRACT FROM AUTHOR]

Almost 15% of persons from 40 to 75 years old suffer from chronic pancreatitis (CP) in combination with metabolic syndrome (MS). Such patients are diagnosed with impaired glucose tolerance or type 2 diabetes mellitus (DM), abdominal obesity, dyslipidemia, arterial hypertension, hyperuricemia, microalbuminuria, etc. The objective: to determine the state of microbiocenosis (MBC) of the colon in CP depending on the presence of concomitant type 2 DM. Materials and methods. 137 outpatient patients with CP and with/without type 2 DM participated in the study. The study group included 112 patients with CP without exacerbation and with comorbid type 2 DM (compensation/subcompensation stage). The comparison group included 25 patients with isolated CP without exacerbation. Patients underwent bacteriological examination of stool with counting of the number of lacto- and bifidobacteria colonies, opportunistic microflora, Escherichia coli, hemolytic and other pathological microorganisms (staphylococci, fungi, etc.) according to a modern modification of the R. V. Epshtein-Litvak and F. L. Vilshanska method. Results. In the group of patients with CP, dysbiosis disorders were found in 72.0% of patients, and with comorbidity of CP and type 2 DM - in 84.8% of patients. In case of comorbidity, colon dysbiosis was deeper than in isolated CP: intestinal dysbiosis of degree I was determined in 56.3% of patients versus 48.0%, and intestinal dysbiosis of degree II was found in 28.5% of patients versus 24.0%. It has been proven that the presence of concomitant type 2 DM aggravated the degree of intestinal dysbiosis by 1.83 times. The results of assessing the state of disorders of colon microflora parameters and the severity of intestinal dysbiosis indicate the aggravating nature of comorbid type 2 DM in CP. Conclusions. In 72.0% of patients with CP, dysbiotic disorders of the large intestine of I-II degree were established, while in cases of combined CP and type 2 DM - in 84.8%. In the presence of comorbidity, colon dysbiosis was deeper than in isolated CP: I degree of intestinal dysbiosis was found in 56.3% of patients versus 48.0%, respectively, and II degree of intestinal dysbiosis was determined in 28.5% of patients versus 24.0%. It has been proven that the presence of concomitant type 2 DM aggravated the degree of intestinal dysbiosis by 1.83 times (p<0.0001). At the same time, there was a significant decrease by 1 order of magnitude in the content of lacto- and bifidobacteria, an increase in the amount of E. coli and lactose-negative E. coli by 1.52 and 2.59 times, respectively, as well as an increase in the content of Candida, Staphylococcus aureus, hemolytic and opportunistic microorganisms - by 2.56; 2.50; 2.69 and 2.94 times, respectively. [ABSTRACT FROM AUTHOR]

Aim. The purpose of the study is to determine the intensity of the manifestation of clinical syndromes in the comorbid course of chronic pancreatitis (CP) in patients with chronic obstructive pulmonary disease (COPD) in comparison with the isolated course of CP and to assess the intensity of the mutual burden syndrome. Material and methods. A prospective cohort study was conducted, analyzing the medical records of 212 inpatients. The first group comprised 96 individuals with an isolated course of chronic pancreatitis (CP), while the second group included 116 patients with CP and comorbid chronic obstructive pulmonary disease (COPD), categorized as Group E. The study focused on subjective manifestations of pain syndrome in CP, the extent of exocrine pancreatic insufficiency, clinical blood analysis, biochemical research regarding the content of markers indicating pancreatic enzyme deviation in the blood, and the level of elastase-1 in feces. Additionally, ultrasonographic examination of the organs in the abdominal cavity was performed. Results. Patients in group 2 exhibited manifestations of abdominal pain syndrome 1.2 times more frequently than those in group 1 (p < 0.05). The frequency of pain in the pancreas radiating to the right subcostal region was 1.9 times higher in group 2 compared to group 1 (p < 0.05), along with a 2.1 times increase in the symptom of girdled pain radiating to the back (p < 0.05). Although the frequency of dyspeptic syndrome was slightly higher in group 2 (1.3 times, p > 0.05), astheno-vegetative syndrome was significantly more pronounced, exceeding the frequency in group 1 by 1.7 times (p < 0.05). Ultrasonography parameters of the pancreas in both groups revealed characteristic signs of chronic pancreatitis (CP). The analysis of pancreatic functional state indicators during exacerbation indicated hyperenzymemia syndrome, with α-amylase activity significantly higher in patients of both groups compared to the control group – by 1.8 and 2.6 times, respectively (p < 0.05). Conclusions. CP with chronic obstructive pulmonary disease (COPD) is characterized by a significantly lower frequency of paroxysmal abdominal pain syndrome but a higher frequency of constant aching pain in the pancreas area. Additionally, it is associated with the maximum intensity of inflammation, hyperfermentemia, a decrease in the activity of elastase-1 in feces, and a higher intensity of astheno-vegetative, painful, dyspepsia, intoxication syndromes. Moreover, there is a more pronounced exocrine dysfunction of the pancreas and more significant changes in the sonographic structure of the pancreas compared to cases with the isolated course of CP.

Background. The frequency of chronic pancreatitis (CP) comorbidity with chronic obstructive pulmonary disease (COPD) has significantly increased recently. It may be accompanied by changes in oxidant-antioxidant homeostasis and activates a cascade of reactions of mutual burdening of these pathologies. The purpose of the current research was to evaluate the intensity of lipid peroxidation, oxidative modification of proteins and the state of individual factors of the antioxidant defense system in the development and course of CP, depending on the comorbid COPD. Materials and methods. Three hundred and seventeen patients were examined, including 62 patients with CP alone (group 1), 132 CP patients with comorbid COPD (group 2), 123 patients with COPD alone (group 3). The content in blood of isolated double bonds in compounds, conjugated dienes, ketodienes and conjugated trienes, malonic aldehyde, nitrites/nitrates, reduced glutathione, the activity of catalase, glutathione-S-transferase, glutathione peroxidase were evaluated in all patients. Results. In CP patients with comorbid COPD, the maximum oxidative stress intensity among the compared groups was registered. There was a reliable increase in the content of malonic aldehyde — by 2.0 times (p

Background. Chronic hepatitis C (СHC) is often complicated by the presence of concomitant gastrointestinal diseases, one of which is chronic pancreatitis (CP). This has a negative impact on the clinical course of both diseases, contributes to nutrient deficiencies, in particular vitamin D, and worsens the quality of life of patients. The aim of the research was to study the features of the clinical course of CHC in comorbidity with CP and to evaluate the quality of life in patients with different levels of vitamin D in blood serum. Materials and methods. The study included 120 patients who were divided into 2 groups: group 1 — 72 patients with CHC and CP and group 2 — 48 patients with CHC. In turn, patients of group 1, depending on the enzymatic activity of the pancreas, were divided into group 1a (n = 52), which included patients with CHC and CP with exocrine insufficiency (EI), and group 1b (n = 20) — patients with CHC and CP with preserved exocrine function of the pancreas. In all patients, fecal coproscopy was performed, the level of fecal elastase (FE-1), vitamin D, viral load was determined, and the degree of fibrosis and necroinflammatory activity was evaluated using FibroTest and ActiTest. Situational anxiety was assessed according to the Spielberger-Hanin method, and quality of life using the SF-12 questionnaire. The analysis and processing of the results of the examination of patients was carried out using the computer program Jamovi 2.3.2.1, Microsoft Office Excel for Windows 2016 using the Kruskal-Wallis method, the Mann-Whitney-Wilcoxon criterion and the Pearson correlation coefficient. The difference was considered to be statistically significant at p A2) and a high viral load have lower levels of vitamin D than those with initial stages of fibrosis and less severe necroinflammatory process in the liver. Patients with CHC, CP and exocrine insufficiency complained of mood changes, increased anxiety, rapid fatigue, and muscle weakness significantly more often than those with preserved exocrine function and patients with CHC. The level of vitamin D in people with CHC, CP and exocrine insufficiency positively correlates with the level of FE-1. In all patients with CHC in comorbidity with CP, a negative effect of low levels of vitamin D on indicators of quality of life and anxiety was found. Conclusions. A reduced level of vitamin D in the blood of patients with CHC and CP worsens the course of the disease and is associated with a decrease in quality of life.

Background. The specific role and place of genetic factors in the development of chronic pancreatitis and hypothyroidism, which determine the activity of glutathione antioxidant protection, have not been clarified. They are interconnected with changes in the fat and carbohydrate metabolism, and also affect the transport and signaling pathways of key nutrients for the work of the immune, endocrine and nervous systems. The purpose of the study is to investigate the selenoprotein P (SEPP1) (rs7579) gene polymorphism and expression in patients with chronic pancreatitis combined with hypothyroidism. Materials and methods. Forty-nine patients with chronic pancreatitis and hypothyroidism and 30 practically healthy individuals passed the screening stage. The SEPP1 (rs7579) gene polymorphism was determined by the polymerase chain reaction. Results. The study showed that out of 98 isolated alleles in patients with chronic pancreatitis and hypothyroidism and 60 alleles of the control group, the G allele of the SEPP1 gene (rs7579, 25191G/A) dominated over the A allele: in the examined patients — by 34.7 % (χ2 = 23.59; p

Background. Viral hepatitis C (HCV) is not only as a liver disease but also as a systemic (generalized) infection that affects ot­her organs, in particular, the pancreas and gastroduodenal zone. The state of the gastrointestinal mucosa in combined course of chronic pancreatitis (CP) and chronic HCV is little studied, but extremely relevant, as it is important for the clinical course, the quality of life of patients, as well as for assessing the safety of the performed (etiotropic, etc.) and planned restorative comprehensive treatment of such patients. The purpose is to evaluate the morphological changes of the gastroduodenal mucosa of patients with chronic pancreatitis associated with chronic viral hepatitis C who were treated etiotropically. Materials and methods. Thirty patients with CP and 65 patients with CP in comorbidity with chronic HCV after etiotropic treatment of HCV were examined. Regardless of the HCV genotype, they received a course of treatment with sofosbuvir at a dose of 400 mg and velpatasvir 100 mg in the morning after meals for 3 months (some patients took daclatasvir at a dose of 60 mg also in the morning after meals for 3 months instead of velpatasvir). The period after diagnosed and treated HCV before the examination was on average (2.35 ± 0.61) years. All patients underwent a morphological study of gastric and duodenal biopsy samples obtained by esophagogastroscopy. The prepared samples were evaluated according to the international OLGA and OLGIM systems based on the evaluation of 5 gastric biopsies (1 from the corner of the stomach, 2 from the body, and 2 from the antrum) with a description of the main pathomorphological changes evaluated on a visual analog scale. Alcian yellow and toluidine blue were used to detect H.pylori. An own system for assessing the morphological state of the gastroduodenal mucosa was also proposed. Results. The detected structural changes indicate the presence of chronic atrophic gastritis with moderate dysplasia of the glandular epithelium. Stage of chronic gastritis according to the OLGA system was III. Stage of chronic gastritis according to the OLGIM system was III. Thus, the practically asymptomatic course of quite significant gastroduodenal changes in CP combined with chronic HCV requires additional therapeutic influence, as well as an assessment of comprehensive treatment based on the effect on the gastroduodenal mucosa. In case of changes in gastroduodenal mucosa in CP on the background of chronic HCV, in contrast to those with isolated CP, a significantly higher level of inflammatory infiltrate density (moderate (2+) vs. mild (1+)) is determined, which is accompanied by moderate neutrophilic infiltration (2+) vs. mild (1+) and mild lymphohistiocytic infiltration (1+) versus no such infiltration (0), the appearance of intestinal metaplasia (2+) and moderate non-metaplastic glandular atrophy (2+) versus the absence of metaplasia (0) and mild non-metaplastic glandular atrophy (1+), as well as zones of metaplastic atrophy (1+), which was manifested by the appearance of Paneth cells and goblet cells. In CP with chronic HCV, mucosa has atrophic changes. Metaplasia is manifested by a change in cellular phenotype: complete intestinal metaplasia type I–II is manifested by the appearance of Paneth cells and goblet cells; incomplete — by the presence of columnar epithelium and goblet cells; colonic metaplasia — by enlargement of the glands and the absence of Paneth cells. Conclusions. It was proved that the state of the gastric and duodenal mucosa in the group of patients with CP and chronic HCV was significantly severe than that in isolated CP: lymphohistiocytic infiltration of the mucous membrane was detected 2.68 times more often, non-metaplastic infiltration glandular atrophy (there was practically no glandular atrophy in the group of isolated CP) — 12.65 times more often, metaplastic atrophy (it was not detected in the group of CP) — 10.64 times more often, acute leukocyte infiltration — 2.31 times more often, dysplasia of the mucosal epithelium (with isolated CP, mild dysplasia was detected) — 7.30 times more often, erosion of the mucosal epithelium — 3.07 times more often, focal hyperplasia of the glands — 3.88 times more often, intestinal metaplasia — 12.89 times more often, which was practically absent in CP. In general, the total number of pathological signs of the mucous membrane in the group of CP with comorbid chronic HCV was found to be 2.76 times higher than that in isolated CP.

Background. The specific role and place of genetic factors in the development of chronic pancreatitis and hypothyroidism, which determine the activity of glutathione antioxidant protection, have not been clarified. They are interconnected with changes in the fat and carbohydrate metabolism, and also affect the transport and signaling pathways of key nutrients for the work of the immune, endocrine and nervous systems. The purpose of the study is to investigate the selenoprotein P (SEPP1) (rs7579) gene polymorphism and expression in patients with chronic pancreatitis combined with hypothyroidism. Materials and methods. Forty-nine patients with chronic pancreatitis and hypothyroidism and 30 practically healthy individuals passed the screening stage. The SEPP1 (rs7579) gene polymorphism was determined by the polymerase chain reaction. Results. The study showed that out of 98 isolated alleles in patients with chronic pancreatitis and hypothyroidism and 60 alleles of the control group, the G allele of the SEPP1 gene (rs7579, 25191G/A) dominated over the A allele: in the examined patients — by 34.7 % (χ2 = 23.59; p < 0.001), in the practically healthy group — by 53.34 % (χ2 = 34.13; p < 0.001). At the same time, the relative frequency of individual genotypes, as well as wild-type and mutant alleles, probably did not differ between the experimental and control groups. The A allele of the SEPP1 gene (rs7579) slightly increases the risk of chronic pancreatitis in the studied population, but non-significantly [risk ratio (RR) = 1.43; RR 95% CI (confidence interval): 0.91–2.26; odds ratio (OR) = 1.65; OR 95% CI: 0.88–3.08; p = 0.115]. Conclusions. In patients with chronic pancreatitis who are residents of Northern Bukovyna, mutation of the SEPP1 gene (rs7579, 25191G/A) in the homozygous state occurs with a frequency of 10.2 %, while it is absent in practically healthy people. In both groups, the G allele dominates over the A allele: in the examined patients — by 34.7 % (χ² = 23.59; p < 0.001), in controls — by 53.34 % (χ² = 34.13; p < 0.001). SEPP1 gene polymorphism (rs7579, 25191G/A) does not determine the risk of chronic pancreatitis in the population. However, the A allele increases the risk of hypothyroidism in chronic pancreatitis patients twice [OR = 2.0; OR 95% CI: 1.09–3.66; p = 0.023], with the lowest chances of its appearance in carriers of the G allele [OR = 0.50; OR 95% CI: 0.27–0.91; p = 0.023]. Mapping of the expression quantitative trait loci on both sides of the SEPP1 gene (rs7579) transcription start site evidenced 152 statistically significant cis-variants of rs7579 of the SEPP1 gene (SELENOP) associations with the expression of 20 genes in 35 different organs and tissues and 22 phenotypic traits. [ABSTRACT FROM AUTHOR]

Background. It was found that in 35–56 % of patients, hepatobiliary diseases are considered to be a factor causing the formation or exacerbation of chronic pancreatitis (CP) while reducing the share of pancreatitis of alcoholic etiology, as it was previously believed. However, the role of the alcohol factor and its consideration in the treatment strategy for CP and comorbidity with chronic viral hepatitis C (HCV) also needs to be clarified, because it is known that excessive alcohol consumption and smoking increases the risk of developing pancreatitis by 8–17 times. The purpose is to conduct a comparative analysis of parameters of the structural and functional state of the liver and pancreas in patients with chronic pancreatitis associated with chronic viral hepatitis C treated etiotropically, depending on the results of testing according to the international CAGE questionnaire. Materials and methods. We have examined 100 ambulatory patients with CP and concomitant HCV, treated etiotropically. All patients were examined according to generally accepted algorithms. To clarify the effect of alcohol on the formation of CP and the state of patients with treated HCV, latent craving for alcohol was verified using the international CAGE questionnaire. The study on the density of the liver parenchyma and the pancreas was carried out not only according to the ultrasound data in the B-mode, but also with the simultaneous shear wave elastography on the Ultima PA scanning ultrasound device with the further measurement of the median of the parameters in kilopascals. Determination of the pre­sence and depth of exocrine pancreatic insufficiency was carried out by the content of fecal elastase-1 evaluated using the enzyme immunoassay method. Results. Screening-testing of patients with CP on the background of HCV treated etiotropically using the CAGE scale made it possible to state that 65.0 % of them had a latent craving for alcohol, and 21.0 % of this cohort were women, which needs to be taken into account in the management of such patients. It has been proven that in the group with CAGE ≥ 2.0, functional and structural changes in the liver and pancreas were significantly more severe (deepening of the exocrine pancreatic insufficiency with a decrease in fecal α-elastase by 13.01 %, an increase in the total index of the coprogram by 15.11 % and the total ultrasound indicator of the pancreatic structure by 28.06 %, and the total ultrasound indicator of the liver structure by 40.68 % (р

Summary. The comorbidity of primary OA and diseases of the gastrointestinal tract, which EPI accompanies, is an extremely relevant, complex, and unstudied problem of modern medicine, as it has a number of unsolved problems both in the treatment and rehabilitation of such patients. Common pathogenetic mechanisms of the progression of such comorbidity often have a mutually aggravating effect, which requires further study. The aim of the study is to analyze the changes in indicators of exocrine pancreatic insufficiency (EPI) in patients with primary OA under the conditions of comorbidity with diseases of the gastrointestinal tract (GI). Research material and methods. 304 patients with primary OA in comorbidity with diseases of the gastrointestinal tract accompanied by non-exacerbation EPI were examined. The comparison group consisted of 30 practically healthy individuals who did not have clinical, anamnestic, and instrumental signs of diseases of the gastrointestinal tract and joints. Results and discussion. It was established that in patients with primary OA in comorbidity with diseases that are accompanied by EPI, the levels of EPI indicators were statistically significantly different depending on the etiology of EPI. Conclusion. Post hoc analysis established the ranking of the pathology of the gastrointestinal tract, accompanied by EPI, according to the indicators of EPI in primary OA, which was located as follows, starting from the highest: CP ˃ T2DM ˃ chronic non-calculous cholecystitis and functional diseases of the gallbladder and biliary system ˃ chronic gastroduodenitis (p ˂0.05).

Background. The article evaluates the impact of autonomic dysfunction according to the heart rate variability data and the Spielberger-Khanin questionnaire on the exocrine function of the pancreas in chronic pancreatitis (CP). The aim is to evaluate the exocrine function of the pancreas depending on the heart rate variability and survey using the Spielberger-Khanin questionnaire. Materials and methods. One hundred outpatients with a diag­nosis of CP who were treated in Ternopil healthcare institutions were examined. The presence of exocrine pancreatic insufficiency was determined by the level of fecal α-elastase. The psycho-emotional state was assessed using the Spielberger-Khanin questionnaire. Statistical and spectral indicators of heart rate variability were ana­lyzed: the range of variation, the amplitude of the mode, stress index, indicator of activity of regulatory systems, total spectrum power, absolute and percentage values of very low frequency (VLF), low frequency (LF), high frequency power (HF), the LF/HF ratio. A correlation analysis was performed of the obtained heart rate variability data, the Spielberger-Khanin questionnaire data with the degree of exocrine pancreatic insufficiency in terms of the level of fecal α-elastase. Results. The average value of reactive anxiety on the Spielberger-Khanin questionnaire is 44.33 ± 0.89, personal anxiety is 43.19 ± 0.82, which corresponds to the upper limit of the moderate level. A negative correlation was found between these parameters and the level of fecal α-elastase (r = –0.482, p

Recently, in medicine, the influence of infectious, hepatobiliary, gastric and duodenogenic factors for the formation and course of chronic pancreatitis (CP) and chronic hepatitis C virus (CHCV) which was treated etiotropically is increasingly being studied. Hepatitis C virus (HCV) is an important infectious factor in CP, for which the ability to chronic course has been proven. The condition of the mucous membrane of the organs in the gastroduodenal zone (GDZ) in the combined course of CP and HCV is important for the patient's quality of life, as well as for assessing the safety of the performed and planned restorative complex treatment of such patients. The objective: to analyze the dynamics of morphological changes of the mucous membrane in the gastrointestinal tract of patients with CP in comorbidity with etiotropically treated HCV under the influence of a protocol therapeutic complex with the additional inclusion of hepatotrophic drugs. Materials and methods. We analyzed the data of 55 patients with CP in comorbidity with HCV after etiotropic treatment of HCV, who were examined according to generally accepted algorithms and received a generally accepted complex of treatment according to the CP protocol. The patients were divided into two groups: the 1st group - 20 patients who received a generally accepted complex of treatment according to the protocol (PC) for 3 months; the 2nd group - 35 patients who received treatment according to the PC with the additional inclusion of a hepatotrophic agent for 3 months. In all the patients before and after treatment a morphological study of biopsies of the mucous membrane of the stomach and duodenum was performed. Results. In the course of the study, a significant improvement in the mucous membrane morphology of the GDZ of patients with a combination of CP and HCV was established after a course of treatment with the use of hepatoprotectors, namely: a decrease in lymphohistiocytic infiltration - by 3.97 times, restoration of the gland structure that did not undergo complete non-metaplastic atrophy - by 5,13 times, increased proliferation of the glandular epithelium as a sign of morphological restoration of the epithelium - 3.9 times, decrease in signs of epithelial dysplasia - 10.35 times, decrease in the number of erosions of the mucous membrane of the organs of the gastrointestinal tract - 2.6 times. Conclusions. The higher efficiency and safety of the complex treatment with the additional inclusion of a combination of hepatotrophic agents on the morphological condition of the mucous membrane of the organs of the gastroduodenal zone have been substantiated. [ABSTRACT FROM AUTHOR]

Despite the significant progress in the study of pancreatic gland (PG) pathology, the clinical symptoms and syndromes, as well as assessment of quality of life using the SF-36 and GSRS questionnaires in patients with chronic pancreatitis (CP) in combination with comorbid pathology of the organs of the gastroduodenal zone (GDZ) remain insufficiently studied and substantiated. The objective: to analyze the clinical symptoms and assessment of quality of life using the SF-36 and GSRS questionnaires in the comorbidity of chronic pancreatitis with H. pylori-associated chronic gastritis. Materials and methods. An examination and study of indicators of 30 outpatients with CP and 117 patients with CP in comorbidity with chronic gastritis (CG) associated with H. pylori was carried out. 87 (59.2%) men and 60 (40.8%) women from 19 to 76 years old (average age - 48.29±1.04 years) were the participants. The control group included 30 practically healthy persons, comparable in age and sex. The clinical manifestations of the participants of the study groups were analyzed. For a reliable assessment of the quality of life, groups of patients were compared: the control group, patients with CP and patients with comorbidities. The physical and psychological components were evaluated using the SF-36 questionnaire. Indicators of the quality of life components of patients according to the scales of the GSRS questionnaire were also studied. Results. Clinical symptomatology in the comorbidity of CP with concomitant gastroduodenal disorders had features compared to those in isolated CP. Painful, dyspeptic, enteropancreatic and asthenovegetative, anemic syndromes were more often detected in patients with CP and disorders of the gastrointestinal tract. It was found that the average total score of the physical component in patients with CP and comorbidity was significantly lower than that in the group of isolated CP according to the SF-36 questionnaire: the difference between the values of the average total score of the physical component of quality of life in patients of the comparison groups was 10.42 points (11.2%). Conclusions. The results of the study show that the difference between the total indicators of the scales of the psychological component of the quality of life according to the SF-36 questionnaire of the groups of patients with CP and patients with comorbidity is 9.71 (11.5%). This proves that the psychological state of patients with CP with accompanying gastroduodenal changes is significantly worse. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MS) is the most urgent problem of modern medicine, which is associated with an unhealthy lifestyle. This is a complex metabolic disorder based on insulin resistance and compensatory hyperinsulinemia. MS is a risk factor for the development of a significant number of various diseases. The objective: to determine the structural and functional state of the liver and pancreatic gland (PG) in patients with chronic pancreatitis (CP) depending on the presence of MS. Materials and methods. 137 patients with CP of biliary genesis (CBP) were included in the study. Patients were divided into two groups: the 1st group - 22 persons with isolated CBP, the 2nd group - 115 patients with CBP+MS. The control group included 20 practically healthy subjects. The age of the study participants ranged from 30 to 71 years. The presence of MS was determined, the state and structure of the PG and liver were examined. Results. A statistically significant higher content of HbA1c was determined in patients with CBP and MS compared to the group of patients with only CBP (6.10±0.14% vs. 5.47±0.15%). A significantly higher blood glucose level was found in the patients with CBP+MS (5.99±0.29 mmol/l vs. 5.31±0.12 mmol/l) compared to patients with CBP. A significantly higher level of the HOMA index was also determined in the group of patients with CBP+MS compared to the CBP group (2.60±0.10 vs. 1.84±0.09). A higher level of liver stiffness was found in patients with CBP compared to the control group. The indicator of fecal α-elastase in patients with CBP+MS was 114.52±2.79 mcg/g, which was significantly lower than that in the group of patients with CBP without MS (158.60±5.55 mcg/g). Conclusions. In the presence of MS in patients with chronic biliary pancreatitis, more significant structural disorders in the liver and pancreas were established in the direction of increased density according to shear wave elastometry. The results of the study demonstrated the aggravating effect of concomitant MS on the structural state of the liver and on the structural and functional state of the pancreas in patients with chronic biliary pancreatitis. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is a disease that is accompanied by systemic inflammatory response syndrome and polysystemic dysfunction. Often acute pancreatitis leads to damage to various organs, including: pleura, mediastinum, cardiovascular structures. These complications cause difficulties in diagnosing and treating patients. In this review, we discuss the complications of acute pancreatitis, focusing on the diagnosis and treatment of pancreatopleural fistulas. Pancreatopleural fistula is a rather rare complication observed in patients with both acute and chronic pancreatitis due to traumatic or iatrogenic damage to the pancreatic duct. Conservative treatment with ocreatid combined with stenting of the pancreatic duct currently makes it possible to achieve closure of the fistula in 31-45% of cases, surgical intervention – in 80-90% of cases. The clinical case presented in this article demonstrates the successful treatment of this difficult complication of acute pancreatitis. The authors emphasized the need for timely diagnosis of this condition, as delaying adequate treatment can worsen the prognosis of recovery of patients with pancreatopleural fistulae. [ABSTRACT FROM AUTHOR]

Background. Viral hepatitis C (HCV) is not only as a liver disease but also as a systemic (generalized) infection that affects other organs, in particular, the pancreas and gastroduodenal zone. The state of the gastrointestinal mucosa in combined course of chronic pancreatitis (CP) and chronic HCV is little studied, but extremely relevant, as it is important for the clinical course, the quality of life of patients, as well as for assessing the safety of the performed (etiotropic, etc.) and planned restorative comprehensive treatment of such patients. The purpose is to evaluate the morphological changes of the gastroduodenal mucosa of patients with chronic pancreatitis associated with chronic viral hepatitis C who were treated etiotropically. Materials and methods. Thirty patients with CP and 65 patients with CP in comorbidity with chronic HCV after etiotropic treatment of HCV were examined. Regardless of the HCV genotype, they received a course of treatment with sofosbuvir at a dose of 400 mg and velpatasvir 100 mg in the morning after meals for 3 months (some patients took daclatasvir at a dose of 60 mg also in the morning after meals for 3 months instead of velpatasvir). The period after diagnosed and treated HCV before the examination was on average (2.35 ± 0.61) years. All patients underwent a morphological study of gastric and duodenal biopsy samples obtained by esophagogastroscopy. The prepared samples were evaluated according to the international OLGA and OLGIM systems based on the evaluation of 5 gastric biopsies (1 from the corner of the stomach, 2 from the body, and 2 from the antrum) with a description of the main pathomorphological changes evaluated on a visual analog scale. Alcian yellow and toluidine blue were used to detect H.pylori. An own system for assessing the morphological state of the gastroduodenal mucosa was also proposed. Results. The detected structural changes indicate the presence of chronic atrophic gastritis with moderate dysplasia of the glandular epithelium. Stage of chronic gastritis according to the OLGA system was III. Stage of chronic gastritis according to the OLGIM system was III. Thus, the practically asymptomatic course of quite significant gastroduodenal changes in CP combined with chronic HCV requires additional therapeutic influence, as well as an assessment of comprehensive treatment based on the effect on the gastroduodenal mucosa. In case of changes in gastroduodenal mucosa in CP on the background of chronic HCV, in contrast to those with isolated CP, a significantly higher level of inflammatory infiltrate density (moderate (2+) vs. mild (1+)) is determined, which is accompanied by moderate neutrophilic infiltration (2+) vs. mild (1+) and mild lymphohistiocytic infiltration (1+) versus no such infiltration (0), the appearance of intestinal metaplasia (2+) and moderate non-metaplastic glandular atrophy (2+) versus the absence of metaplasia (0) and mild non-metaplastic glandular atrophy (1+), as well as zones of metaplastic atrophy (1+), which was manifested by the appearance of Paneth cells and goblet cells. In CP with chronic HCV, mucosa has atrophic changes. Metaplasia is manifested by a change in cellular phenotype: complete intestinal metaplasia type I–II is manifested by the appearance of Paneth cells and goblet cells; incomplete — by the presence of columnar epithelium and goblet cells; colonic metaplasia — by enlargement of the glands and the absence of Paneth cells. Conclusions. It was proved that the state of the gastric and duodenal mucosa in the group of patients with CP and chronic HCV was significantly severe than that in isolated CP: lymphohistiocytic infiltration of the mucous membrane was detected 2.68 times more often, non-metaplastic infiltration glandular atrophy (there was practically no glandular atrophy in the group of isolated CP) — 12.65 times more often, metaplastic atrophy (it was not detected in the group of CP) — 10.64 times more often, acute leukocyte infiltration — 2.31 times more often, dysplasia of the mucosal epithelium (with isolated CP, mild dysplasia was detected) — 7.30 times more often, erosion of the mucosal epithelium — 3.07 times more often, focal hyperplasia of the glands — 3.88 times more often, intestinal metaplasia — 12.89 times more often, which was practically absent in CP. In general, the total number of pathological signs of the mucous membrane in the group of CP with comorbid chronic HCV was found to be 2.76 times higher than that in isolated CP. [ABSTRACT FROM AUTHOR]

Background. According to evidence, within approximately 8 years, 50 % of patients with chronic pancreatitis (CP) develop endocrine and exocrine insufficiency, which manifests itself as steatorrhea, weight loss, diabetes mellitus (DM), and nutritional disorders. Diabetes mellitus aggravates these phenomena, which deepens the disorder of metabolic processes in CP, inclu­ding protein metabolism. Protein structures include components of the kallikrein-kinin system (KKS), which plays a role in the regulation of vascular tone, diuresis, inflammation, coagulation, and pain reception. Due to repeated exacerbations of pancreatitis, there is fibrosis of the pancreas, which increases the risk of insulin resistance and the formation of type 2 diabetes. Thus, di­sorders of the kallikrein-kinin system and the progression of CP are interrelated, which makes it important to study the state of KKS in CP, especially in combination with type 2 diabetes mellitus. The purpose is to investigate the state of the kallikrein-kinin system in chronic pancreatitis in outpatients, depending on the presence of concomitant type 2 diabetes. Material and methods. 137 outpatients with CP with concomitant diabetes mellitus and without dia­betes were studied: the main group — 112 patients with CP without exacerbation in combination with diabetes mellitus in a state of complete or subcompensation, and the comparison group — 25 patients with isolated CP. Evaluation of general and specific proteolysis (α1-proteinase inhibitor, α2-macroglobulin, kallikrein, kininase II activity, prekallikrein, plasma proteolytic activity) was performed by the method analysis using standard kits from BIOSERV ELISA. Results. There was a 20.8 % increase in the level of the total proteolytic activity of plasma in the group of patients with comorbidity of CP and diabetes mellitus compared with the group with isolated CP, 51.9 % increase in specific proteolysis (or kininogenesis) — the level of kallikrein (proteolysis enzyme), p

Background: Chronic pain is a serious problem occurring in patients suffering from pancreatic cancer or chronic pancreatitis. It often contributes to anorexia and significantly deteriorates the quality of life, including the possibility of shortening the survival of such patients. Thoracoscopic splanchnicectomy is a surgical procedure consisted of the excision of the major thoracic visceral nerve or its branches, which attend the transmission of pain stimuli from the abdominal viscera. Aim of the study: The study aim is to indicate benefits of videothoracoscopic splanchnicectomy as a procedure performed in chronic pain management in patients suffering from pancreatic cancer and chronic pancreatitis. Material and methods: The literature available in the databases such as PubMed, Google Scholar and polish scientific journals was reviewed, using the following keywords: videothoracoscopic splanchnicectomy, pancreatic cancer, chronic pancreatitis. Results and conclusions: Videothoracoscopic splanchnicectomy is a minimally invasive yet highly effective surgical procedure, which allows to avoid traumatizing procedures such as thoracotomy or laparotomy in patients suffering from a severe chronic pain associated with pancreatic cancer, chronic pancreatitis and other conditions. Moreover it contributes to a statistically significant decrease in pain intensity and considerably improves the quality of patients’ lives.

Background. It was found that in 35–56 % of patients, hepatobiliary diseases are considered to be a factor causing the formation or exacerbation of chronic pancreatitis (CP) while reducing the share of pancreatitis of alcoholic etiology, as it was previously believed. However, the role of the alcohol factor and its consideration in the treatment strategy for CP and comorbidity with chronic viral hepatitis C (HCV) also needs to be clarified, because it is known that excessive alcohol consumption and smoking increases the risk of developing pancreatitis by 8–17 times. The purpose is to conduct a comparative analysis of parameters of the structural and functional state of the liver and pancreas in patients with chronic pancreatitis associated with chronic viral hepatitis C treated etiotropically, depending on the results of testing according to the international CAGE questionnaire. Materials and methods. We have examined 100 ambulatory patients with CP and concomitant HCV, treated etiotropically. All patients were examined according to generally accepted algorithms. To clarify the effect of alcohol on the formation of CP and the state of patients with treated HCV, latent craving for alcohol was verified using the international CAGE questionnaire. The study on the density of the liver parenchyma and the pancreas was carried out not only according to the ultrasound data in the B-mode, but also with the simultaneous shear wave elastography on the Ultima PA scanning ultrasound device with the further measurement of the median of the parameters in kilopascals. Determination of the presence and depth of exocrine pancreatic insufficiency was carried out by the content of fecal elastase-1 evaluated using the enzyme immunoassay method. Results. Screening-testing of patients with CP on the background of HCV treated etiotropically using the CAGE scale made it possible to state that 65.0 % of them had a latent craving for alcohol, and 21.0 % of this cohort were women, which needs to be taken into account in the management of such patients. It has been proven that in the group with CAGE ≥ 2.0, functional and structural changes in the liver and pancreas were significantly more severe (deepening of the exocrine pancreatic insufficiency with a decrease in fecal α-elastase by 13.01 %, an increase in the total index of the coprogram by 15.11 % and the total ultrasound indicator of the pancreatic structure by 28.06 %, and the total ultrasound indicator of the liver structure by 40.68 % (р < 0.05)) and corresponded to the average degree of severity of the process in the pancreas according to the criteria of the Marseille-Cambridge classification, and in the group with CAGE < 2.0 — only to a mild degree. Conclusions. The negative effect of the factor of increased alcohol use according to the CAGE was proven by increased density of pancreatic echotexture by 5.73 % (p < 0.05), and of the hepatic echotexture by 5.16 % (p < 0.05). According to the results of the correlation analysis on the dependence of the structural state of the liver and pancreas on the CAGE score, which were R = 0.713, p < 0.05, and R = 0.686, p < 0.05, respectively, there was found a strong direct dependence of the structural state of the liver and pancreas on the CAGE score, which proved an independent, reliably significant role of alcohol consumption for patients with a comorbid course of CP and HCV. [ABSTRACT FROM AUTHOR]

110 patients aged 45-65 years with chronic pancreatitis were examined. The first group consisted of patients with a combined course of chronic pancreatitis with arterial hypertension; the second group - patients with chronic pancreatitis without concomitant hypertension. All patients were examined for total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol. Arterial stiffness was determined by the pulse wave velocity. It was found that patients of the 1st group had significantly higher levels of triglycerides (37.2%), low-density lipoprotein cholesterol (13%), total cholesterol (25%), atherogenic ratio (19.6%) and significantly lower levels of high-density lipoprotein cholesterol (15.4%). Correlations between age and the level of atherogenic ratio, low-density lipoprotein cholesterol were established – r=0.35; p

Background. The article evaluates the impact of autonomic dysfunction according to the heart rate variability data and the Spielberger-Khanin questionnaire on the exocrine function of the pancreas in chronic pancreatitis (CP). The aim is to evaluate the exocrine function of the pancreas depending on the heart rate variability and survey using the Spielberger-Khanin questionnaire. Materials and methods. One hundred outpatients with a diagnosis of CP who were treated in Ternopil healthcare institutions were examined. The presence of exocrine pancreatic insufficiency was determined by the level of fecal α-elastase. The psycho- emotional state was assessed using the Spielberger-Khanin questionnaire. Statistical and spectral indicators of heart rate variability were analyzed: the range of variation, the amplitude of the mode, stress index, indicator of activity of regulatory systems, total spectrum power, absolute and percentage values of very low frequency (VLF), low frequency (LF), high frequency power (HF), the LF/HF ratio. A correlation analysis was performed of the obtained heart rate variability data, the Spielberger-Khanin questionnaire data with the degree of exocrine pancreatic insufficiency in terms of the level of fecal α-elastase. Results. The average value of reactive anxiety on the Spielberger-Khanin questionnaire is 44.33 ± 0.89, personal anxiety is 43.19 ± 0.82, which corresponds to the upper limit of the moderate level. A negative correlation was found between these parameters and the level of fecal α-elastase (r = –0.482, p < 0.01, and r = –0.555, p < 0.01, respectively). Based on the heart rate variability of patients with CP, a tendency among them to sympathicotonia was detected, which was accompanied by a significant increase in the amplitude of the mode, stress index, the LF/HF ratio and a decrease in the range of variation compared to the control group. In contrast to the healthy individuals, the humoral-metabolic effect of heart rhythm regulation prevailed in those with CP (VLF — (48.66 ± 1.21) %) and the share of the nervous component (LF — (31.69 ± 0.67) %, HF — (19.65 ± 0.75) %) decreased, there was a significant decrease in the total power of the spectrum compared to the control group (1546.25 ± 44.18 versus 3155.65 ± 211.38). The indicator of the activity of regulatory systems in patients with CP (6.91 ± 0.12) was at the upper limit of the intense load of regulatory systems, which reflects a significant impairment of adaptation among them and reliably differs from the control level (3.90 ± 0.31). A significant correlation was found between the total power of the spectrum, indicator of the activity of regulatory systems and the level of fecal α-elastase (r = 0.511, p < 0.01, and r = –0.398, p < 0.01, respectively). Conclusions. During the study, it was found that with a deterioration in the psycho-emotional state (according to the data of the Spielberger-Khanin questionnaire), exocrine insufficiency of the pancreas in patients with CP increased: there was a correlation between the content of fecal α-elastase and the level of reactive and personal anxiety. Positive statistically significant correlations between the amplitude of the mode, stress index with the duration of the course of CP indicate compensatory activation of the sympathetic division of the autonomic nervous system. It was also proved that exocrine insufficiency (according to the content of fecal α-elastase) worsened with an increase in sympathicotonia (according to the stress index). A decrease in the functional reserve in patients with СР was revealed: a significant decrease in the total power of the spectrum was found compared to that of the control group; against this background, there was a decrease in the adaptive potential, deterioration in the psycho-emotional state, which resulted in an increase in exocrine pancreatic insufficiency. The obtained data motivate to improve the generally accepted comprehensive therapy of patients with chronic pancreatitis with the additional inclusion in it of agents to stabilize the autonomic nervous system. [ABSTRACT FROM AUTHOR]

Relevance. The variety of functional changes in internal organs characteristicofgeriatricage necessitates the search for drugs that can exert a multifaceted effect on various links in the pathogenesis of chronic pancreatitis (CP) in comorbidity with the most common diseases of the elderly. Purpose. Investigation of the effectiveness of the inclusion of a systemic enzyme therapy drug in the complex treatment of chronic pancreatitis in elderly patients. Materials and methods. We examined 77 patients with CP over the age of 66 years, the average age (71.3 ± 1.4) g. Group I of patients with CP (23 patients) - took aconventional therapeutic complex (MC) for three months: pantoprazole 40 mg on an empty stomach according to requirement, continuous enzyme replacement therapy with pure pancreatin in an adequate dose with each meal, prokinetics / or antispasmodics if necessary. Group II consisted of 34 patients with CP (MC + W), in addition to LK, the drug of systemic enzyme therapy (SET) Wobenzym, 5 tablets, was taken. three times a day for three months. The control group consisted of 20 patients without signs of pathology of the digestive system. The parameters of lipid metabolism were determined by the enzymatic-colorimetric method. The assessment of the depth of exocrine pancreatic insufficiency (PI) was determined by the level of fecal α-elastase (FαE) by enzyme-linked immunosorbentassay using standard BIOSERVELASTASE 1-ELISA kits. Statistical analysis was performed using Excel and the statistical package Statistica v. 5.0. Results. Additional inclusion of the drug SET (Wobenzym) in the generally accepted MC promoted a significant improvement in lipid profile parameters in elderly patients with CP, as well as a reliable correction of the excretory function of the P by the level of FαE (from the level of moderate to mild insufficiency). Conclusions. 1) The inclusion of Wobenzym in the general treatment complex contributed toa decrease in the levels of TC, βLP, TG and LDLP by 15.4%, 19.8%, 32.0% and 33.9%, respectively (p 0.05).

Background. According to evidence, within approximately 8 years, 50 % of patients with chronic pancreatitis (CP) develop endocrine and exocrine insufficiency, which manifests itself as steatorrhea, weight loss, diabetes mellitus (DM), and nutritional disorders. Diabetes mellitus aggravates these phenomena, which deepens the disorder of metabolic processes in CP, including protein metabolism. Protein structures include components of the kallikrein-kinin system (KKS), which plays a role in the regulation of vascular tone, diuresis, inflammation, coagulation, and pain reception. Due to repeated exacerbations of pancreatitis, there is fibrosis of the pancreas, which increases the risk of insulin resistance and the formation of type 2 diabetes. Thus, disorders of the kallikrein-kinin system and the progression of CP are interrelated, which makes it important to study the state of KKS in CP, especially in combination with type 2 diabetes mellitus. The purpose is to investigate the state of the kallikrein-kinin system in chronic pancreatitis in outpatients, depending on the presence of concomitant type 2 diabetes. Material and methods. 137 outpatients with CP with concomitant diabetes mellitus and without diabetes were studied: the main group — 112 patients with CP without exacerbation in combination with diabetes mellitus in a state of complete or subcompensation, and the comparison group — 25 patients with isolated CP. Evaluation of general and specific proteolysis (α1-proteinase inhibitor, α2-macroglobulin, kallikrein, kininase II activity, prekallikrein, plasma proteolytic activity) was performed by the method analysis using standard kits from BIOSERV ELISA. Results. There was a 20.8 % in crease in the level of the total proteolytic activity of plasma in the group of patients with comorbidity of CP and diabetes mellitus compared with the group with isolated CP, 51.9 % increase in specific proteolysis (or kininogenesis) — the level of kallikrein (proteolysis enzyme), p < 0.05. At the same time, a decrease in prekallikrein (inactive precursor of kallikrein) was found in the group of patients with comorbidity by 19.4 % compared to that in isolated CP (p < 0.05). The presence of dissociation of protective parameters of kallikrein-kinin system is proved; increase by 9.4 % of α1 -proteinase inhibitor content at comorbidity of CP and DM2 in relation to that in isolated CP; decrease in the content of α2 -macroglobulin in CP relative to the control group (p < 0.05), which showed a decrease in the body’s compensatory capacity in CP, at the same time found an increase in α2 -macroglobulin in the comorbidity of CP with DM2 by 49.5 % relative to isolated CP; reduction of kininase-II activity in CP and diabetes mellitus by 14.5 % relative to that in CP. Conclusions. Activation of KKS with multidirectional changes in KKS parameters and general and specific proteolysis in CP was noted. In CP and in the comorbid course with diabetes mellitus, further activation of proteolysis took place with the simultaneous inclusion of protective mechanisms for resolving inflammation and detoxification. Excessive production of kinins in concomitant DM2 has been proven, which weakened the body’s protective response. [ABSTRACT FROM AUTHOR]

The article describes and analyzes the results of bioelectrical impedance analysis in patients with chronic pancreatitis and chronic obstructive pulmonary disease considering the level of fecal elastase-1.The aim of our study was to investigate the features of Bioelectrical impedance analysis in patients with chronic pancreatitis (CP) and chronic obstructive pulmonary disease (COPD) considering the level of fecal elastase-1.Materials and methods. We examined 84 patients: 30 patients with CP and 54 patients with comorbid pathology - CP and COPD aged 30-65 years (52.36 ± 1.83 years). Patients were hospitalized in the gastroenterology department of theRegionalClinicalHospital,Chernivtsy,Ukraine with exacerbation of CP. COPD was in stable or unstable remission. Fecal elastase-1 level was determined by using the Pancreatic Elastase ELISA (BIOSERV Diagnostics). Biometric measurements were performed with a body composition analyzer BC-601 (TANITA,Japan). All examined patients were divided into groups depending on the exocrine pancreatic insufficiency (EPI): severe (n=9), moderate (n=34), mild (n=23) and normal (n=18).Results. The group of patients with severe EPI was characterized by weight loss. It can be explained by the appearance of absorption disorders of nutrients (malabsorption and maldigestion syndromes). In the groups of moderate and mild EPI fat and cell mass were significantly lower than normal rate in control group. There is a positive correlation between fecal elastase-1 and the level of patients’ metabolism (pConclusions. Bioelectrical impedance analysis (percentage of fat mass, visceral fat level and muscle mass) correlates with the level of fecal elastase-1, which can be used as an additional criteria for the severity of CP and for the control of the effectiveness of substitution therapy.

The origin of pain in jaundiced patients with the cancer of the pancreatobiliary zone and chronic pancreatitis hasn’t been entirely studied yet. The aim of the study was to assess the effect of cholemia on the severity of pain syndrome in patients with surgical pathology of the pancreas. The results of surgical treatment of 54 patients with chronic pancreatitis and 218 patients with pancreatobiliary cancer complicated by obstructive jaundice were analyzed. In these patients pancreatoduodenal resection was performed. The main group patients (112 patients) have been prepared to surgery by combination of conservative measures for express detoxification and decompression of the biliary tract. The control one (160 patients) – only conservatively. The severity of pain syndrome was assessed using a visual analogue scale. In main group, the initial level of total bilirubin was 274.3±5.9 μmol/L, direct – 211.2±2.2 μmol/L, indirect – 63.4±2.6 μmol/L. In the control group – 270.6±4.6 mmol/L, 206.3±2.4 mmol/L and 64.1±2.6 mmol/L. The intensity of pain syndrome on admission was 4.9±0.4 and 5.7±0.2 points in the main and control groups, respectively. Due to the preoperative preparation, there was a slight decrease in the intensity of pain according to the visual analogue scale (4.5±0.4 points in the main and 5.4±0.3 points in the control group). In the main group, the intensity of pain decreased, respectively, from 6.4±0.3 through 5.1±0.4 to 2.8±0.4 points. In the control group – from 8.6±0.4 through 6.7±0.5 to 3.1±0.2 points. A strong positive correlation between the intensity of pain syndrome and the level of cholemia was determined (r = 0.74 in the main and r = 0.79 in the control groups).

Paraduodenal pancreatitis (PDP) is a rare disease that develops as a result of chronic inflammation of the ectopically located pancreas in the duodenal wall. Aim. Present our own observations of paraduodenal pancreatitis as a rare pathological condition, its clinical and pathomorphological manifestations, methods of diagnosis and surgical treatment. Materials and methods. An analysis of clinical and instrumental studies and the results of surgical treatment was carried out in eight patients with PDP, who underwent pancreatoduodenal resection in the clinic of surgery and minimally invasive technologies of Zaporizhzhia State Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine and in the multidisciplinary clinical hospital VITACENTER (Zaporizhzhia) in 2015–2019 (6 patients), gastric resection according to Billroth 2 (1 patient), one patient refused surgery. All patients were examined by laboratory methods and modern methods of radiation diagnostics, pathomorphological examination of the operating material was performed in the pathological department of the Zaporizhzhia Regional Pathological Bureau. Paraffin sections for histopathological examination were stained with hematoxylin and eosin and analyzed using Leica DM2000Led microscope (Germany) with Leica MC190HD camera. Results. Preoperative diagnosis of PDP was established in 7 (87.5 %) patients, in 1 case, before the operation, the diagnosis was made of cystic tumor of the head of the PO. A characteristic feature of PDP on computer tomography was the presence of a thickened fibrous plate between the head of the pancreas (RV) and the duodenum (DPC), more pronounced in the venous phase, and the presence of cystic formations in the paraduodenal zone. Endoscopic examination revealed deformity with stenosis or submucosal formation in the descending part of the duodenum. Endoscopic ultrasound examination revealed a thickening of the duodenum wall with the presence of cystic formations. In macroscopic examination of the removed pathology specimen, the walls of the duodenum were thickened, with cicatricial changes and cystic cavities. The main pathological sign of PDP was the presence of ectopic foci of pancreatic acinar tissue and clusters of abnormal pancreatic ducts of various sizes with periductal chronic inflammation found in 4 (57.2 %) cases in the fibrously changed thickened wall of the duodenum. In all cases, in the fields of fibrosis and chronic inflammation, cysts of various sizes were found: ductal cysts lined with ductal epithelium, and acinar cysts without epithelial lining with thickened connective tissue walls (encapsulated foci of enzymatically self-destroyed pancreatic tissue). In 5 (62.5 %) patients in the area of pancreatic ectopia microscopy Brunner’s gland hyperplasia was revealed. In 6 (75 %) patients, chronic inflammation and dense fibrosis in the region of the pancreato-duodenal sulcus was revealed, as well as chronic inflammation and peri-intralobular fibrosis of the pancreatic head adhesion to the duodenum. Complications after pancreatoduodenectomy were observed in 2 (28.5 %) patients in the form of gastrostasis (type B according to ISGPS) and pancreatic fistula (type B according to ISGPF). In the long-term period, there was an improvement in the condition of 2 patients with stabilization of weight and an improvement in the functional state according to the scales of the SF-36 and EORTIC questionnaires. In other patients, the follow-up period does not exceed 1 year. Conclusions. The optimal method of clinical diagnosis of paraduodenal pancreatitis is endoscopic ultrasound, and its pathomorphological confirmation is the presence of ectopic pancreatic tissue or cysts in the duodenal wall, chronic inflammation and fibrosis, Brunner's gland hyperplasia, chronic inflammation in the area of pancreato-duodenal inflammation and fibrosis in the pancreatic head adhesion. The most justified method of surgical treatment of paraduodenal pancreatitis is still pancreatoduodenectomy.

Today, comorbidity has been recognized as a global problem of modern medicine around the world. The combined pathology of the thyroid gland and pancreas requires constant search and improvement of an individual approach to the treatment of patients and can improve large-scale socio-economic consequences. The article presents the analysis of quality of life (QL) of patients with comorbidity of hypothyroidism and chronic pancreatit is (CP). Materials and methods. The study included 62 inpatient patients with hypothyroidism and concomitant CP, who were treated at the gastroenterology center of the Yuriy Semeniuk Rivne Regional Clinical Hospital. The comparison group involved 48 patients with isolated CP. GSRS (Gastrointestinal Symptom Rating Scale) was used to evaluate the severity of gastroenterological symptoms and QL. Results. Analyzing the data of the GSRS questionnaire, it was found that in patients with hypothyroidism with concomitant CP, reflux, pain and dyspeptic syndromes were the most common clinical manifestations (p>0.05). According the GSRS questionnaire results, the clinical course of patients with the hypothyroidism was complicated by the comorbidity of the CP, namely: on the scale of gastric reflux - by 48.57 %, on a scale of dyspepsia - by 35.84 %, diarrhea - by 26.94 %, constipation - by 19.93 %, abdominal pain - by 40.81 %. Conclusions. As a result of the study, the lower level QL in patients with hypothyroidism with concomitant chronic pancreatitis (CP) was established compared to the isolated course of CP. It was determined that the comorbidity of hypothyroidism and CP leads to a complication of the clinical condition of patients. [ABSTRACT FROM AUTHOR]

Background. Chronic pancreatitis (CP) is characteri­zed by a progressive exocrine and endocrine insufficiency of the pancreas as evidenced by a lot of investigations data and expe­rience of practitioners. Polynutritional and trophological insufficiency develops as a common consequence of functional inability of the pancreas and requires adequate management. The purpose: to justify the expediency of using the modified bowel lavage me­thod for the treatment of maldigestion, polynutritional and trophological insufficiency in chronic pancreatitis, which appeared after acute pancreatitis. Materials and methods. The effectiveness of using the modified bowel lavage method to improve enteral digestion and decrease the signs of polynutritional and trophological insufficiency in CP, which developed due to acute pancreatitis, has been studied. Sixty patients with CP were examined, who have a history of acute pancreatitis. Group I (38 people) received common treatment for CP. Group II (22 individuals) received the set of treatment measures including traditional medicines and a course of modified bowel lavage, 1–5 procedures. Efficacy and duration of this regimen were determined by severity of clinical symptoms, laboratory, anthropometric and instrumental test data, which characterized the peculiarities of CP and polynutritional and trophological insufficiency manifestation in case of acute pancreatitis in the past medical history. Results. The proposed method of intestinal lavage has the following advantages: it allows increasing the time of intestinal lavage due to the pulsating flow of fluid, provides a gentle effect of washing on the intestinal mucosa, prevents additional traumatization of the intestine if such administration of medications is needed. The use of a double loop contour gives possibility to administrate the drugs immediately after lavage without removing the tube, thus preventing mixing and possible side effects when several drugs are used simultaneously. Conclusions. The conducted analysis of study data shows that C-reactive protein (CRP) level can be considered as a marker of the of intoxication and inflammation severity, as well as criterion for determining the number of the intestinal lavage procedures: in patients with CRP level of 3.0–7.0 g/ml, one procedure was performed; 7.0–14.0 mg/l — three procedures, with CRP level of ≥ 14.0 mg/l, five procedures were performed. The combination of the traditional treatment with course of procedures of intestinal lavage in patients with chronic pancreatitis after acute pancreatitis has shown a significant more effective pain reduction, improvement of anthropometric parameters, indicators of coprogram and normalization of pro- and antioxidants markers.

The review article provides up-to-date information on the complications of pancreatitis that are important for the tactics and strategy of patient management both at the inpatient and outpatient stages of observation. The purpose of the review was to emphasize the importance of complications for the course and life of patients with chronic pancreatitis. The authors draw the attention of internists to the course of such complications as pseudocysts, cysts, fistulas, thrombohemorrhagic, cholestatic syndromes, compression syndrome of adjacent organs, pancreatic encephalopathy (acute and chronic). The symptomatology of complications of chronic pancreatitis is discussed in detail, which is very important for differential diagnosis with the corresponding diseases. Such complications include the formation of erosive and ulcerative lesions, varicose veins of the esophagus and bleeding from varicose veins of the esophagus and stomach, portal hypertension syndrome with pancreatic ascites and chronic pancreatic encephalopathy, idiopathic non-cirrhotic portal hypertension, pancreatic cancer. The authors emphasize the need to analyze the corresponding symptoms, indicating the possibility of complications, negative consequences with each recurrence or exacerbation of chronic pancreatitis, since it concerns the prognosis and life of the patient. [ABSTRACT FROM AUTHOR]

Background. Pain in chronic pancreatitis (CP) can occur as a consequence of mechanical factors — pancreatic ductal hypertension, interstitial pressure, inflammatory and neuropathic pathological changes in the pancreas. The purpose was to evaluate a novel modification of the classic Partington-Rochelle procedure via comparing functional results of conventional surgery group and wirsungectomy group. Materials and methods. A retrospective analysis of the case histories of patients with CP and an enlarged (≥ 4 mm) main pancreatic duct was carried out for the period from 2003 to 2009, which underwent surgical treatment of CP. The SF-36 and EORTC QLQ-C30 questionnaires, and visual analogue scale of pain were used for the assessment. The first group included five patients with wirsungectomy with lateral pancreaticojejunostomy (PEA + WE); the second group consisted of 20 patients after the lateral pancreaticojejunostomy (PEA) only. Cross-tabulation analyses were performed to compare PEA and PEA + WE groups as well as those groups in different time points using a two-sided Student’s t-test. The significance level was set to p < 0.05. Results. The groups were compared in terms of VAS and the EORTC QLQ-C30 questionnaire before and 2 years after surgery using Student’s t-test for unrelated values: statistically significant differences between the groups according to VAS as before (p = 0.757) and after surgery (p = 0.696) were not obtained. There were no significant differences (p > 0.05) between the PEA and PEA + WE groups before and after surgery according to the EORTC QLQ-C30 questionnaires, except for some items (p < 0.05) Within the groups according to VAS and EORTC QLQ-C30 (pain severity), in the PEA group (p = 0.000001, p = 0.000109) and the PEA + WE group (p = 0.018, p = 0.017) after surgery, there was a statistically significant decrease in pain. Conclusions. Longitudinal pancreaticojejunostomy with wirsungectomy is justified in patients with long-term CP, severe fibrosis of the pancreas with multiple calcifications of the periphery pancreatic ducts to decompress pancreatic ducts, and parenchyma. In the long-term period after 2 years, the proposed method of longitudinal pancreaticojejunostomy with wirsungectomy in patients with CP with dilation of main pancreatic duct according to the VAS scale and EORTC QLQ questionnaires C30 and SF-36 is accompanied by a significant reduction in pain. [ABSTRACT FROM AUTHOR]

Background. The majority of studies on the surgical treatment of chronic pancreatitis (CP) compare treatment outcomes by the type of the procedure. However, some studies, especially systematic reviews and meta-analyses, indicate the equality of different surgeries by their long-term results. During last 5–9 years, several studies showed advantages of early surgery in chronic pancreatitis, within three years after symptoms onset. Objective: to analyze the short- and long-term results of surgical treatment for chronic pancreatitis regarding timing and, accordingly, the neglect of the disease. Materials and methods. Retrospective analysis of data of 147 patients from 2001 to 2020, the main intervention was surgery aimed at the main manifestations of CP, such as pancreatic ductal and/or parenchymal hypertension. Patients who suffered from CP symptoms 3 years or more were included in the control group (late surgery), and those who noted symptoms of CP for less than 3 years were included in the study group (early surgery). All patients completed the EORTC QLQ-30, SF-36 questionnaires, as well as the questionnaire developed by the study authors, via telephone or mail, or during the visit. Results. According to all scales of the SF-36 questionnaire, except for Physical functioning, the group of early surgery prevails over the group of late surgery. The early surgery group had the best average scores on all functional scales of the EORTC QLQ-30 questionnaire compared to the late surgery group, except for the Cognitive functioning. Of the symptomatic scales, the early surgery group had the best averages on Pain and Diarrhea. The average Health/Quality of life scale was significantly better in the early surgery group. Conclusions. The quality of life, pain control, pancreatic function in patients operated within 3 years from the onset of CP symptoms were better compared to those with longer disease duration, with the same short-term results. The duration of the disease is a major factor for the success of surgical treatment of chronic pancreatitis in terms of long-term results. The early surgery is effective approach to obtain better long-term outcomes in chronic pancreatitis. [ABSTRACT FROM AUTHOR]

Objective. Estimation of variants of the pancreatic gland pathology and rate of the unfavorable results occurrence in late postoperative period in patients, suffering complicated forms of chronic pancreatitis, depending on the procedures of surgical treatment. Materials and methods. Results of surgical treatment of complicated forms of chronic pancreatitis in department of the gut surgery in 2007 - 2017 yrs were studied in 107 patients, who were divided into two groups: the Group I – 67 (62.7%) patients, in whom pancreato- and virsungodigestive operations were performed, and the Group II – 40 (37.4%) patients, in whom duodenum—preserving resection-drainage surgical interventions were done. Results. Unfavorable variants of pancreatic pathology were observed significantly more frequently in patients of the Group I – in 34/67 (50.7%) in comparison with patients of the Group II – in 6/40 (15.0%) (χ2=9.49, p=0.002). Conclusion. Analysis of rate of the unfavorable results occurrence in late postoperative period, depending on surgical tactics appled, have shown a trustworthy advantage of the resection-drainage operations.

A review of the literature considers the question of the involvement of certain mechanisms in the comorbid course of chronic pancreatitis with chronic obstructive pulmonary disease (COPD). Attention is drawn to the fact that the common mechanisms of development can reveal the essence of adaptation processes or serve for their use in developing strategies and treatments, prevention and rehabilitation of patients in polymorbidity with an individual approach. The authors attempted to consider the development and progression of diseases from the perspective of theory of syntropic and interfe­rence mechanisms. Significance of oxidative stress, chronic systemic inflammation (including C-reactive protein in the development of insulin resistance), endothelial dysfunction, microcirculatory disorders and hypoxia was considered. Emphasis is placed on the fact that microcirculatory disorders and hypoxia, as well as C-reactive protein effect on the formation of insulin resistance can be considered as transsyndromal mechanisms in comorbid flow of chronic pancreatitis with COPD. This is important for the tactics and strategy of medical rehabilitation activities conducted in patients suffering from chronic pancreatitis with COPD, as it prevents polypharmacy.

Background. The article analyzes the features of the state of the autonomic nervous system in patients with chronic pancreatitis (CP). Studies have shown that the presence of autonomic dysfunction (AD) complicates the course of this disease. All organs and systems of our body are under constant control of the autonomic nervous system. The problem of CP remains one of the most pressing problems in modern gastroenterology. Despite the introduction of new methods, there is a low effectiveness of CP treatment, which is probably due to the lack of knowledge about certain mechanisms of pathogenesis, in particular regarding the role of AD in the development and progression of CP. Consequently, the peculiarities of the state of the autonomic nervous system in chronic pancreatitis are of considerable scientific inte­rest. The purpose of our work was to study the degree of vegetative disorders and their clinical course in patients with chronic pancreatitis. Materials and methods. We have examined 45 patients with CP who underwent outpatient treatment at the gastroenterology department of Ternopil Municipal Clinical Hospital No. 2. The diagnosis of CP was verified on the basis of the clinical protocol adopted in accordance with the order No. 638 of the Ministry of Health of Ukraine dated 09.10.2014. General clinical and biochemical examinations were performed to the patients with CP in the phase of exacerbation and unstable remission (days 10–14 of outpatient treatment). Results. According to the Wein questionnaire, 91.1 % (n = 41) of patients with CP had signs of autonomic dysfunction, which was accompanied by the most pronounced dyspeptic ((3.2 ± 1.0) points) and pain ((2.9 ± 1.3) points) syndromes according to the Gastrointestinal Symptom Rating Scale. The presence of autonomic dysfunction in patients with CP was accompanied by an increase in reactivity (mean 45.0 ± 5.7) and personal (mean value 43.0 ± 5.2) anxiety, as well as an increase in neuroticism (mean value 14.7 ± 2.4) in 75.6 % of patients. Patients with CP and AD according to the index of Kerdo had predominance of vagotonia (56 %) over sympathonia (31 %) at the level of the eutonia of 13 %. According to the results of the orthostatic test, 13 % of patients with chronic hepatitis had a normal hemodynamic response, 6.5 % — hypersympathicotonic and hyperdiastolic variants, and 74 % were asympathicotonic, indica­ting the depletion of the compensatory mechanisms of vegetative tone regulation. Conclusions. According to the data of the study, the negative influence of vegetative dysfunction on the course of chronic pancreatitis has been established.

The purpose of the work was to evaluate the algorithm of surgical treatment of complicated forms of chronic pancreatitis. The results of surgical treatment of 181 patients with complicated forms of chronic pancreatitis were analyzed. 24.5% of patients were admitted with type B pain syndrome. Among them, all patients had multiple strictures of the main pancreatic duct and tissue pressure resistance was >200 mm Hg. Histologically,these patients had stage 4 of pancreatic fibrosis. A combined local resection by Frey-Izbickiy allows to reduce the number of relapses of pancreatic hypertension by 11.1%.

A prospective study of 182 patients with pan­creatic pseudocyst was conducted. By studying changes in ion-acid-alkaline status of cysts cavity, the correlations between these indicators, indicators of proteinogram of blood, findings of ultrasound examination and computed tomography were established. The algorithm for surgical treatment of pancreatic pseudocysts for each of the clinical groups of patients has been developed. Patients of the first group underwent interventions mainly in the cyst, as the structural changes in the pancreas were minor and did not require correction. In the second group 63.16% of patients underwent draining operations, in 57.89% of patients it was the final treatment stage, and 15.80% required the correction of manifestations of chronic pancreatitis. In the third group of patients pancreas was almost completely damaged by chronic inflammation of fibrous-degenerative character, calculosis, ductal hypertension, there with mostly direct interventions were performed on the pancreas. New approaches pathogenetically justify differential surgical treatment strategy for pancreatic pseudocyst using both minimally invasive and open surgery.

Chronic pancreatitis is a serious disease of the pancreas, diagnosis of which remains difficult to date due to the difficulties in detecting early changes in the pancreas. Transabdominal ultrasound is regarded as the basic morphological diagnostic technique, but the sensitivity and specificity of the study is low. Additional methods for diagnosing pancreatic changes are computer tomography and endoscopic retrograde cholangiopancreatography. The purpose of our study was to study the possibilities of modern methods of instrumental diagnosis of clinical and morphological forms of chronic pancreatitis. Material: 210 patients with chronic pancreatitis were observed: I group - 26 obstructive patients, II - 56 calcifying, III - 78 patients with fibro-parenchymal form, IV - 50 patients with chronic pancreatitis complicated by pseudocyst. The structural state of the pancreas was studied by ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography. The data obtained were evaluated according to the Cambridge criteria. The results demonstrate with ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography revealed changes in the parenchyma and pancreatic ducts characteristic of chronic pancreatitis: an increase / decrease in the size of the pancreas, the presence of calcification in the ducts and parenchyma of the gland, pseudocyst and local parenchyma, enlargement / stenosis and the change in the contour of the main pancreatic duct and its connection with pseudocyst, the change in the structure of the parenchyma and the contours of the pancreas of the mammary gland. The majority of patients have severe structural changes in the pancreas, the highest frequency being determined in patients with a longer course of the disease (II - 75.0%, IV - 85.0%), somewhat less severe structural changes were detected in patients with a lesser history disease (I - 66.7%). To assess the sphincter of Oddi dysfunction, a diagnostic method has been developed, which consists in using the eufillin-calcium test with subsequent sonographic monitoring of the pancreatic duct system. A comparison was made between the data obtained with ultrasound, ERCP and CT and the sensitivity and specificity of each method was determined in the diagnosis of various forms of chronic pancreatitis. When comparing CT and ultrasound data, the following results were obtained: complete coincidence of diagnoses in 64.7% of cases, partial discrepancy of 28.5%, total discrepancy of 6.8%. Conclusions. For the diagnosis of chronic pancreatitis it is necessary to apply a complex of instrumental research. Usage of ultrasound has the highest sensitivity and specificity for calcifying (93,8% and 85,6%) and cystic (92,3% and 88,5%) forms of chronic pancreatitis, for the diagnosis of other forms of the disease, CT and ERCP should be used additionally. The developed non-invasive method for diagnosing the pathology of the sphincter of Oddi makes it possible to differentiate the presence of a mechanical obstruction in the duct of the gland with spasm of the sphincter.

The literature review considers the problems of the treatment of abdominal pain syndrome, pancreatic exocrine insufficiency syndrome, chronic pancreatitis of Oddi’s sphincter dysfunction, disorders of gall bladder, bile ducts, dysbiosis, intestinal dyskinesia against the background of the latest European recommendations and international con­sensus.

Objective. To study up the early and late results of distal pancreatic resection with the aim to improve diagnosis and surgical treatment of the distal pancreatic segment disease. Маterials and methods. Resectional interventions on distal pancreatic segment were performed in 19 patients in Department of General Surgery of Ivano-Frankivsk Regional Clinical Hospital in 2013 - 2017 yrs. In 12 (63.2%) patients the complicated forms of chronic pancreatitis (CHP) were diagnosed, and in 7 (36.8%) – pancreatic neoplasia. For diagnosis of pathological changes in corpora-caudal pancreatic segment there were applied laboratory investigations, ultrasound investigation, computed tomography, magnet-resonance tomography, pathohistological investigation of operational material. Results. In CHP a DR, using anterior operative access, was performed in 7 patients, and using a posterior one - in 5. For pancreatic neoplasia a standard DR was done in 3 patients, a radical one – in 1, radical antegrade module (RAMPS) - 2, and applying a laparoscopic operative access – in 1 woman-patient. Postoperative complications have occurred in 6 (31.6%) patients. Late results were followed-up in 13 (68.4%) patients in 6 mo – 5 yrs terms: after DR for CHP – in 9, after DR for tumors – in 4. Good late results were obtained in 7 (77.7%) patients after DR for CHP and in 2 (50.0%) – for tumors, satisfactory results – in 2 (22.3%) and in 1 (25.0%) patients, accordingly, and poor result - in 1 (25.0%) after pancreatic DR, performed for malignant tumor. Conclusion. Complex diagnosis of the distal pancreatic segment diseases with obligatory application of computed tomography gives possibility to establish strict indications for operation and to select a mostly adequate method of surgical intervention individually. Laparoscopic pancreatic DR constitutes a perspective method of surgical treatment in patients with CHP and locally-spread pancreatic neoplasia, it has good and fair early and late results. Resectional interventions on distal pancreatic segment leads to the diabetes mellitus occurrence in 16.6% of the patients.

Актуальність. Останніми роками зросла увага до інфекційного агента, вплив якого може призвести до розвитку запального процесу в підшлунковій залозі. Значне поширення вірусного гепатиту С серед населення, різноманітність його позапечінкових проявів обумовлюють актуальність проблеми. Недостатність розробки питань первинної й вторинної профілактики хронічного панкреатиту мотивує до глибшого вивчення механізму його розвитку на тлі вірусного гепатиту С. Мета: вивчити клінічний перебіг хронічного панкреатиту у хворих із супутнім вірусним гепатитом С. Матеріали та методи. Обстежено 57 хворих на хронічний панкреатит із супутнім вірусним гепатитом С. Групу порівняння становили 20 осіб, хворих на хронічний панкреатит. Для встановлення клінічного діагнозу хронічного панкреатиту й вірусного гепатиту С усі хворі були обстежені згідно з протоколами, затвердженими наказами МОЗ України № 638 від 10.09.2014 і № 729 від 18.07.2016. Діагноз хронічного панкреатиту й вірусного гепатиту С верифікували на підставі даних анамнезу захворювання, клінічних проявів і результатів досліджень. Загальноклінічні й біохімічні обстеження проводили хворим на хронічний панкреатит у фазі загострення й нестійкої ремісії, хворим із вірусним гепатитом С — у фазі стійкої ремісії. Результати. У клінічному перебігу хронічного панкреатиту із супутнім вірусним гепатитом С провідне місце посідали больовий, диспептичний синдроми й порушення випорожнення, що були більш вираженими, ніж у групі порівняння (вірогідна відмінність від показників II групи, p < 0,05). У хворих на хронічний панкреатит із супутнім вірусним гепатитом С виявили анемію легкого ступеня, зниження рівня загального білка в крові, гіпербілірубінемію, гіперхолестеринемію, підвищення рівня ферментів аланінамінотрансферази й аспартатамінотрансферази, підвищення рівнів амілази крові й діастази сечі (вірогідна відмінність стосовно II групи, p < 0,05). У хворих на хронічний панкреатит із супутнім вірусним гепатитом С показник копрограми становив (5,20 ± 0,82) бала, а у хворих на хронічний панкреатит — (3,10 ± 0,32) бала (виявлено значно гірші показники, більш виражений запальний синдром і дисбактеріоз). У двох досліджуваних групах переважала стеаторея II типу. Глибина структурних змін у підшлунковій залозі за даними ультразвукового дослідження в групі хворих на хронічний панкреатит із супутнім вірусним гепатитом С становила (2,56 ± 1,10) бала, що відповідає процесу середнього ступеня тяжкості. У контрольній групі ступінь ураження становив (1,90 ± 0,60) бала. Висновки. На підставі оцінки даних дослідження встановлено негативний вплив супутнього вірусного гепатиту С на перебіг хронічного панкреатиту.

Background. Chronic pancreatitis is a disease with severe course that leads eventually to disturbances of all types of metabolism and progression of nutritional deficiency with increasing age of patients. The purpose was to conduct a laboratory study of vitamin and mineral metabolism indicators in the blood of patients with chronic pancreatitis depending on their biological age. Materials and methods. Examination of 218 patients with chronic pancreatitis in the age aspect, on the basis of quantitative study of certain parameters of vitamin and mineral metabolism in the blood. Results. The study of nutritional insufficiency in chronic pancreatitis depending on the biological age of patients indicates that the age of patients is a predictor of vitamin and mineral deficiency, as well as accumulation of toxic minerals in the blood serum. Conclusions. The data obtained indicate that the age of patients with chronic pancreatitis is a predictor of vitamin and mineral deficiency, accumulation of toxic minerals, which must be taken into account when developing a comprehensive treatment for this category of patients.

Background. Chronic pancreatitis (CP) is characterized by a progressive exocrine and endocrine insufficiency of the pancreas as evidenced by a lot of investigations data and experience of practitioners. Polynutritional and trophological insufficiency develops as a common consequence of functional inability of the pancreas and requires adequate management. The purpose: to justify the expediency of using the modified bowel lavage method for the treatment of maldigestion, polynutritional and trophological insufficiency in chronic pancreatitis, which appeared after acute pancreatitis. Materials and methods. The effectiveness of using the modified bowel lavage method to improve enteral digestion and decrease the signs of polynutritional and trophological insufficiency in CP, which developed due to acute pancreatitis, has been studied. Sixty patients with CP were examined, who have a history of acute pancreatitis. Group I (38 people) received common treatment for CP. Group II (22 individuals) received the set of treatment measures including traditional medicines and a course of modified bowel lavage, 1–5 procedures. Efficacy and duration of this regimen were determined by severity of clinical symptoms, laboratory, anthropometric and instrumental test data, which characterized the peculiarities of CP and polynutritional and trophological insufficiency manifestation in case of acute pancreatitis in the past medical history. Results. The proposed method of intestinal lavage has the following advantages: it allows increasing the time of intestinal lavage due to the pulsating flow of fluid, provides a gentle effect of washing on the intestinal mucosa, prevents additional traumatization of the intestine if such administration of medications is needed. The use of a double loop contour gives possibility to administrate the drugs immediately after lavage without removing the tube, thus preventing mixing and possible side effects when several drugs are used simultaneously. Conclusions. The conducted analysis of study data shows that C-reactive protein (CRP) level can be considered as a marker of the of intoxication and inflammation severity, as well as criterion for determining the number of the intestinal lavage procedures: in patients with CRP level of 3.0–7.0 g/ml, one procedure was performed; 7.0– 14.0 mg/l — three procedures, with CRP level of ≥ 14.0 mg/l, five procedures were performed. The combination of the traditional treatment with course of procedures of intestinal lavage in patients with chronic pancreatitis after acute pancreatitis has shown a significant more effective pain reduction, improvement of anthropometric parameters, indicators of coprogram and normalization of pro- and antioxidants markers. [ABSTRACT FROM AUTHOR]

Background. Chronic pancreatitis (CP) is characterized by a number of specific changes in the structure and function of the pancreas, including atrophy of functional tissue, fibrosis and ductal degeneration, a decrease in the number of islets. Despite a large number of possible etiological factors, the main pathophysiological mechanisms of CP development have much in common. Thus, with the preservation of secretory activity under obstruction of the ducts and their compensatory expansion, pancreatic secret infiltrates the surrounding tissue with the formation of edema, followed by intrapancreatic activation of digestive enzymes, in particular trypsinogen, which initiates proteolytic necrobiosis of the pancreocytes. The duct cells make up to 30 % of the human pancreas, compared to 1–2 % of endocrine cells. One of the first signs of CP is the abnormal increase in the number of ductal branches. It has also been shown that in the ducts of CP patients, the number of cells containing insulin increases, as well as cells that contain other endocrine and exocrine markers. Modeling chronic, acute and complicated pancreatitis in rats also confirmed that epithelial cells are involved in the regulation of extracellular matrix of the pancreas. Materials and methods. Comprehensive histopathological and immunohistochemical (IHC) study was performed in the laboratory of histological and immunohistochemical diagnosis of the university hospital of Zaporizhia State Medical University on postoperative material of 40 patients with CP aged 28 to 74 years, who were opera­ted at the clinic of surgery and minimally invasive technologies of Zaporizhia State Medical University. Immunohistochemical exa­mination was carried out according to standard procedures using a mouse monoclonal antibody Alpha Smooth Muscle Actin (Clone 1A4) against the a-isoform of smooth muscle actin (a-SMA) and Desmin (Clone D33) against desmin (DAKO, USA), monoclonal rabbit antibody against collagen I (Clone RAH C11) anti-collagen type 1 (Imtek, RF) and rabbit polyclonal antibodies against fibronectin (DAKO, USA). Quantitative determination of the intensity and the relative area of the markers’ stromal expression was reproduced using the program for medical digital image processing ImageJ v.1.48, embedded plugin Colour Deconvolution analysis circuit and coloring H DAB (hematoxylin + DAB) for determi­ning the area occupied by immunopositive structure in immunohistochemical preparations and optical (densitometric) intensity of immunostaining by patented procedure. Results. Pathohistological study of biopsies with a specific staining of collagen (by Van Gieson and Masson’s trichrome) showed that fibrotic changes in all the patients with CP were characterized by a combination of pronounced perilobular fibrosis, which covered all lobules, widespread intralobular fibrosis, and significant periductal fibrosis near large, sharply defined narrowed and cystically dilated ducts. There was also a pronounced expansion of interlobular fibrosis, a noticeable thickening of intralobular connective tissue strands directed deep into the lobules and connective tissue strands that surrounded some acini, as well as a significant tortuosity and widening of the ducts with retention cysts. In most cases, the deformation of the ductal system was one of the most significant structural changes. Thus, 87.5 % of cases were characterized by the unevenly narrowed and cystic-altered interlobular ducts, pronounced concentric fibrosis, protein plugs and concrements observed in the ducts. In 7.5 % of the cases, in the main pancreatic duct, foci of the epithelium atrophy were present, which alternated with foci of papillary intraepithelial hyperplasia, identified as pancreatic intraepithelial neoplasia. The parenchyma of the pancreas was thus constituted small, atrophic acini, surrounded by dense fibrous strands, with an increased number of gaping ducts of different diameters. Also, in 17.5 % of cases, phenomena of acinar-ductal metaplasia were observed. In the centers of the acinar-ductal metaplasia zones, the transformation of some acinar cells into ductal cells was determined with the formation of small duct-like structures, the so-called tubular complexes, which, according to the literature, are the primary focus of acinar tissue regeneration. In particular, a large number of activated a-SMA + pancreatic stellate cells (PSC) is detected in the zones of fibrosis. The pattern of expression of this marker is characterized by pronounced a-SMA-immunopositive staining of both PSC and their processes, and, in part, of the fibrillar component. Primary statistical processing of morphometry data revealed a direct relationship between the expression of a-SMA and the area of collagen I type, but this relationship was not significant (r = +0.321, p > 0.05). In order to further objectify the statistical studies, we isolated a group of cases characterized by low a-SMA expression (n = 9). A further study using medical statistics methods showed that the average area of type I collagen and the intensity of its expression in this group was significantly lower than in the other biopsy specimens (p < 0.05). In contrast, desmin expression was identified both in connective tissue, which was characterized by a lower intensity of immunostaining, in acinar tissue and in the epithelium of the pancreatic ducts. The pattern of its expression in fibrosis zones in CP was similar to that of a-SMA, but in 27.5 % of cases, the intensity of staining was below the threshold for determination by morphometric methods. We isolated a group of cases characterized by high expression of fibronectin (n = 9). A further study using medical statistics showed that the average area of type I collagen and the intensity of its expression in this group was significantly higher than in the other biopsy specimens (p < 0.05). Thus, IHC study of the material obtained from patients with CP showed that a large number of activated PSC expressing a-SMA and desmin are concentrated in the pancreatic ductal zones. Also, in these zones, a significant accumulation of fibronectin was found, which is synthesized in excess by activated PSC. The pattern of IHC staining of type I collagen in the zones of severe pancreatic fibrosis is characterized by a weak and moderate intensity with a average level of its expression. Conclusions. A characteristic morphological picture of the CP development is a combination of fibrosis with deformation of the ductal system due to periductal fibrosis with the expansion of interlobular fibrosis, thickening of intralobular connective tissue strands, as well as considerable tortuosity and widening of the ducts with retention cysts. Significant structural reorganization of the pancreatic duct system in patients with CP was observed in 87.5 % of cases, in 17.5 % of cases, the picture was supplemented by phenomena of acinar-ductal metaplasia with the transformation of acinar cells into ductal cells and the formation of small duct-like structures, the so-called tubular complexes. In 7.5 % of cases, in the main pancreatic duct, foci of atrophy of the epithelium were identified, which alternated with foci of papillary intraepithelial epithelial hyperplasia (PanIN). The development of pancreatic fibrosis in CP is facilitated by the accumulation of a-SMA+ activated pancreatic stellate cells synthesizing an excess of components of the extra-cellular matrix, in particular type I collagen. The mean area of type I collagen and the intensity of its expression were significantly lower with reduced a-SMA expression (p < 0.05), and significantly higher in cases of pronounced fibronectin expression (p < 0.05).

Metabolic therapy is one of the few ways to restore normal functions of all the vital organs and systems. The goal of the research was to explore the effectiveness of a course of treatment using metabolic drug Vazonat (meldonium dihydrate) to correct prooxidant-antioxidant and trophological disorders in patients with comorbid course of chronic pancreatitis (CP) and stable coronary artery disease (SCAD). The study included 90 patients with CP in combination with SCAD, who were divided into two groups (depending on the treatment program): I group (45 patients) received conventional treatment (CT); group II (45 patients) in addition to CT received Vazonat as follows: 5 ml intravenous bolus injection 1 time a day for 10 days followed by administration of 1 capsule (250 mg), 2 times per day for one month. It has been shown that the addition of Vazonat to the treatment of patients with comorbidity of CP and SCAD is more conducive to improving the performance and trophological prooxidant-antioxidant status than the standard basic therapy.

Background. Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality in the world. We can see a combination of chronic obstructive pulmonary disease with disorders of the digestive system, such as chronic pancreatitis, in clinical practice. The functional status of the pancreas plays a direct role in the development of the main components of the metabolic syndrome (hyperinsulinemia, insulin resistance with impaired glucose tolerance). Materials and methods. We have examined 90 patients with chronic obstructive pulmonary disease and chronic pancreatitis, and studied of carbohydrate metabolism, lipid peroxidation and the content of final metabolites of nitric oxide (nitrites/nitrates). Results. The study found an increase in the degree of insulin resistance and the development of oxidative stress. Comprehensive treatment of patients with chronic obstructive pulmonary disease and chronic pancreatitis, which included the administration of basic therapy and reduced glutathione, led to a decrease of the insulin resistance and the restoration of serum reduced glutathione. Conclusions. Decrease in the serum reduced glutathione and the increase of serum level of final metabolites of nitric oxide is accompanied by the increase of degree of insulin resistance.

Background. Differential diagnostics of chronic pancreatitis and the pancreas cancer with prevalent affection of head is on of the most difficult and important problems of surgical pancreatology. Methods. Analyzed the results of surgical treatment of 132 patients, including 68 - for cancer of the pancreatic head (in 46 - with jaundice) and 64 - chronic pancreatitis (CP) with a primary lesion of the pancreatic head (16 - with jaundice). The distribution of patients into groups was carried out with a maximum value of classification functions calculated by special formulas. Next studied indicators of endothelial dysfunction for differential diagnosis. Results. It was defined the threshold of VEGF = 346 pg/ml, which shared the group of chronic pancreatitis or cancer of the pancreatic head, which was determined based on the Pareto criterion. This model sensitivity was 72.1% and specificity of 75% for the overall accuracy of 72.7%. Even more precision indicator was on the threshold of VEGF = 248 pg/ml, which compared groups of patients with cancer and software of the control group (125.9 pg/ml) and the sensitivity was 86.8%, specificity 82.4%, and overall accuracy of 82.3%. At about the same accuracy had this test and the comparison group of patients with chronic pancreatitis and control: sensitivity 84.4% and specificity of 76.5% overall accuracy of 81.5% in the threshold VEGF of 155 pg/ml (p

Aim. To study the L-carnitine and L-glutathione influence on the clinical course of chronic pancreatitis (CP) in patients with obesity. Materials and methods. Three representative groups of patients were formed to determine the effectiveness of treatment. The average age of patients was (41.7±4.2) years. The common control group included 30 practically healthy persons (PHP) of the corresponding age and gender. The control group (group 1 (K), 25 persons), the basic group 2 (group 2 (A), 30 persons), the basic group 3 (group 3 (B) 25 persons). Results. After applying the proposed therapy in CP patients (group b) in the course of the disease compared with the group K showed an improvement of health, reduction of asthenic-vegetative, intoxication, and dyspepsia syndromes signs. After 2 weeks of therapy asthenic-vegetative syndrome was absent. Analysis of indicators in 3 months after treatment indicated that patients of the 2nd and the 3rd were achieved stable remission of CP, as no patient visited doctors for medical aid again. But, in 3 months after treatment 2 patients of the K group (10%) were admitted again, 5 patients (25%) sought medical help repeatedly concerning exacerbation of CP symptoms to the gastroenterologists. The result of the complex therapy with L-glutathione and L-carnitine addition positive effect on the IR syndrome is defined in our study a significant decrease of body mass index in patients of the 2nd and the 3rd groups during a 60 days period respectively: 7.5% and 8.1% (p