PATHOGENETIC RATIONALE FOR COMBINATION THERAPY OF PATIENTS WITH CHRONIC PANCREATITIS

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Abstract

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

About the authors

V. B. Grinevich

S.M. Kirov Military Medical Academy, Saint Petersburg

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

E. I. Sas

S.M. Kirov Military Medical Academy, Saint Petersburg

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

Yu. A. Kravchuk

S.M. Kirov Military Medical Academy, Saint Petersburg

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

N. N. Shcherbina

S.M. Kirov Military Medical Academy, Saint Petersburg

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

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

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