[Capabilities of ultrasonic histography in the evaluation of the degree of pancreatic fibrosis in chronic pancreatitis].

AIM: To analyze the clinical and pathogenetic significance of ultrasonic histography in pancreatic fibrosis in patients with chronic pancreatitis (CP). SUBJECTS AND METHODS: One hundred and eighty-six patients with CP were examined. Complete blood count, urinalysis, biochemical blood and urine tests, duodenal intubation test, coproscopy, enzyme immunoassay, and radioimmune assay were performed. The levels of blood transforming growth factor ß1 (TGFß1) and fecal elastase-1 were measured. Ultrasonography and ultrasonic histography of the pancreas and liver, Doppler sound study of the abdominal aorta, celiac trunk, and superior mesenteric artery were carried out. RESULTS: There were correlations suggesting the decreased exocrine function of the pancreas as its fibrosis progressed, which was indirectly reflected in the increased L index of an ultrasonic histogram. The positive correlation between L index and TGFß1 also showed increased L index in more obvious pancreatic fibrosis. A CP exacerbation was shown to be accompanied by decreased Kgst and N, which was confirmed by pronounced hyperenzymenia (the blood enzyme release phenomenon) with the decrease of those indicators. Pancreatic fibrosis was reflected in the magnitude of clinical manifestations of CP, particularly in the rise of the number of dyspeptic complaints showing diminished pancreatic exocrine secretion. This was also supported by the fact that as the L index increased, the debit hour of lipase and the activity of fecal elastase-1 decreased. There were correlations pointing to more significant fibrosis of the pancreas and its insufficiency with worsened blood flow in it. Moreover, ultrasonic histographic findings accounted for a positive correlation between pancreatic and hepatic fibrosis. CONCLUSION: Examination of ultrasonic histographic correlations of the pancreas has led to the conclusion that this technique may be used to indirectly estimate the degree of pancreatic fibrosis and a CP exacerbation.

[CLINICAL CASE OF COMBINATION OF PRIMARY SCLEROSING CHOLANGITIS WITH NONSPECIFIC ULCERATIVE COLITIS IN TWINS MONOZYGOTIC].

The article presents discussion of basic hypotheses of pathogenesis of primary sclerosing cholangitis (PSC): genetically conditioned pathology, autoimmune pathology, result of inflammatory reaction in bile ducts, cholangiopathy. The authors presents a clinical case of monozygotic twins with association of PSC and nonspecific ulcerative colitis (NUC). The first twin had a severe course of PSC and mild course of NUC; he died due to bacterial complications of cholangitis. The second twin--patient B--had an opposite situation: severe course of NUC, while PSC was suspected only after determination of cholestasis biochemical markers. As soon as cholestasis was revealed, patients B was treated with Ursofalk and Budenofalk (2001). He received Salofalk as a remedy of basic therapy for NUC. Repeated liver biopsy (2005) showed no progression of PSC, but there were present minimal biochemical signs of cholestasis. So, it is necessary to investigate the first degree relatives of patients with PSC. The timely administered treatment in some cases gives the possibility of the control of the disease course.

[Polymorphism of ethanol metabolism genes in alcoholic chronic pancreatitis].

AIM: To study the gene polymorphisms of alcohol dehydrogenase (ADH), aldehyde dehydrogenase (ALDH), and cytochrome CYP2E1 in patients with alcoholic chronic pancreatitis (ACP) and to compare them with laboratory and instrumental findings. SUBJECTS AND METHODS: Seventy-two patients with ACP and 80 healthy individuals were examined. Polymorphic DNA loci were analyzed by polymerase chain reaction of DNA synthesis, followed by electrophoretic detection. Polymorphism in genes involved in ethanol metabolism was studied. RESULTS: The patents with ACP had mutations in the genes involved in ethanol metabolism. The study results of the rate of the alleles and genotypes of ADH, ALDH, and CYP2E1 genes were controversial. However, investigating the combinations of the genotypes of ADH and ALDH revealed that the patients having ADH1 B*47His and ALDH2*2 genotypes had a much higher risk for ACP and constituted more than 50% of the ACP patients. With this combination, ACP took its course with more evident structural and functional disorders of the pancreas. The CYP2E1 C/C homozygotes had an especially high risk of ACP. CONCLUSION: The investigation perspectives are to increase the number of examined patients and apparently healthy individuals and to find correlations between clinical, laboratory, and instrumental parameters and genotyping findings. The results of these investigations can define the possible strategy of prevention of CAP.

[Cholestasis and pancreatic insufficiency: how to start treatment?].

The article presents a detailed analysis of pathogenesis and clinical manifestation of secondary pancreatic excretory insufficiency due to disorders of bile production and choleresis. Pathogenesis of hepatogenic (chologenic) pancreatic insufficiency considered in view of impairment of bile acids' different functions in cholestasis. Authors review pathology of liver and bile ducts resulted in steatorrhea. It was conducted pathogenetic substantiation treatment tactics of patients, which have a combination of cholestasis and secondary pancreatic insufficiency.

A 6-month, open-label clinical trial of pancrelipase delayed-release capsules (Creon) in patients with exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery.

BACKGROUND: Pancreatic enzyme replacement therapy (PERT) is necessary to prevent severe maldigestion and unwanted weight loss associated with exocrine pancreatic insufficiency (EPI) due to chronic pancreatitis (CP) or pancreatic surgery (PS). AIM: To assess the long-term safety and efficacy of pancrelipase (pancreatin) delayed-release capsules (Creon) in this population. METHODS: This was a 6-month, open-label extension of a 7-day, double-blind, placebo-controlled study enrolling patients ≥18 years old with confirmed EPI due to CP or PS who were previously receiving PERT. Patients received individualised pancrelipase doses as directed by investigators (administered as Creon 24 000-lipase unit capsules). RESULTS: Overall, 48 of 51 patients completed the open-label phase; one withdrew due to the unrelated treatment-emergent adverse event (TEAE) of cutaneous burns and two were lost to follow-up. The mean age was 50.9 years, 70.6% of patients were male, 76.5% had CP and 23.5% had undergone PS. The mean±s.d. pancrelipase dose was 186960±74640 lipase units/day. TEAEs were reported by 22 patients (43.1%) overall. Only four patients (7.8%) had TEAEs that were considered treatment related. From double-blind phase baseline to end of the open-label period, subjects achieved a mean±s.d. body weight increase of 2.7±3.4 kg (P<0.0001) and change in daily stool frequency of -1.0±1.3 (P<0.001). Improvements in abdominal pain, flatulence and stool consistency were observed. CONCLUSIONS: Pancrelipase was well tolerated over 6 months and resulted in statistically significant weight gain and reduced stool frequency in patients with EPI due to CP or PS previously managed with standard PERT.

[Efficacy and safety of pancrealipase delayed-release capsules (Creon) in patients with pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery].

In the article design, objectives, methods of conducting double-blind, randomized study which results prove efficacy and safety of new formulation of Creon are presented.

[Pancreatitis in intestinal diseases].

In article review of the literature and own data about pathogenesis of pancreatitis and secondary pancreatic insufficiency in various diseases of small and large intestines is presented. The special attention is given to pancreatic insufficiency in celiac disease and in inflammatory bowel disease. The main directions of pancreatitis and exocrine pancreatic insufficiency therapy are grounded.

[Reflections on the articles of professor Iu. V. Vasil'ev "Does enzyme and antisecretory preparations correctly used in therapy of chronic pancreatitis?"].

The article is a discussion of controversial points published in the article of prof. Y.V. Vasilyev. It presents substantiation of contraindications for enzymatic preparations and specification of situations when these contraindications could be reduced. There was proved inexpediency of powerful antisecretory drugs in chronic pancreatitis with severe exocrine pancreatic insufficiency. Author showed reasonableness of alginates in such cases. There were specified spasmolytics of choice in chronic pancreatitis therapy.

[Possibility of laboratory diagnostics of pancreas diseases].

The article presents literature review and critical analysis of informative capacity of laboratory tests for diagnostics of pancreas pathology. All of these tests are divided on 6 groups: methods for determination of destruction of pancreatic parenchyma, for assessment of pancreatitis severity and prognosis, for estimation of pancreatitis etiology, functional tests, study of oncomarkers, special methods (genetic, cytologic etc.). The author accentuates positive and negative sides of the most accepted laboratory methods, gives diagnostic algorithms for acute and chronic pancreatitis.

[Have we at last any practical classification of chronic pancreatitis?].

The article analyses international classification of chronic pancreatitis produced in different years. There are discussed advantages and disadvantages of these classifications. The article presents classification, which on author's opinion is most useful for practitioners.

[Antibiotics in pancreatology: pros and contras].

The problems of antibioticotherapy in patients with pancreatic diseases and pancreonecrosis in the first place, are discussed in the article in detail. The paper covers the indications and contraindications, as well as the most preferable classes of antibiotics according to bacterial flora present. The authors have developed a classification of medications as possible agents provoking pancreatitis.

[Clinical and pathogenetic significance of the euphylline-calcium test for direct analysis of the exocrine secretory function of the pancreas in chronic relapsing pancreatitis]. / Kliniko-patogeneticheskoe znachenie éufillin-kal'tsievogo testa dlia priamogo issledovaniia vneshnesekretornoi funktsii podzheludochnoi zhelezy pri khronicheskom retsidiviruiushchem pankreatite.

The authors improved the probe assay of the pancreas: an original euphylline-calcium test was developed. The examination is informative and safe in the diagnostics of the chronic relapsing pancreatitis. A number of advantages of the optimized method of diagnostics before the traditional ones, including the secretin-pancreazimin test, were proven.

[Gastrozepin: is its oblivion fair?]. / Gastrotsepin: spravedlivo li zabvenie?

Pharmacologic properties of selective M1--cholinolytic preparation gastrocepin (pirenzepine), its advantages and disadvantages were analyzed. Special attention is given to cytoprotective effect of gastrocepin, Administration of the preparation in complex therapy for chronic recurrent pancreatitis, prophylaxis and treatment of the stress gastroduodenal ulcers and ulcerative hemorrhage is pathogenetically substantiated.

[Immunogenetic aspects of pathogenesis, prognosis and treatment of the main forms of chronic pancreatitis]. / Immunogeneticheskie aspekty patogeneza, prognoza i lecheniia osnovnykh form khronicheskogo pankreatita.

Immunogenetic examination comprising determination of erythrocyte antigens (ABO systems and resus-factor) and leukocytes (HLA system) using hemagglutination and compliment-dependent cytotoxicity, respectively, was performed for 138 patients with chronic recurrent pancreatitis, 52 patients with chronic pancreatitis and 456 healthy subjects. Analysis of relations between the above antigens, the disease risk, clinical and laboratory parameters, readings of ultrasound histogram and the efficacy of treatment helped discover not only provoking and protecting genes, but also some pathogenetic mechanisms involved in genetic predisposition. These findings may be used in the choice of treatment policy and to upgrade the significance of prognosis of principal forms of chronic pancreatitis.

[The functional and sonographic parallels in chronic pancreatitis]. / Funktsional'no-sonograficheskie paralleli pri khronicheskom pankreatite.

Ultrasonic histogramme was studied in 35 patients with chronic pancreatitis and 20 donors, taken in the area of the head and body of the pancreas, as were levels of immunoreactive trypsin--fasting and after standard food load,--and C-peptide in blood serum on an empty stomach. To increase informative value and specificity of ultrasonic and radioimmunologic investigations an index has been suggested, based on the findings from histogramme and radioimmunity analysis.

[The characteristics of the diagnosis and clinical picture of pseudotumorous chronic pancreatitis]. / Osobennosti diagnostiki i klinicheskoi kartiny psevdotumoroznogo khronicheskogo pankreatita.

As many as 12 patients with pseudotumorous chronic pancreatitis have been examined. While studying the functional state of the pancreas a conclusion was reached about a decrease in the organ's exocrine activity, with the hormone output remaining unaffected. Particular features of the immunity status in the patients are outlined. It is recommended that dynamic ultrasonic investigation and computerized tomography to the abdominal cavity and retroperitoneal space, transcutaneous puncture biopsy of the pancreas, should be used for the differential diagnosis with carcinoma of the organ to be made possible.

[The diagnostic significance of soluble fibrin monomer complexes in exacerbated chronic recurrent pancreatitis]. / Diagnosticheskoe znachenie rastvorimykh kompleksov fibrin-monomerov pri obostrenii khronicheskogo retsidiviruiushchego pankreatita.

The authors theoretically explain the elevation of blood plasma levels of soluble fibrin monomer complexes occurring in elevated trypsin concentrations in the blood. Examinations of 50 patients with chronic relapsing pancreatitis and of 20 donors demonstrated a marked correlation between the levels of immunoreactive trypsin and soluble fibrin-monomer complexes in the blood. The authors recommend measurements of blood soluble fibrin-monomer complexes for the diagnosis of exacerbations of chronic relapsing pancreatitis.