What is chronic pancreatitis? Symptoms, treatment

In the structure of diseases of the digestive organs, the proportion ranging from 5.1 to 9% belongs to chronic pancreatitis (CP). With these ailments, the pancreas is affected, the inflammatory process begins. As a result, degenerative changes occur in the body . Initially, the pathological process can occur in the tail of the pancreas, its head or middle part. The outcome of the disease is the defeat of the whole organ. Some people who suffer from chronic pancreatitis eventually die. The lethality in the world on average is about 11%.

More about the disease

So, what is chronic pancreatitis? By this term, specialists designate a whole group of pancreatic diseases. All the ailments are characterized by the following features:

• Phase-progressive course with episodes of acute pancreatitis ;
• Focal, segmental or diffuse lesions of the pancreatic parenchyma followed by replacement with connective tissue;
• Changes in the organ's duct system;
• The formation of cysts, pseudocysts, stones and calcifications;
• Development of endocrine and exocrine insufficiency.

The fact that there are different types of disease is evidenced by the International Statistical Classification of the tenth revision. Chronic pancreatitis ICD-10 is divided into:

• HP of alcoholic etiology (code K86.0);
• Other CP is infectious, recurrent, recurrent, unspecified etiology (code K86.1).

The most common causes of chronic pancreatitis

Most often, the disease occurs due to alcohol abuse for a long time. In men, chronic pancreatic pancreatitis can develop if they drink more than 15 years. In women, the likelihood of an ailment increases with the abuse of alcoholic beverages for more than 10 years.

Alcohol is not the only factor that contributes to the emergence of chronic pancreatitis. The cause of the disease can be smoking. Substances that enter the lungs with smoke penetrate the blood and spread throughout the body, have a negative impact on all internal organs, including the pancreas.

Other causes of the disease

Other factors that cause chronic pancreatitis (code for ICD-10 - 86.0 and 86.1) include:

• Abuse of fatty foods, prolonged protein-free diet;
• Various diseases of the gastrointestinal tract (neoplasms, cholecystitis, etc.);
• Overweight, obesity;
• Taking certain medicines (Azathioprine, Furosemide, Prednisolone, synthetic estrogens, Erythromycin, Ampicillin, etc.);
• Infection with viruses (cytomegalovirus, hepatitis B virus, C, etc.).

Studies conducted in recent years have shown that there is a hereditary chronic pancreatitis pancreatitis. This is an autosomal dominant disease with incomplete penetrance (with a different frequency of the gene manifestation in the phenotype of carriers). In patients with human hereditary chronic pancreatitis manifests itself rather early. However, the final stage comes later than with other forms of the disease.

Forms of pancreatitis

There are different classification of the disease. One of them is a list of the following forms of chronic pancreatitis:

1. Recurrent. It occurs in 55-60% of cases. With this form, the periods of remission are replaced by exacerbations of the pathological process.
2. Constant painful. This form is found much less often (in 20% of cases). With her, patients complain of persistent pain localized in the upper half of the abdomen and radiating into the back.
3. Pseudotumoral (icteric). The incidence of this form of chronic pancreatitis is 10%. The pathological process is characterized by the development of inflammation in the head of the pancreas and compression of the common bile duct.
4. Painless (latent). The form is revealed in 5-6% of cases. Pain with the disease is mild or not felt at all. Periodically, dyspeptic disorders occur due to impaired pancreatic function.
5. Sclerosing. With this form of pain occur in the upper half of the abdomen. They intensify after meals. Pain is accompanied by nausea, loose stool, weight loss. When carrying out an ultrasound study, specialists notice a reduction in size and compaction of the pancreas.

According to the Marcel-Roman classification, there are forms of pancreatitis, such as calcific, obstructive, parenchymal and fibrosis. At the first of them, uneven lobular lesion of the pancreas is observed. Pseudocysts, cysts, calcints, stones appear in the ducts. What is chronic pancreatitis in obstructive form? With this type of disease, the internal organ is affected evenly. Stones are not formed, obstruction of the main duct of the pancreas is observed. In the parenchymal form, the foci of inflammation develop in the parenchyma. Calcifications are not formed, the duct system is not affected. For fibrosis, replacement of the parenchyma of the internal organ with a connective tissue is characteristic. Because of this process, exo-and endocrine insufficiency progresses.

Symptoms of the disease

Talking about chronic pancreatitis, it is worth considering the signs of this ailment. Attacks occur at early stages during exacerbations. They are characterized by pain in the epigastric region. In most cases, they radiate posteriorly. Much less often observed shingles. In people suffering from chronic pancreatitis, seizures occur because of the impact on the body of provoking factors. They are the reception of fatty foods, alcoholic and carbonated drinks.

The disease is also characterized by a dyspeptic syndrome. Approximately 56% of sick people report nausea and vomiting. In 33% of cases weight loss is observed, in 29% - flatulence, in 27% - a decrease in appetite. With ailment, symptoms such as general weakness, fatigue, reduced ability to work may appear.

The course of chronic pancreatitis

Specialists distinguish 4 stages in the development of the disease:

1. Preclinical stage. At this stage, sick people do not notice symptoms of chronic pancreatitis. The disease is often detected accidentally during an ultrasound examination or computed tomography of the abdominal cavity.
2. The stage of initial manifestations in the development of such a disease as chronic pancreatitis. Adults at this time begin to torment the first symptoms of the disease. The duration of the stage can be several years. In some cases, the disease progresses very quickly.
3. Stage of development of constant clinical symptoms. In patients, there are signs of endocrine and exocrine insufficiency. People eat very little, complain of abdominal pain.
4. The final stage. Pain becomes less pronounced. People noticeably lose weight. At the final stage, there are various complications of chronic pancreatitis due to atrophy of the pancreas, endocrine and exocrine insufficiency. One of them is the cancer of this internal organ.

Depending on the peculiarities of the development of chronic pancreatitis, a mild course, medium degree and severe course of the disease are isolated. With easy flow, periods of exacerbation occur rarely (1-2 times a year). The pains are mild. Functions of the pancreas are not violated.

What is chronic pancreatitis of moderate severity? This disease, in which there are 3-4 exacerbations per year. They are longer than with mild pancreatitis. In sick people, body weight decreases. The exocrine function of the pancreas decreases moderately, pancreatic hyperfermentemia is observed.

In severe course of the disease, exacerbations are frequent and prolonged. Pain is accompanied by a marked dyspeptic syndrome.

Treatment of the disease: goals and necessary measures

In chronic pancreatitis, therapy is prescribed to achieve the following goals:

• Reduction of clinical manifestations of the disease;
• Prevention of relapse;
• Reducing the likelihood of complications of the disease.

Specialists prescribe to their patients non-drug treatment, drug therapy. If necessary, surgery is performed. Treatment of chronic pancreatitis in adults can be carried out both at home and in the hospital. Indication for hospitalization is the transition of the disease to the stage of exacerbation, because it is during this period that there is a threat to the life of the patient and there is a need for parenteral administration of drugs.

Non-drug treatment

In the treatment of chronic pancreatitis, nutrition plays an important role. At the expressed exacerbations the hungry days (1-3 and more) and a plentiful alkaline drink are shown. The indications are parenteral or enteral (nutrition of nutrients into the large intestine using a special probe). Thanks to this measure, it is possible to stop the secretion of the pancreas, reduces intoxication and becomes a weaker pain syndrome.

After the normalization of the condition, the sick people are transferred to oral nutrition. Meals should be frequent, divided. The daily menu is made up of mucous soups, vegetable purees, liquid mashed milk porridges. From drinks are allowed compotes, jelly, soft tea, mineral water, broth of wild rose.

The following products are necessarily excluded:

• Provoking flatulence;
• Having in their composition a coarse fiber;
• Stimulating the production of digestive juices;
• Rich in extractive substances.

Is it possible to have fish and meat broths, mushroom and strong vegetable decoctions, canned food, smoked meat, sausages, fatty fish and meat varieties, fried foods, vegetables and fruits in raw form, baked pastry, confectionery, black bread in case of chronic pancreatitis? All these products are prohibited when the disease worsens, so they should be abandoned. Also you need to remove from your menu spices, ice cream, alcohol.

During the remission, the diet changes slightly. People with a diagnosis of "chronic pancreatic pancreatitis" are allowed to eat pasta, raw vegetables and fruits, soft cheeses, baked fish. Rubbed soups can be replaced with ordinary vegetarian (cabbage from the ingredients must be excluded). Porridge can be friable, more dense.

Pharmacotherapy of chronic pancreatitis

The task of drug therapy at the first stage is to provide functional dormancy of the pancreas. This is achieved by:

1. Reception of large doses of modern polyenzymatic agents. , «Креон » , «Панцитрат » . To such medicines carry "Mezim-forte " , "Creon " , "Pantsitrat " .
2. , «Фамотидина » ) или ингибиторов протонной помпы («Омепразола » , «Эзомепразола » ). The maximum inhibition of acidic gastric secretion with the help of blockers of H2-receptor histamine ("Ranitidine " , "Famotidine " ) or inhibitors of the proton pump ("Omeprazole " , "Esomeprazole " ). The drugs are administered parenterally or taken internally.
3. или «Сандостатина » . The introduction of "Octreotide " or "Sandostatin " . These drugs are synthetic analogues of the hormone somatostatin. Thanks to them, hypertension in the duct system of the pancreas decreases, and due to this, the pain is reduced and stopped.

If treatment measures aimed at reducing pancreatic secretion do not have an anesthetic effect, doctors prescribe non-narcotic or narcotic analgesics. "Analgin", "Ketoprofen", "Paracetamol" - any remedy for chronic pancreatitis can be prescribed by a doctor from the first group of medicines. From drugs related to narcotic analgesics, Promedol, Tramal, Fortral can be chosen.

Treatment of chronic pancreatitis in adults may also include substitution polyenzymatic therapy. Indications for its appointment - allocation with feces more than 15 grams of fat per day, diarrhea, rapid weight loss. Polyferment preparations are Abomin, Forte-N, Creon, Pancreatin, Festal, Pankreoflat, Digestal, and Wobenzym.

Surgical treatment of the disease

In some cases, chronic pancreatitis requires surgery. The indications are:

• Pain that does not stop with drugs and diet;
• Presence of abscesses and cysts in the pancreas;
• Obstruction of the bile ducts, which can not be resolved by the endoscopic method;
• Stenosis of the duodenum;
• Fistulas in the pancreas with the development of pleural effusion or ascites;
• Suspicion of cancer, not confirmed cytologically or histologically.

"Chronic pancreatitis, symptoms and treatment in adults" is an important medical topic that requires attention. This is an insidious disease, a progressive and irreversible process. However, treatment is still necessary. It allows prolonging the life of sick people, relieves of unpleasant symptoms characteristic of chronic pancreatitis. For example, if you follow the recommendations for diet, refusal of alcohol, correct drug therapy, patients live up to 10 years. Half of those who do not seek medical help and continue to drink alcohol, smoke, eat badly, die before that time.