Clinical and morphological forms of chronic pancreatitis: features of development, diagnosis and treatment

Abstract

Introduction. Chronic pancreatitis (CP) is a common disease with a complex pathogenesis, characterized by difficulties in its diagnosis and treatment. Purpose of the study. To determine the main pathogenetic links of clinical and morphological forms of CP, markers of disease progression, to develop a diagnostic algorithm and principles of treatment of patients. Material and methods. 210 patients with CP were examined, who were divided into 4 groups: I - obstructive, II - calcifying, III - fibrous-parenchymal, IV – CP, complicated by pseudocyst. Instrumental, functional, morphological, biochemical, immunological, microbiological methods were used. To study the main morphological and biological changes in the pancreas during the development of CP and to study the effectiveness of the proposed treatment, we conducted experimental studies on 45 laboratory white Wistar male rats weighing 180-230 g. Results. Imbalance of the immune system, oxidative stress, toxic-metabolic disorders, and diseases of the biliary system are important in the development of various forms of CP. However, there are differences in the severity of these changes. The most pronounced activity of fibrotic processes in the pancreas is typical for patients with a long course of the disease and in the presence of complications (pseudocyst). The most unfavorable course and prognosis are seen in the calcifying form of CP. The markers of CP progression are the value of the calcification coefficient of 0.5-1.0, the translocation of DNase I from the cytoplasm to the nucleus of the acinar cell, the activation of collagen formation, the increase in the level of fibrosis activators (TGF-β1, TNF-a), and the intensification of lipid peroxidation processes. An early marker of apoptosis is the translocation of DNase I from the cytoplasm to the nucleus of an acinar cell. Conclusions. The developed diagnostic algorithm allows assessing the pathophysiological features of functional and organic disorders of the pancreas, predicting the course of the disease and choosing the optimal treatment. The proposed treatment of patients with CP effectively reduces the severity of pain and oxidative stress, normalizes the cytokine profile, improves the general condition and quality of life of patients.