Diagnostics and treatment of exocrine pancreatic insufficiency: clinical guidelines of the Russian gastroenterological Association
The aim of publication. To present the modern concept of etiology and pathogenesis of exocrine pancreatic insufficiency to general practitioners as well as with the established approach to diagnostics and treatment of this syndrome. Summary. Exocrine pancreatic insufficiency (EPI) develops if activi...
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| Language: | Russian |
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Gastro LLC
2018-08-01
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| Series: | Российский журнал гастроэнтерологии, гепатологии, колопроктологии |
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| Online Access: | https://www.gastro-j.ru/jour/article/view/135 |
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| author | V. T. Ivashkin I. V. Mayev A. V. Okhlobystin S. A. Alekseyenko Ye. V. Beloborodova Yu. A. Kucheryavy T. L. Lapina A. S. Trukhmanov I. B. Khlynov M. V. Chikunova A. A. Sheptulin O. S. Shifrin |
| author_facet | V. T. Ivashkin I. V. Mayev A. V. Okhlobystin S. A. Alekseyenko Ye. V. Beloborodova Yu. A. Kucheryavy T. L. Lapina A. S. Trukhmanov I. B. Khlynov M. V. Chikunova A. A. Sheptulin O. S. Shifrin |
| author_sort | V. T. Ivashkin |
| collection | DOAJ |
| description | The aim of publication. To present the modern concept of etiology and pathogenesis of exocrine pancreatic insufficiency to general practitioners as well as with the established approach to diagnostics and treatment of this syndrome. Summary. Exocrine pancreatic insufficiency (EPI) develops if activity of the enzymes in duodenal lumen in response to meal stimulation is insufficient to maintain normal nutrient digestion. This state can develop primarily, due to various pancreatic diseases (chronic pancreatitis, pancreatic cancer, cystic fibrosis), and secondarily, due to impaired stimulation of pancreatic secretion or non-physiological conditions for activity of digestive enzymes. Basic manifestations of EPN the syndromes of maldigestion and malabsorption leading to development of nutritional failure. At the present time there is no standardized diagnostic method for estimation of pancreatic exocrine function, therefore there are no standard diagnostic criteria for EPN. In clinical practice EPN is diagnosed according to decreased fecal elastase activity in patients with verified pancreatic disease, which can cause decrease of pancreatic exocrine function. The basic EPN treatment method is pancreatic enzyme replacement therapy (PERT). For last 50 years there was an significant progress in development of PERT, numerous pancreatin-containing preparations were developed. Treatment of PERT require prescription of capsules, containing pancreatin microparticles protected by enteric coating. The highest evidential base at EPN is accumulated for pancreatin mini-microspheres. The starting dose of pancreatic enzymes for adults is 25 000 units of lipase per meal, which should be subsequently increased up to achievement of complete response confirmed by both clinical and laboratory scores. Digestive enzymes should be taken at the beginning of food intake, to increase treatment efficacy PERT should be accompanied by prescription of proton pump inhibitors. Patient’s diet quantity and content should be adjusted with participation of nutritionist. Patient should intake at least normal daily amount of fat and divide daily ration to at least six meals. Patients should be motivated to restrain from alcohol consumption and smoking as they can lead to further progression of pancreatic exocrine insufficiency and symptoms of pancreatitis. |
| format | Article |
| id | doaj-art-427ab6b5fb0e43279919c402fbdc1e56 |
| institution | Kabale University |
| issn | 1382-4376 2658-6673 |
| language | Russian |
| publishDate | 2018-08-01 |
| publisher | Gastro LLC |
| record_format | Article |
| series | Российский журнал гастроэнтерологии, гепатологии, колопроктологии |
| spelling | doaj-art-427ab6b5fb0e43279919c402fbdc1e562025-02-10T16:14:28ZrusGastro LLCРоссийский журнал гастроэнтерологии, гепатологии, колопроктологии1382-43762658-66732018-08-01272548010.22416/1382-4376-2017-27-2-54-80135Diagnostics and treatment of exocrine pancreatic insufficiency: clinical guidelines of the Russian gastroenterological AssociationV. T. Ivashkin0I. V. Mayev1A. V. Okhlobystin2S. A. Alekseyenko3Ye. V. Beloborodova4Yu. A. Kucheryavy5T. L. Lapina6A. S. Trukhmanov7I. B. Khlynov8M. V. Chikunova9A. A. Sheptulin10O. S. Shifrin11The State Education Institution of Higher Professional Training «The First Sechenov Moscow State Medical University»State educational government-financed institution of higher education «Yevdokimov Moscow State University of Medicine and Dentistry»The State Education Institution of Higher Professional Training «The First Sechenov Moscow State Medical University»State educational government-financed institution of higher education «Far East state medical university»The State educational institution of higher education «Siberian State Medical University»State educational government-financed institution of higher education «Yevdokimov Moscow State University of Medicine and Dentistry»The State Education Institution of Higher Professional Training «The First Sechenov Moscow State Medical University»The State Education Institution of Higher Professional Training «The First Sechenov Moscow State Medical University»The State educational institution of higher education «Ural state medical university»The State educational institution of higher education «Ural state medical university»The State Education Institution of Higher Professional Training «The First Sechenov Moscow State Medical University»The State Education Institution of Higher Professional Training «The First Sechenov Moscow State Medical University»The aim of publication. To present the modern concept of etiology and pathogenesis of exocrine pancreatic insufficiency to general practitioners as well as with the established approach to diagnostics and treatment of this syndrome. Summary. Exocrine pancreatic insufficiency (EPI) develops if activity of the enzymes in duodenal lumen in response to meal stimulation is insufficient to maintain normal nutrient digestion. This state can develop primarily, due to various pancreatic diseases (chronic pancreatitis, pancreatic cancer, cystic fibrosis), and secondarily, due to impaired stimulation of pancreatic secretion or non-physiological conditions for activity of digestive enzymes. Basic manifestations of EPN the syndromes of maldigestion and malabsorption leading to development of nutritional failure. At the present time there is no standardized diagnostic method for estimation of pancreatic exocrine function, therefore there are no standard diagnostic criteria for EPN. In clinical practice EPN is diagnosed according to decreased fecal elastase activity in patients with verified pancreatic disease, which can cause decrease of pancreatic exocrine function. The basic EPN treatment method is pancreatic enzyme replacement therapy (PERT). For last 50 years there was an significant progress in development of PERT, numerous pancreatin-containing preparations were developed. Treatment of PERT require prescription of capsules, containing pancreatin microparticles protected by enteric coating. The highest evidential base at EPN is accumulated for pancreatin mini-microspheres. The starting dose of pancreatic enzymes for adults is 25 000 units of lipase per meal, which should be subsequently increased up to achievement of complete response confirmed by both clinical and laboratory scores. Digestive enzymes should be taken at the beginning of food intake, to increase treatment efficacy PERT should be accompanied by prescription of proton pump inhibitors. Patient’s diet quantity and content should be adjusted with participation of nutritionist. Patient should intake at least normal daily amount of fat and divide daily ration to at least six meals. Patients should be motivated to restrain from alcohol consumption and smoking as they can lead to further progression of pancreatic exocrine insufficiency and symptoms of pancreatitis.https://www.gastro-j.ru/jour/article/view/135панкреатит хроническийосложнениярентгенографияультразвуковое исследованиеэндоскопическая ретроградная панкреатохолангиографиядиагностические методы визуализацииболикачество жизнистеатореязаместительная терапия ферментами поджелудочной железылечение |
| spellingShingle | V. T. Ivashkin I. V. Mayev A. V. Okhlobystin S. A. Alekseyenko Ye. V. Beloborodova Yu. A. Kucheryavy T. L. Lapina A. S. Trukhmanov I. B. Khlynov M. V. Chikunova A. A. Sheptulin O. S. Shifrin Diagnostics and treatment of exocrine pancreatic insufficiency: clinical guidelines of the Russian gastroenterological Association Российский журнал гастроэнтерологии, гепатологии, колопроктологии панкреатит хронический осложнения рентгенография ультразвуковое исследование эндоскопическая ретроградная панкреатохолангиография диагностические методы визуализации боли качество жизни стеаторея заместительная терапия ферментами поджелудочной железы лечение |
| title | Diagnostics and treatment of exocrine pancreatic insufficiency: clinical guidelines of the Russian gastroenterological Association |
| title_full | Diagnostics and treatment of exocrine pancreatic insufficiency: clinical guidelines of the Russian gastroenterological Association |
| title_fullStr | Diagnostics and treatment of exocrine pancreatic insufficiency: clinical guidelines of the Russian gastroenterological Association |
| title_full_unstemmed | Diagnostics and treatment of exocrine pancreatic insufficiency: clinical guidelines of the Russian gastroenterological Association |
| title_short | Diagnostics and treatment of exocrine pancreatic insufficiency: clinical guidelines of the Russian gastroenterological Association |
| title_sort | diagnostics and treatment of exocrine pancreatic insufficiency clinical guidelines of the russian gastroenterological association |
| topic | панкреатит хронический осложнения рентгенография ультразвуковое исследование эндоскопическая ретроградная панкреатохолангиография диагностические методы визуализации боли качество жизни стеаторея заместительная терапия ферментами поджелудочной железы лечение |
| url | https://www.gastro-j.ru/jour/article/view/135 |
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