Diagnostics and treatment of pancreatic exocrine insufficiency: clinical guidelines of the Russian gastroenterological association
Aim of publication. To present the modern concept on the causes and pathogenesis of pancreatic exocrine insufficiency (PEI) as well as the new diagnostic and therapeutic approaches at this syndrome to general practitioners. Summary. PEI in the state it which secretion of pancreatic enzymes into duod...
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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/232 |
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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 | Aim of publication. To present the modern concept on the causes and pathogenesis of pancreatic exocrine insufficiency (PEI) as well as the new diagnostic and therapeutic approaches at this syndrome to general practitioners. Summary. PEI in the state it which secretion of pancreatic enzymes into duodenum is insufficient for normal digestion of nutrients. This syndrome may develop primarily, due to various pancreatic diseases (chronic pancreatitis, pancreatic cancer, cystic fibrosis etc.), and secondarily, at impaired stimulation of pancreatic secretion or impairment of conditions, necessary for the normal action of pancreatic enzymes. Basic clinical manifestations of PEI include maldigestion and malabsorption that lead to development of nutritional failure. No standardized methods of pancreatic exocrine function assessment are developed at the present time, therefore standard diagnostic criteria of PEI are lacking. In routine clinical practice PEI is diagnosed mainly on the basis of decreased pancreatic enzymes activity in stool in patients with verified pancreatic disease but can result in decreased exocrine function. Basic method of PEI treatment is pancreatic enzyme replacement therapy (PERT). Within 50 years which passed after initial implementation of PERT in clinical practice it was significantly modified, numerous pharmaceutical forms of pancreatin were developed. Anyhow for the purpose of replacement therapy capsules with enteric-coated pancreatin microparticles should be applied. Initial recommended dose of PERT for adult patient is 25’000 lipolytical units per meal that should be subsequently increased up to normalization of patients nutritional status according to both clinical and laboratory scores. Digestive enzymes should be taken at the beginning of the meal, in the case of incomplete response it can be recommended to use antisecretory agents. Patient should be consulted by nutritionist, no significant limitation of fat intake is recommended. Daily ration should be divided into six or more meals. Patients should be motivated to stop both alcohol intake and smoking as they can cause progression of PEI alone and/or persistence of symptoms, like pancreatic pain. |
| format | Article |
| id | doaj-art-45a1cc8a1a994b7b88f03324ab822079 |
| 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-45a1cc8a1a994b7b88f03324ab8220792025-02-10T16:14:28ZrusGastro LLCРоссийский журнал гастроэнтерологии, гепатологии, колопроктологии1382-43762658-66732018-08-012827210010.22416/1382-4376-2018-28-2-72-100232Diagnostics and treatment of pancreatic exocrine 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. Shifrin11Sechenov First Moscow State Medical University (Sechenov University)Yevdokimov Moscow State University of Medicine and DentistrySechenov First Moscow State Medical University (Sechenov University)Far East state medical universitySiberian state medical universityYevdokimov Moscow State University of Medicine and DentistrySechenov First Moscow State Medical University (Sechenov University)Sechenov First Moscow State Medical University (Sechenov University)Ural state medical universityUral state medical universitySechenov First Moscow State Medical University (Sechenov University)Sechenov First Moscow State Medical University (Sechenov University)Aim of publication. To present the modern concept on the causes and pathogenesis of pancreatic exocrine insufficiency (PEI) as well as the new diagnostic and therapeutic approaches at this syndrome to general practitioners. Summary. PEI in the state it which secretion of pancreatic enzymes into duodenum is insufficient for normal digestion of nutrients. This syndrome may develop primarily, due to various pancreatic diseases (chronic pancreatitis, pancreatic cancer, cystic fibrosis etc.), and secondarily, at impaired stimulation of pancreatic secretion or impairment of conditions, necessary for the normal action of pancreatic enzymes. Basic clinical manifestations of PEI include maldigestion and malabsorption that lead to development of nutritional failure. No standardized methods of pancreatic exocrine function assessment are developed at the present time, therefore standard diagnostic criteria of PEI are lacking. In routine clinical practice PEI is diagnosed mainly on the basis of decreased pancreatic enzymes activity in stool in patients with verified pancreatic disease but can result in decreased exocrine function. Basic method of PEI treatment is pancreatic enzyme replacement therapy (PERT). Within 50 years which passed after initial implementation of PERT in clinical practice it was significantly modified, numerous pharmaceutical forms of pancreatin were developed. Anyhow for the purpose of replacement therapy capsules with enteric-coated pancreatin microparticles should be applied. Initial recommended dose of PERT for adult patient is 25’000 lipolytical units per meal that should be subsequently increased up to normalization of patients nutritional status according to both clinical and laboratory scores. Digestive enzymes should be taken at the beginning of the meal, in the case of incomplete response it can be recommended to use antisecretory agents. Patient should be consulted by nutritionist, no significant limitation of fat intake is recommended. Daily ration should be divided into six or more meals. Patients should be motivated to stop both alcohol intake and smoking as they can cause progression of PEI alone and/or persistence of symptoms, like pancreatic pain.https://www.gastro-j.ru/jour/article/view/232панкреатит хроническийосложнениярентгенографияультразвуковое исследованиеэндоскопическая ретроградная панкреатохолангиографиядиагностические методы визуализацииболькачество 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 pancreatic exocrine 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 боль качество жизни стеаторея заместительная терапия ферментами поджелудочной железы лечение |
| title | Diagnostics and treatment of pancreatic exocrine insufficiency: clinical guidelines of the Russian gastroenterological association |
| title_full | Diagnostics and treatment of pancreatic exocrine insufficiency: clinical guidelines of the Russian gastroenterological association |
| title_fullStr | Diagnostics and treatment of pancreatic exocrine insufficiency: clinical guidelines of the Russian gastroenterological association |
| title_full_unstemmed | Diagnostics and treatment of pancreatic exocrine insufficiency: clinical guidelines of the Russian gastroenterological association |
| title_short | Diagnostics and treatment of pancreatic exocrine insufficiency: clinical guidelines of the Russian gastroenterological association |
| title_sort | diagnostics and treatment of pancreatic exocrine insufficiency clinical guidelines of the russian gastroenterological association |
| topic | панкреатит хронический осложнения рентгенография ультразвуковое исследование эндоскопическая ретроградная панкреатохолангиография диагностические методы визуализации боль качество жизни стеаторея заместительная терапия ферментами поджелудочной железы лечение |
| url | https://www.gastro-j.ru/jour/article/view/232 |
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