Functional Features of the Pancreas during Chronic Pancreatitis

B.F. Shevchenko, A.M. Babiy, O.М. Tatarchuk, V.A. Makarchuk, V.E. Kudryavtseva


Aim of study: to identify functional status of pancreas in patients with chronic pancreatitis depending on the stage of fibrotic transformation and activity of parenchymal inflammation. Materials and methods. The preoperative laboratory results and the data of morphological study performed on biopsies obtained during surgery in 88 patients with complications of chronic pancreatitis (CP) were compared. According to morphological study of pancreatic biopsies, the early pancreatic parenchymal fibrosis (I–II degree) has been diagnosed in 31 cases (35.2 %), late fibrosis (III–IV degree) — in 57 (64.8 %) cases. Results. Active parenchymal inflammation at early and late stages of pancreatic fibrosis are associated with changes in pancreatic secretion and intracellular activation of pancreatic enzymes, leading to autodigestion and release of these enzymes from acinar cells into the blood, which has been confirmed by an increase of trypsin and amylase activity in blood compared with inactive inflammation. At late stages of fibrosis reduction of fecal elastase‑1 (161.7 ± 4.8) mg/g was observed in 73.9 % of patients. Reverse correlation has been found between fibrotic transformation of pancreatic parenchyma and the level of fecal elastase‑1 (r = –0.46; p = 0.05), i.e. progressing fibrotic transformation of pancreas leads to reduced exocrine function. Correlation analysis showed that the progression of fibrotic transformation violates carbohydrate metabolism — a direct correlation with glycosylated hemoglobin (r = 0.496; p = 0.05), namely, the endocrine secretion deficiency. Novelty in science. The pancreas functioning was studied depending on the inflammation activity and stage of fibrosis transformation of its parenchyma at chronic pancreatitis. The active inflammation of the pancreas was found to be accompanied by significant activation of pancreatic enzymes (significant increase in blood amylase and trypsin activity), which causes the progression of fibrotic transformation of pancreas in CP. Conclusions. Progression of fibrotic transformation of the pancreatic parenchyma in CP leads to deterioration of the exocrine pancreatic function, as defined by a decrease in the level of fecal elastase‑1 in case of late fibrosis of the pancreas and to the deterioration of endocrine pancreatic function, as manifested by impaired fasting glucose metabolism both at early and late stages of fibrosis, the development of pancreatogenic type II diabetes at the early stages of pancreatic fibrotic transformation, insulin resistance and type I diabetes at later stages of pancreatic fibrotic transformation.


pancreas; chronic pancreatitis; stage of fibrosis; inflammation activity; exocrine function; endocrine function


Ysmaylov S.Y., Nazyrov F.H., Azyzov B.A. Narushenyya uhlevodnoho obmena u bol'nykh s khronycheskym pankreatytom [Violations of carbohydrate exchange for patients with chronic pancreatitis]. Mezhdunarodnyy endokrynolohycheskyy zhurnal, 2014, no. 1 (57), pp. 25-28.

Apte M., Pirola R., Wilson J. New insights into alcoholic pancreatitis and pancreatic cancer. Journal of Gastroenterology and Hepatology, 2009, vol. 24, no. 3, pp. 51–56.

Fitzner B., Muller S., Walther M. [et al.] Senescence determines the fate ofactivated rat pancreatic stellate cells. J. Cell. Mol. Med., 2012, vol. 16, no. 11, pp. 2620–2630.

Hu W., Fu L. Simultaneous characterization of pancreatic stellate cells and other pancreatic components within three-dimensional tissue environment during chronic pancreatitis. Journal of Biomedical Optics, 2013, vol. 18, no. 5, p. 9.

Phillips P. Editors: Grippoand P.J., Munshi H.G. Pancreatic stellate cells and fibrosis (Pancreatic Cancer and Tumor Microenvironment). Kerala, India: Transworld Research Network, 2012, no. 00, pp. 29–53.

Krasyl'nykov D.M., Salymzyanov Sh.S. Dyahnostyka y khyrurhycheskoe lechenye bol'nykh khronycheskym pankreatytom [Diagnostics and surgical treatment of patients chronic pancreatitis]. Kazanskyy medytsynskyy zhurnal, 2009, vol. 90, no. 1, pp. 93-101.

Perederyy V.H,. Tkach S.M., Parunyan L.M. Chastota y vozmozhnye prychyny ekzokrynnoy nedostatochnosty podzheludochnoy zhelezy pry sakharnom dyabete [Frequency and possible reasons of exocrine insufficiency of pancreas at diabetes]. Ukr. Terapevt. Zhurna, 2004, no. 2, pp. 12-16.

Huberhryts N.B., Lukashevych H.M., Holubova O.A. Pankreatohennyy sakharnyy dyabet [Pankreatogennyy saccharine diabetes]. Rossyyskyy zhurnal hastroenterolohyy, hepatolohyy, koloproktolohyy, 2007, no. 6, pp. 11-16.

Khrystych T.M., Kendzers'ka T.B. Mozhlyva rol' funktsional'noho stanu pidshlunkovoyi zalozy u rozvytku ta prohresuvanni metabolichnoho syndromu [A possible role of the functional state of pancreas is in development and progress of metabolic syndrome]. Mystetstvo likuvannya, 2006, no. 4 (30), pp. 93-101.

Klymenko A.V. Endokrynnaya funktsyya podzheludochnoy zhelezy u bol'nykh khronycheskym pankreatytom posle parenkhymosokhranyayushchykh operatsyy [Endocrine function of pancreas for patients chronic pancreatitis after parenchyma preserving operations]. Zaporozhskyy medytsynskyy zhurnal, 2012, no. 4 (73), pp.25-27.

Lankish P., Loehr H.A., Otto J., Creutzfeldt W. Natural cource in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency prognosis of the disease. Digestion, 2003, Vol. 64, pp. 148-155.

Morgenroth K., Kozuschek W. Pancreatitis. Berlin-NewYork, Walterde Gruyter Publ., 1991. 88 p.

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