Clinical and pathogenetic aspects of chronic pancreatitis in conjunction with autonomic dysfunction

Abstract

Background. The article analyzes the features of the state of the autonomic nervous system in patients with chronic pancreatitis (CP). Studies have shown that the presence of autonomic dysfunction (AD) complicates the course of this disease. All organs and systems of our body are under constant control of the autonomic nervous system. The problem of CP remains one of the most pressing problems in modern gastroenterology. Despite the introduction of new methods, there is a low effectiveness of CP treatment, which is probably due to the lack of knowledge about certain mechanisms of pathogenesis, in particular regarding the role of AD in the development and progression of CP. Consequently, the peculiarities of the state of the autonomic nervous system in chronic pancreatitis are of considerable scientific inte­rest. The purpose of our work was to study the degree of vegetative disorders and their clinical course in patients with chronic pancreatitis. Materials and methods. We have examined 45 patients with CP who underwent outpatient treatment at the gastroenterology department of Ternopil Municipal Clinical Hospital No. 2. The diagnosis of CP was verified on the basis of the clinical protocol adopted in accordance with the order No. 638 of the Ministry of Health of Ukraine dated 09.10.2014. General clinical and biochemical examinations were performed to the patients with CP in the phase of exacerbation and unstable remission (days 10–14 of outpatient treatment). Results. According to the Wein questionnaire, 91.1 % (n = 41) of patients with CP had signs of autonomic dysfunction, which was accompanied by the most pronounced dyspeptic ((3.2 ± 1.0) points) and pain ((2.9 ± 1.3) points) syndromes according to the Gastrointestinal Symptom Rating Scale. The presence of autonomic dysfunction in patients with CP was accompanied by an increase in reactivity (mean 45.0 ± 5.7) and personal (mean value 43.0 ± 5.2) anxiety, as well as an increase in neuroticism (mean value 14.7 ± 2.4) in 75.6 % of patients. Patients with CP and AD according to the index of Kerdo had predominance of vagotonia (56 %) over sympathonia (31 %) at the level of the eutonia of 13 %. According to the results of the orthostatic test, 13 % of patients with chronic hepatitis had a normal hemodynamic response, 6.5 % — hypersympathicotonic and hyperdiastolic variants, and 74 % were asympathicotonic, indica­ting the depletion of the compensatory mechanisms of vegetative tone regulation. Conclusions. According to the data of the study, the negative influence of vegetative dysfunction on the course of chronic pancreatitis has been established.