Modernization of enteral digestion of patients with chronic pancreatitis with trophological disorders after acute pancreatitis

Abstract

Background. Chronic pancreatitis (CP) is characteri­zed by a progressive exocrine and endocrine insufficiency of the pancreas as evidenced by a lot of investigations data and expe­rience of practitioners. Polynutritional and trophological insufficiency develops as a common consequence of functional inability of the pancreas and requires adequate management. The purpose: to justify the expediency of using the modified bowel lavage me­thod for the treatment of maldigestion, polynutritional and trophological insufficiency in chronic pancreatitis, which appeared after acute pancreatitis. Materials and methods. The effectiveness of using the modified bowel lavage method to improve enteral digestion and decrease the signs of polynutritional and trophological insufficiency in CP, which developed due to acute pancreatitis, has been studied. Sixty patients with CP were examined, who have a history of acute pancreatitis. Group I (38 people) received common treatment for CP. Group II (22 individuals) received the set of treatment measures including traditional medicines and a course of modified bowel lavage, 1–5 procedures. Efficacy and duration of this regimen were determined by severity of clinical symptoms, laboratory, anthropometric and instrumental test data, which characterized the peculiarities of CP and polynutritional and trophological insufficiency manifestation in case of acute pancreatitis in the past medical history. Results. The proposed method of intestinal lavage has the following advantages: it allows increasing the time of intestinal lavage due to the pulsating flow of fluid, provides a gentle effect of washing on the intestinal mucosa, prevents additional traumatization of the intestine if such administration of medications is needed. The use of a double loop contour gives possibility to administrate the drugs immediately after lavage without removing the tube, thus preventing mixing and possible side effects when several drugs are used simultaneously. Conclusions. The conducted analysis of study data shows that C-reactive protein (CRP) level can be considered as a marker of the of intoxication and inflammation severity, as well as criterion for determining the number of the intestinal lavage procedures: in patients with CRP level of 3.0–7.0 g/ml, one procedure was performed; 7.0–14.0 mg/l — three procedures, with CRP level of ≥ 14.0 mg/l, five procedures were performed. The combination of the traditional treatment with course of procedures of intestinal lavage in patients with chronic pancreatitis after acute pancreatitis has shown a significant more effective pain reduction, improvement of anthropometric parameters, indicators of coprogram and normalization of pro- and antioxidants markers.