In the recent past, pancreatic diseases, accompanied by exocrine insufficiency, were found mainly in people over fifty years of age.Their development was explained by age-related changes in the body, as well as by the presence of other diseases of the digestive system.To date, there has been a sharp increase in the number of patients with pancreatitis among young people, citizens of developed countries.
The statistics is disappointing: the pancreas increasingly suffers from malnutrition, alcohol and bad ecology, and chronic pancreatitis becomes one of the most common diseases.In its course, two stages can be distinguished: on the first, lasting about ten years, there are pains in the pancreas region, but its functions practically remain unchanged.
In the second stage of pancreatitis development pain syndrome is less common, but pancreatic tissues lose their exocrine functions, they are replaced by connective tissue, cysts are formed in the gland, and stones appear in its ducts that prevent normal outfl
In this case, the development of external secretory deficiency, the cause of which is the inability of the pancreas to produce the juices necessary for digestion.Its tissues simply cease to fulfill the tasks assigned to them.The consequence of the development of exocrine insufficiency is a violation of the digestion of protein and fatty foods.At the same time, patients lose weight sharply, and when analyzing the stool, undigested protein and fat are found in it.
Secretory insufficiency can be a consequence of changes in the composition of juices produced by the pancreas and increase their viscosity, which also leads to blockage of its ducts.To the same consequences leads to the formation of stones in the ducts, which in turn is the cause of the syndrome of exocrine insufficiency.
For the treatment of secretory insufficiency, preparations are used whose composition is similar to digestive enzymes.They should be taken with food.It should be borne in mind that this is about normalizing digestion and improving the quality of life of the patient.There is no restoration of damaged tissues.
If the syndrome of insufficiency of the exocrine function is caused by obstruction of the ducts due to the formation of stones in them, then it is necessary to resort to the help of surgeons.
Chronic and parenchymal pancreatitis with excretory insufficiency
Excretory insufficiency( ENP) is the result of an isolated or general decrease in the production of pancreatic enzymes.According to statistics, most often the cause of the emergence of absolute( pancreatic) excretory insufficiency is chronic or parenchymal( recurrent, occurring several times a year) pancreatitis.
Disorders of the excretory function of the pancreas have the following clinical manifestations:
- belching, flatulence, nausea;
- poor appetite and, as a result, a sharp weight loss;
- aversion to fatty foods, hypersalivation;
- is a loose stool containing pieces of undigested food and having a sharp, fetid odor.
They appear at a decrease in the production of enzymes( trypsin, lipase, amylase) by 70-80%.
For the diagnosis of excretory failure in chronic or parenchymatous pancreatitis, direct and indirect methods of investigation are used.The first group includes duodenal intubation tests with several stimulants of secretion( holitsstokinin, secretin).Indirect methods include laboratory studies of stool and the determination of the concentration of pancreatic enzymes in it( measurement of pancreatic digestive activity).
Treatment of insufficient pancreatic secretion
Replacement enzyme therapy is used to treat insufficient pancreatic secretion.This method of treatment is safe and practically has no side effects.
Substitution therapy for chronic or parenchymal pancreatitis with exocrine insufficiency is aimed at minimizing nutritional intake disorders, namely lipids.To prevent inactivation of enzymes, a special coating is used.It dissolves in the stomach with an acidity level of over 5.5.In gastroenterology, Mezim forte is widely used.The required dosage is calculated by lipase.Treatment begins with a daily dosage of 1000 units / 1 kg.Body weight.Additionally, fat-soluble vitamins( A, E, K, D) are prescribed.The main indicator of the effectiveness of treatment is the removal or significant relief of the main symptoms of the disease, such as flatulence, abdominal pain.The chair will be normalized.Along with substitution therapy, treatment is required and concomitant diseases, since normal secretion depends on the state of full functioning of all organs of the digestive system.The obligatory component of therapy is medical nutrition.