Новые возможности лечения хронического панкреатита с использованием препарата Ливерия IC

Donetsk National Medical University n. a. M. Gorky, Ukraine, Conferinţa Naţională de Gastroenterologie și Hepatologie cu participare internaţională 20 iunie 2014 Chişinău, Republica MoldovaAcest studiu a examinat pacienţii cu pancreatită cronică. Se demonstrează eficienţa preparatului Liveria IC, inclus în tratamentul tradiţional al pancreatitei cronice, în ceea ce priveşte diminuarea sindroamelor dolor şi dispeptic, precum şi în scăderea indicilor izoamilazei pancreatice în sânge şi urină.Нами обследованы пациенты с хроническим панкреатитом. Исследование показало эффективность включения в традиционную терапию хронического панкреатита препарата Ливерия IC относительно уменьшения болевого и деспептических синдромов, а также показателей панкреатической изоамилазы крови и мочи

Генетические мутации у больных хроническим панкреатитом в Украине

Summary: The authors conducted a genetic analysis of patients with chronic pancreatitis in Ukraine. It turned out that more than a quarter of patients had mutations of PRSS1, SPINK1, CFTR genes. Peculiarities of combinations of ADH, ALDH, CYP2E1 genes, encoding enzymes involved in ethanol metabolism, are revealed. Obtained data testify to the reasonability of continuing research in this field.Резюме: Авторы провели генетический анализ у больных хроническим панкреатитом в Украине. Оказалось, что более чем у четверти больных имеют место мутации генов PRSS1, SPINK1, CFTR. Выявлены особенности комбинации генов ADH, ALDH, CYP2E1, кодирующих ферменты, участвующие в метаболизме этанола. Полученные данные свидетельствуют о целесообразности продолжения исследований в этом направлении

Differences in In Vitro Properties of Pancreatin Preparations for Pancreatic Exocrine Insufficiency as Marketed in Russia and CIS

BACKGROUND: Pancreatic enzyme-replacement therapy (PERT), provided as pancreatin to patients with pancreatic exocrine insufficiency (PEI), is considered an essential substitute for the pivotal physiological function the pancreas fulfills in digestion. PEI involves a reduction in the synthesis and secretion of pancreatic enzymes (lipase, protease, amylase), which leads to an inadequate enzymatic response to a meal and consequently to maldigestion and malabsorption of nutrients. The efficacy of PERT is strongly dependent on enzyme activity, dissolution, and pancreatin particle size. OBJECTIVE: The physiological properties of eight pancreatin preparations (nine batches; five different brands) available in Russia and CIS (Commonwealth of Independent States: Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Uzbekistan) were investigated. METHODS: The lipase activity, dissolution, and particle size distribution of samples from multiple batches of pancreatin of different strengths were measured. RESULTS: Regarding lipase activities, all pancreatin preparations except Micrazim(R) matched the labeled content. Considerable differences were observed in particle size and dissolution. CONCLUSION: Pancreatin preparations available in Russia and CIS demonstrate product-to-product and batch-to-batch variability regarding the measured properties of lipase activity, dissolution, and particle size. This may impact the efficacy of PERT and therefore clinical outcomes

Спленоз: путы неизвестности или шаг через существующие предосторожности (часть I)

Aim: to present a rare clinical case of multiple post-traumatic intra-abdominal splenosis in combination with type 2 macroamylasemia, chronic pancreatitis in a 27-year-old woman, clinically manifested like a palpable mass in the right iliac region.Main results. In the first part of the article, a detailed analysis of the medical history is given, the results of archival imaging studies and the data of laboratory and instrumental examination at the time of treatment are presented. The literature review presents modern definitions of splenosis, as well as brief information about the anatomy and physiology of the spleen.Conclusion. The diagnostic process requires a detailed analysis of the history of the disease, the performance of laboratory studies in combination with modern imaging studies, as well as a thorough study of the literature data.Цель исследования: представить редкий клинический случай множественного посттравматического интраабдоминального спленоза в сочетании с макроамилаземией 2-го типа, хроническим панкреатитом у женщины 27 лет, клинически манифестировавшего появлением пальпируемого образования в правой подвздошной области.Основные положения. В I-й части статьи приведен детальный анализ анамнеза болезни, представлены результаты архивных визуализирующих исследований и данные лабораторно-инструментального обследования на момент обращения. В обзоре литературы изложены современные определения понятия спленоз, а также краткие сведения об анатомии и физиологии селезенки.Заключение. Диагностический процесс требует детального анализа анамнеза болезни, выполнения лабораторных исследований в сочетании с проведением современных визуализирующих исследований, а также тщательного изучения литературных данных

European guideline on IgG4-related digestive disease – UEG and SGF evidence-based recommendations

The overall objective of these guidelines is to provide evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive disease in adults and children. IgG4-related digestive disease can be diagnosed only with a comprehensive work-up that includes histology, organ morphology at imaging, serology, search for other organ involvement, and response to glucocorticoid treatment. Indications for treatment are symptomatic patients with obstructive jaundice, abdominal pain, posterior pancreatic pain, and involvement of extra-pancreatic digestive organs, including IgG4-related cholangitis. Treatment with glucocorticoids should be weight-based and initiated at a dose of 0.6–0.8 mg/kg body weight/day orally (typical starting dose 30-40 mg/day prednisone equivalent) for 1 month to induce remission and then be tapered within two additional months. Response to initial treatment should be assessed at week 2–4 with clinical, biochemical and morphological markers. Maintenance treatment with glucocorticoids should be considered in multi-organ disease or history of relapse. If there is no change in disease activity and burden within 3 months, the diagnosis should be reconsidered. If the disease relapsed during the 3 months of treatment, immunosuppressive drugs should be added

Спленоз: путы неизвестности или шаг через существующие предосторожности (часть II)

Aim: to present a review of the literature on post-traumatic splenosis of different localization, as well as to complete the presentation of a rare clinical case of multiple post-traumatic intra-abdominal splenosis in combination with type 2 macroamylasemia, chronic pancreatitis in a 27-year-old woman.Main results. The literature data of the pathogenesis and classification of splenosis are considered. Close attention is paid to the clinical manifestations of post-traumatic splenosis: the results of imaging studies in intrathoracic, disseminated abdominal, intrahepatic and intrapancreatic forms of splenosis are presented.The end of the description of a rare clinical case of progressive multiple post-traumatic intra-abdominal splenosis in combination with type 2 macroamylasemia and chronic pancreatitis is presented. The process of diagnostic search, differential diagnosis is described, the controversial points to the patient’s management, the possibility and expediency of pregnancy are considered.Conclusion. The exclusivity of this clinical case requires further dynamic monitoring, especially in the possible pregnancy. Цель исследования: представить результаты обзора литературы, посвященной посттравматическому спленозу различной локализации, а также завершить изложение редкого клинического случая множественного посттравматического интраабдоминального спленоза в сочетании с макроамилаземией 2-го типа, хроническим панкреатитом у женщины 27 лет.Основные положения. Рассмотрены данные литературы, освещающие патогенез и классификацию спленоза. Пристальное внимание уделено клиническим проявлениям постравматического спленоза: приведены результаты визуализирующих исследований при внутригрудной, диссеминированной абдоминальной, внутрипеченочной и внутрипанкреатической формах спленоза.Представлено окончание описания редкого клинического случая прогрессирующего множественного посттравматического интраабдоминального спленоза в сочетании с макроамилаземией 2-го типа, хроническим панкреатитом. Описан процесс диагностического поиска, дифференциальной диагностики, рассмотрены дискутабельные моменты в отношении тактики ведения пациентки, возможность и целесообразность беременности.Заключение. Исключительность данного клинического случая требует проведения дальнейшего динамического наблюдения, особенно в случае наступления беременности.

Abernethy Malformation in Combination with Gilbert’s Syndrome

Aim. To present a clinical case of the Abernethy syndrome.Key points. Abernethy syndrome is a rare vascular anomaly associated with a congenital absence of the portal vein, as a result of which portal blood from the intestines and spleen drains directly into the systemic circulation bypassing the liver though a complete or partial shunt. In the vast majority of cases, Abernethy syndrome is manifested during the newborn period by jaundice syndrome, hypergalactosemia and encephalopathy. In rare cases, this vascular malformation is diagnosed in older patients during ultrasound screening. A 31 year-old patient sought medical attention with the complaints of sleep disturbance and fatigue. The conducted instrumental observation revealed echo-signs of malformation (agenesia) of the portal vein, which was further confirmed by both X-ray-contrast computed tomography and the pathohistological analysis of liver biopsy slides. The genotype UGT1A1•28 confirmed Gilbert's syndrome. Neutropenia (0.8 × 109/L) with a drop in the level of segmented neutrophils up to 27% was regarded as shunt neutropenia. Number connection test confirmed shunt encephalopathy. Conservative therapy for correcting hepatic encephalopathy was prescribed, followed by a dynamic monitoring of the patient’s condition.Conclusion. Diagnosis of Abernethy malformation is important for choosing the right treatment for the timely correction of complications of the disease and early detection of adenoma or hepatocellular carcinoma