EFFICIENCY OF APPLICATION OF THE COMBINED HEPATOPROTECTOR IN COMPLEX TREATMENT OF CHRONIC PANCREATITIS WITH CONCOMITANT LIVER DAMAGE
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i4.14291Keywords:
chronic pancreatitis, chronic viral hepatitis C, hepatotrophic agent Heparizin, complex rehabilitative treatment, fecal elastase-1Abstract
SUMMARY. Comorbidity of chronic pancreatitis (CP) and chronic viral hepatitis C (CVHC) is quite common and problematic, even after etiotropic treatment of viral hepatitis C infection.
The aim – to investigate the state of the functional capacity of the pancreas and general clinical and selected biochemical parameters of patients with CP against the background of treated CVHC under the influence of the proposed complex treatment with the additional inclusion of the hepatotrophic drug heparizin (HZ).
Material and Methods. 45 patients with CP comorbid with CVHC were studied. All patients were examined according to generally accepted algorithms and received a generally accepted complex of treatment according to the protocol (GAT) for CP in accordance with the order of the Ministry of Health of Ukraine No. 638 dated 2014 and CVHC – according to the Clinical Guideline of the Ministry of Health of Ukraine, based on evidence "Viral Hepatitis C" dated 2020. All outpatient patients with a comorbid course of CP and CVHC were divided into 2 groups to study the effectiveness of the proposed correction programs: 1 group (20 patients) received a generally accepted complex of treatment according to the protocol (GAT) for three months, Group 2 (GAT+HZ) – 25 patients with CP and CVHC) – received GAT with the additional inclusion of the hepatotrophic agent Heparizin PLC, 1 capsule 3 times a day after meals for 3 months.
Results. A more significant level of effectiveness of the treatment complex with the additional inclusion of the hepatotrophic drug heparizin was established in relation to this protocol treatment for the restoration of the functional and structural state of the pancreas according to the studied parameters: the content of fecal α-elastase increased by 54.4 % vs. 39.9 %, respectively, and glucose content decreased – by 15.6 % vs. 10.0 %, the co-program score decreased – by 40.2 % vs. 25.1 %, the US score of the software structure decreased – by 74.4 % vs. 33.6 % (p <0.05).
Conclusions: The reliable positive effect of heparizin on the disturbed parameters of the functional state of the pancreas and liver in CP in combination with CVHC was proven and allowed to assert the anti-inflammatory activity of heparizin, optimizing its effect on protein metabolism and functions of the pancreas and liver. It is recommended to additionally include the hepatotrophic agent heparizin to the protocol complex therapy of patients with chronic pancreatitis against the background of treated etiologically CVHC at the stage of outpatient rehabilitative treatment.
References
Babinets, L.S., Kryskiv, O.I., Shaihen, O.R., & Khomyn, H.O (2013). Analiz vplyvu riznykh etiolohichnykh chynnykiv na vynyknennia khronichnoho pankreatytu [Analysis of the influence of various etiologic factors on the occurrence of chronic pancreatitis]. Visnyk Vinnytskoho derzh. med. universytetu – Herald Vinnytsia State Medical University, 7(2/1), 444-445 [in Ukrainian].
Babinets, L.S., (2020). Efektyvnist biorehuliatsiinoho pidkhodu u kompleksnii korektsii endohennoi intoksykatsii pry khronichnykh urazhenniakh pankreatohepatobiliarnoi systemy [The effectiveness of the bioregulatory approach in the complex correction of endogenous intoxication in chronic lesions of the pancreatohepatobiliary system]. Hastroenterolohiya – Gastroenterology, 2, 84-87 [in Ukrainian].
Babinets, L.S., & Sasyk, H.M. (2020) Analiz funktsionalnoi spromozhnosti pidshlunkovoi zalozy pry komorbidnosti khronichnoho pankreatytu z tsukrovym diabetom 2-ho typu [Analysis of the functional capacity of the pancreas in the comorbidity of chronic pancreatitis with type 2 diabetes]. Simeyna medytsyna – Family medicine, 5-6(91-92), 47-50 [in Ukrainian]. DOI: https://doi.org/10.30841/2307-5112.5-6.2020.225345
Mostovyi, Yu.M. (2022). Suchasni klasyfikatsii ta standarty likuvannia rozpovsiudzhenykh zakhvoriuvan vnutrishnikh orhaniv [Modern classifications and standards of treatment of widespread diseases of internal organs]. Vinnytsya : VNMU imeni M. I. Pyrohova – Vinnytsia: VNMU named after M. I. Pirogov [in Ukrainian].
Babinets, L.S., Sasyk, H.M., Halabitska, I.M., & Mykuliak, V.R. (2021). Possibilities of complex rehabilitation of patients with type 2 diabetes and concomitant chronic pancreatitis in ambulatory practice. Balneologia, 1, 12-15. DOI: https://doi.org/10.36740/ABal202101105
Babinets, L.S., Shaihen, O.R., Homyn, H.O., & Halabitska, I.M. (2019). Specific aspects of clinical course in case of combination of chronic pancreatitis and concomitant viral hepatitis C. Wiadomosci lekarskie, 72(4), 95-599. DOI: https://doi.org/10.36740/WLek201904117
Chevaliez, S., Soulier, A., Poiteau, L., Bouvier-Alias, M., & Pawlotsky, J.M. (2014). Clinical utility of hepatitis C virus core antigen quantification in patients with chronic hepatitis C. J. Clin. Virol., 61, 145-148. DOI: https://doi.org/10.1016/j.jcv.2014.05.014
Dominguez-Munoz, J.E., Lucendo, A., Carballo, L.F., Iglesias-Garcia, J., & Tenias, J.M. (2014). A Spanish multicenter study to estimate the prevalence and incidence of chronic pancreatitis and its complications. Rev. Esp. Enferm. Dig., 106(4), 239-245.
European Association for Study of the Liver (2015). EASL Recommendations on Treatment of Hepatitis C 2015. J. Hepatol., 63, 199-236. DOI: https://doi.org/10.1016/j.jhep.2015.03.025
European Union HCV Collaborators (2017). Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimina- tion in the European Union by 2030: a modelling study. Lancet Gastroenterol. Hepatol., 2. 325-336.
Levy, P., Dominguez-Munoz, E., Imrie, C., Lohr, M., & Maisonneuve, P. (2014). Epidemiology of chronic pancreatitis: burden of the disease and consequences. United European Gastroenterol. J., 2(5), 345-354. DOI: 10.1177/ 2050640614548208. DOI: https://doi.org/10.1177/2050640614548208
Lew, D., Afghani, E., & Pandol, S. (2017). Chronic pancreatitis: current status and challenges for prevention and treatment. Dig. Dis. Sci., 62(7), 1702-1712. DOI: 10.1007/sl0620- 017-4602-2. DOI: https://doi.org/10.1007/s10620-017-4602-2
Lohr, J.M., Oliver, M.R., & Frulloni, L. (2013). Synopsis of recent guidelines on pancreatic exocrine insufficiency. United European Gastroenterol. J., 1(2), 79-83. DOI: 10.1177/2050640613476500. DOI: https://doi.org/10.1177/2050640613476500
Nahon, P., Bourcier, V., Layese, R., Audureau, E., Cagnot, C., & Marcellin, P. (2017). Eradication of hepatitis C virus infection in patients with cirrhosis reduces risk of liver and non-liver complications. Gastroenterology, 152, 142-156. DOI: https://doi.org/10.1053/j.gastro.2016.09.009
Soulier, A., Poiteau, L., Rosa, I., Hezode, C., Roudot-Thoraval, F., Pawlotsky, J.M. (2016). Dried blood spots: a tool to ensure broad access to hepatitis C screening, diagnosis, and treatment monitoring. J. Infect. Dis., 213, 1087-1095. DOI: https://doi.org/10.1093/infdis/jiv423
