Effectiveness of Intestinal Lavage for the Inflammatory, Pro- and Antioxidant Processes Correction in the Treatment of Chronic Pancreatitis Therapeutic Exacerbation

Abstract

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas with periods of exacerbation and remission. Frequent long-term exacerbations lead to the destruction of the soft tissue and a decrease in its functional properties. CP is manifested by an activation of inflammation, severe pain that reduces the quality of life, the development of exocrine and endocrine insufficiency and the development of polynutrient trophologic insufficiency (PTI), which requires adequate correction. The objective: to study the dynamics of inflammatory, pro- and antioxidant parameters under the influence of the use of the intestinal lavage method in patients with the therapeutic exacerbation of CP that occurred after acute pancreatitis (AP). Materials and methods. The study included 60 patients with CP after a history of AP. Patients were divided into two groups. I group included 38 patients who received a generally accepted complex of CP treatment. II group included 22 patients, whose treatment complex included a course of modified intestinal lavage in addition to the drug therapy. The effectiveness and duration of the procedures were determined by laboratory, anthropometric and instrumental parameters of CP and PTI in the patients with CP after AP history. The processes of pro- and antioxidant disorders were studied with the determination of the content of malonaldehyde, superoxide dismutase, catalase, and SH-groups. Results. The proposed method of intestinal lavage demonstrated that its use makes possible to increase the time of intestinal lavage due to the “pulsating” supply of liquid, provides a gentle effect of washing on the intestinal mucous membrane, and prevents additional traumatization of the intestine in case of the need to administer drugs. The use of a double circuit allows to administer drugs immediately after lavage without the probe removement, and in such way to prevent the mixing and possible side effects when using several drugs at the same time. Conclusions. The study demonstrated that the higher level of effectiveness of the proposed treatment complex with the inclusion of a course of intestinal lavage compared to the protocol complex for the management of patients with a therapeutic exacerbation of chronic pancreatitis (CP) after a history of acute pancreatitis (AP) was proved. The analysis of the level of C-reactive protein proved that this parameter can be a marker of the depth of intoxication and the severity of inflammation. The use of a course of intestinal lavage procedures in the generally accepted treatment of patients with CP after the history of AP led to a decrease in pain syndrome, improvement of anthropometric parameters, coprogram indicators and normalization of pro- and antioxidant changes.