Symptoms and treatment of enzyme deficiency in children. Enzyme deficiency - causes of pathology and methods of its treatment

Pancreatic insufficiency is a deficiency of pancreatic enzymes that prevents normal digestion and absorption of food. nutrients.

Causes

The causes of pancreatic insufficiency can be congenital (cystic fibrosis, lipomatosis, Shwachman syndrome) or acquired ( surgical removal pancreas, death of some cells due to pancreatitis).

The progressive loss of acinar cells of the gland inevitably leads to impaired absorption due to inadequate production of digestive enzymes. However, the significant functional reserve of the pancreas prevents symptoms of pancreatic insufficiency (PII) from appearing until most of the pancreas has been destroyed. Pancreatic enzymes perform basic digestive functions, but there are alternative pathways for digesting some nutrients. During the experimental blocking of pancreatic secretion, the intestines continued to absorb up to 63% of incoming proteins and up to 84% of fats. This is limited enzymatic activity, probably manifests itself as a result of the work of lingual and/or gastric lipases, gastric pepsins, esterases and peptidases of the intestinal mucosa and, in young patients, milk lipase activated by the action of bile salts. However, when severe violation exocrine pancreatic function, these alternative digestive pathways are deficient, resulting in signs of malabsorption. EPI is less common in children than in adults, but more reliable TPI tests developed for children have shown that this disease occurs in them much more often than previously thought.

Spontaneous development of atrophy of pancreatic acinar cells, PAA (pancreatic acinar atrophy) in previously healthy adult patients is quite common and is the main cause of EPI. Similar disorders periodically occur in children; there are known cases of identical histologically confirmed pathological changes. Recent research has revealed that some people develop RAA as a consequence of asymptomatic lymphocytic and possibly autoimmune pancreatitis. These patients do not develop diabetes, since islet cells are preserved.

It is usually not possible to make a diagnosis of EPI based on the results of standard laboratory tests. Alanine aminotransferase (ALT) activity may be mildly or moderately increased, possibly reflecting hepatocyte damage caused by excessive uptake of hepatotoxic substances due to impaired mucosal permeability small intestine. Others' results biochemical research serum levels are not pathognomonic except that a decrease in the level of total fats, cholesterol and polyunsaturated fats is often detected fatty acids. The protein concentration in the blood serum usually remains normal, despite the marked disturbance in the supply of nutrients to the body of the sick patient. Lymphopenia and eosinophilia may also be detected; however, if any other changes in the blood are detected, the possibility of the presence of other concomitant or alternative diseases should be considered.

The activity of amylase, isoamylase, lipase and phospholipase A 2 in the blood serum with EPI decreases minimally, indicating that in this type of patient these enzymes are secreted not only by the pancreas. The most reliable and widely used test currently is the assessment of serum TPI.

Trypsinogen is synthesized only by the pancreas, and measurement of serum concentrations of this proenzyme using species-specific radioimmunoassays is the most reliable indirect indicator of exocrine pancreatic function. Assessment of TPI in blood serum is a highly sensitive and specific method for diagnosing EPI, since the concentration of trypsinogen decreases significantly compared to that in healthy patients and patients with diseases of the small intestine. Marked weakening of TPI (up to<2 мкг/л) может даже предшествовать развитию потери массы тела и диареи. Метод прост в исполнении: все, что для этого требуется, — это однократное взятие крови с предва­рительным выдерживанием больного на голодной диете в течение нескольких часов. ТПИ в сыворотке крови очень стабильна, что позволяет отправить об­разец с курьером в лабораторию, где проводят подоб­ные исследования.

There are other tests used to diagnose EPI: assessment of proteolytic activity in stool using azoprotein, radial diffusion of enzymes in gelatin methods, specific assessment of pancreatic elastase in stool, bentiromide test (BT-PABA), changes in plasma clarity after oral administration of fats and microscopic examination of stool. In many cases, the results of these tests are both false-positive and false-negative, so they are not recommended even as crude screening tests. Moreover, not all laboratories can carry out these tests, and even if there is somewhere to perform them, they are inconvenient and expensive. If EPI is suspected, TPI evaluation is recommended.

Treatment of pancreatic insufficiency

Enzyme replacement therapy

In most patients, pancreatic insufficiency can be successfully treated by adding enzymes, which are a dry extract of the pancreas, to each serving of food. The extract may have varying bioavailability, come in many forms (tablets, capsules, powders, granules) and may contain various enzymes. The initial effective dose is usually approximately two teaspoons of extract powder per 20 kg of body weight at each meal. The extract should be added to food immediately before feeding. Usually, feeding twice a day is enough for the patient to begin to gain weight. Weight gain is usually 0.5-1.0 kg per week, diarrhea and other disorders, such as polyphagia, are eliminated within 4-5 days.

After clinical improvement, patients will be able to independently select the minimum effective dose of enzyme preparations to prevent relapse of the disease. The dose is selected individually for each patient, since the amount of the drug depends on the batch of extract and the patient’s body’s need for additional enzyme administration. For this condition, the minimum requirement is one full teaspoon of enzymes added to each feeding, but children may need less. For some, feeding 3-4 times a day is sufficient, while others may require five feedings a day. As an inexpensive alternative to dry extract, you can use chopped raw pancreas of cattle or pigs (in the amount of 100-150 g per 20 kg of weight), if these patients are found healthy according to the results of a mandatory post-mortem examination. This by-product can be stored frozen at minus 20 ° C for three months without significant loss of enzyme activity.

A special enteric (enteric) coating has been developed to protect the enzymes from destruction by the acidic environment of the stomach, but these products are often less effective than powdered pancreatic extract. This effect may be due to selective retention of enteric-coated particles in the stomach during the entire period of food in it, or possibly due to their rapid transit through the intestine, which prevents adequate enzyme release in the proximal small intestine. In the future, it may be more effective to use enteric-coated drugs, but developed specifically for patients with pancreatic insufficiency. The use of new drugs containing fungal or gastric lipases that are not destroyed in an acidic environment may also be effective and cost-effective. At the same time, the likelihood of the effect of such drugs for patients with suboptimal weight gain is low, as well as increasing the dose of enzymes more than recommended or prescribing cimetidine. This information indicates the possible participation in this process of other factors not related to the content of enzymes in the proximal parts of the small intestine.

Diet changes for pancreatic insufficiency

Even the administration of optimal enzyme therapy does not normalize fat absorption. patients easily compensate for this by increasing their food consumption, which necessitates the regulation of this indicator in order to maintain ideal body weight. Some types of dietary fiber reduce the activity of pancreatic enzymes in vitro, so you should avoid giving patients dietary fiber containing significant amounts of indigestible fiber. However, a low-fat diet only reduces the calorie intake of pancreatic insufficiency, so this should also be avoided. In order to correct residual deficiency of digestive function, it is advisable to use feed containing a large amount of digestible and low amount of indigestible dietary fiber.

Prognosis for pancreatic insufficiency

The pathological processes that led to the development of EPI are usually irreversible, so treatment must be carried out throughout life. It is important to take into account that patients, in addition to replacement therapy with enzyme preparations, often require vitamin B12. Given the high cost of treatment, it is logical to periodically either repeat the TPI test or stop the enzyme administration approximately every 6 months so that it can be assessed whether clinical signs of the disease will reappear or not. Acinous tissue has some ability to regenerate, so it is understandable that after pancreatitis or RAA, the remaining pancreatic tissue can regenerate to such an extent that even normalization of digestion is possible. Cases of recovery from clinically significant enzyme deficiency have been described. However, in most cases, treatment is required throughout the patient's life, and if they are willing to carry out expensive enzyme replacement therapy for pancreatic insufficiency, the prognosis in this case is quite satisfactory. Some patients never regain their previous body weight, but they do not experience diarrhea and polyphagia, which significantly improves the quality of life. A high incidence of mesenteric torsion and gastric dilatation/volvulus has been reported in Finland, but has not been reported in other countries.

Due to the lack of enzyme compounds that are responsible for fat, protein and carbohydrate breakdown, there is a deficiency of pancreatic enzymes, the symptoms of which are clearly expressed, indicating a change in the functioning of digestion. To restore pancreatic enzyme deficiency, treatment is carried out using special medications. However, the organ also produces their precursors, which carry out their activities; therapy for the pancreas is selected for each victim separately.

There are 4 types of pancreatic pathologies.

1. Insufficiency of external secretion of pancreatic enzymes.
2. Exocrine pancreatic insufficiency.
3. Enzyme deficiency in gastric juice.
4. Decreased production of the hormones glucose, lipocaine and glucagon with endocrine deficiency of the organ.

Due to external secretory insufficiency of the pancreas, there is a decrease in the activity of special secretion elements that break down eaten foods into substances that are easily absorbed by the body, or the secretory waste of digestive juice into the intestines changes due to narrowing of the ducts due to existing tumors and fibrosis. When enzyme activity is disrupted, the secretion becomes thick and viscous, and food is poorly broken down. If there is a narrowing of the passages into the intestines, an incomplete volume of enzyme elements arrives, which do not cope with their task as needed.

The main features include:

• inability to tolerate fatty and spicy foods;
• feeling of heaviness in the stomach area;
• stool disorder;
• colic in the abdominal area, bloating.

Due to a decrease in protein fermentation content, this leads to the formation of:

• shortness of breath;
• anemia;
• weaknesses in the body;
• fatigue;
• tachycardia.

Exocrine insufficiency of pancreatic enzymes is manifested by a decrease in productivity, which is responsible for the natural working process of the gastrointestinal tract.

The disease is formed by the following symptoms:

• indigestion;
• nausea;
• heaviness in the stomach area;
• excess gases in the intestines;
• intestinal dysfunction.

Exocrine pancreatic deficiency occurs:

• relative - characterized by an irreversible course, the integrity of the pancreas does not change, malaise is often a consequence of immaturity of the pancreas or impaired secretion. Often observed in childhood;
• absolute disorder - accompanied by necrosis of the acini, fibrosis of organ tissue, and decreased production of pancreatic enzymes. Develops as a result of chronic and acute pancreatitis, cystic fibrosis, Shwachman-Diamond syndrome.

Inferiority of organ enzymes is manifested by indigestion.

1. Flatulence.
2. Nausea.
3. Vomit.
4. Feces have an unpleasant odor.
5. Loss of fluid in the body.
6. Weakness.

The most significant symptom of enzyme deficiency is a change in stool. The patient's frequency of bowel movements increases, the feces have excess fats that are difficult to wash off, the stool has a gray tint and a putrid odor.

In the case of endocrine disruption, this type is dangerous because it leads to the development of organ dysfunction in the body and irreversible consequences. When insulin production changes, diabetes mellitus develops. The main symptoms that indicate a deficiency include:

• increased blood glucose after eating;
• feeling of thirst;
• frequent urination;
• itching in the genital area in women.

When the production of glucagon decreases, the patient complains of weakness, dizziness, cramps in the limbs, impaired mental state, and loss of reason.

Causes

There are two types of pancreatic enzyme disorders:

1. Congenital type - formed as a result of a genetic defect that disrupts and blocks the enzymes produced by the pancreas.
2. Acquired type - often manifests itself as a result of diseases of the pancreas or due to poor nutrition.

In addition, enzyme deficiency is divided into primary and secondary, relative and absolute disorders.

The development of a primary disorder is formed due to pathology developing in the parenchyma of the organ and leading to the suppression of its work. In the secondary, the mechanism of occurrence is different - enzymes are produced in the required volume, but upon penetration into the intestines, due to unknown factors, they do not become active.

Factors that can lead to the development of a pathological process.

1. Tumor formations in the pancreas.
2. Obesity, which leads to the deposition of fat cells in organ tissues.
3. Operations.
4. Shwachman-Johanson-Blizzard syndrome.

Often, the factors of exocrine deficiency lie in the functionality of the stomach and intestines. In addition, the problem arises due to the abuse of various diets, which leads to an imbalance in the saturation of the body with nutrients and an increase in alcohol consumption.

Symptoms are not the main link by which the diagnosis is made. To clarify the type of disorder and determine the method of treatment, a number of examinations are carried out.

The reason for the formation of exocrine disorder lies in the appearance of diseases that contribute to a decrease in the size of the cells of the glandular tissue of the gland, which are responsible for the synthesis of secretions.

The main factors in the development of enzyme disorders include:

• the appearance of infection;
• negative impact of medications used in the treatment of certain diseases;
• congenital anomalies;
• the occurrence of dysbacteriosis.

With a lack of pancreatic enzymes, symptoms manifest as a disorder of the pancreas.

Endocrine deficiency is formed due to various injuries that affect the gland, the appearance of fragmented damage to its tissues.

Diagnosis of pathological changes

To identify the presence or absence of a deficiency digestive enzymes apply:

1. Radiography.
2. Probe and probe-free examination.

endoscopy

A more informative diagnosis of pancreatic enzyme deficiency is a probe analysis. But such a study is quite expensive and brings discomfort to the patient during the diagnostic period. The probeless test is painless, but it is impossible to detect enzyme deficiency of the pancreas at the developmental stage. Such tests make it possible to identify a disease that is accompanied by a strong decrease in the synthesis of organ enzymes or their complete absence.

Diagnosis is often made by direct probe secretin-cholecystokinin testing. It involves stimulating the production of enzymes due to the introduction of individual elements - secretin with cholecystokinin. Then a laboratory analysis of the taken material is carried out to determine the rate of enzyme secretion. In addition, the concentration of bicarbonates is determined.

In the absence of changes in the functioning of the gland, the increase in the amount of secretion will show 100%, bicarbonate saturation no more than 15%. In case of a significant decrease in indicators from the norm, the formation of enzyme deficiency is observed.

Procedure for performing a probeless test:

1. Initially, tests are taken. Biochemical analysis of blood and urine, research is being carried out.
2. Elements are introduced into the body that interact with enzymes found in urine and the bloodstream.
3. Blood and urine tests are required again.
4. The results are compared.

In addition to the tests, a coprogram is made. Thanks to the coprogram, the stage of absorption of amino acids by the gland, the coefficient of the presence of fat, chymotrypsin and trypsin in excrement are determined.

If inferiority is detected after these enzyme studies, CT, MRI, etc. are performed. With the help of these diagnostics, underlying or adjacent inferiority diseases are identified.

Treatment of diseases

In order to normalize work in most of the pancreas and eliminate changes, therapy is directed based on the type of deficiency. In the presence of pancreatitis, when symptoms of the pathology where it hurts are identified, treatment is carried out with the help of multienzyme medications that replace the missing enzyme elements.

If the factor causing a lack of enzymes is associated with chronic gastritis in an adult, pancreatitis, diabetes and other pathologies, then agents are used that restore the level of digestive enzymes in the body.

1. Mezim.
2. Pancreatin.
3. Creon.

The choice of medication for the treatment of enzyme deficiency of the gland is carried out individually, based on the characteristics of the body.

To normalize the condition, a diet is needed that is aimed at controlling the blood glucose level and the use of medications prescribed to the patient. The patient's meals are divided, up to 6 times a day. The diet consists of vegetables, cereals, which are rich in carbohydrates, and protein foods.

When enzyme activity decreases, drugs are prescribed that increase digestive ability and stabilize the alkaline environment.

1. Omeprozole.
2. Lanzoprazole.
3. Pantoprazole.

When enzymatic deficiency is complicated by diabetes, the gland is treated with sugar-lowering medications or injections.

Functional digestive disorders are constant companions of modern man. Pain and heaviness in the stomach, heartburn, flatulence - all this is the price for irregular and unhealthy diet, abuse of fatty foods and alcohol. It is believed that among the urban population, more than 80–90% of residents suffer from various diseases of the gastrointestinal tract, while slightly more than half seek medical help. However, a correctly diagnosed diagnosis and a well-chosen drug can significantly improve the patient’s quality of life. Complete digestion depends, first of all, on the normal functioning of the pancreas, which synthesizes more than two dozen different enzymes that ensure the digestion and subsequent absorption of food. When creating the human body, nature did not foresee that people would purposefully consume the strongest poisons - alcohol and acetaldehyde (a product of the breakdown of tobacco smoke). And if, for example, there are at least some protective barriers in the liver, represented by enzymes that break down alcohol, then the pancreas cannot resist the action of aggressive substances. This leads to inevitable damage to the structure and function of the organ. However, clinical symptoms do not appear immediately and only in 25–40% of patients. Thus, one of the most common diseases of the gastrointestinal tract - chronic pancreatitis - can be asymptomatic for several years, affecting both people of working age (average age - 39 years) and adolescents. The importance of the pancreas in ensuring the processes of digestion and absorption of nutrients is extremely high. When a bolus of food (chyme) enters through the pylorus, it triggers the release of pancreatic juice (up to 2 l/day). It contains a whole complex of digestive enzymes and a solution of sodium bicarbonate, which creates an alkaline environment. The maximum concentration of enzymes in the duodenum is reached 30 minutes after eating and decreases over the next 3–4 hours. The quantitative and qualitative composition of pancreatic secretion is relatively unstable and can vary depending on the nature of the diet. However, normally it contains three main groups of enzymes - proteolytic, lipolytic and amylolytic. Amylase breaks down carbohydrates into monosaccharides, lipase acts on lipids, forming monoglycerides and fatty acids, proteins are broken down into amino acids under the influence of proteases (Fig. 1).

In the large intestine, water is absorbed from the food bolus and feces are formed. Absorption of water-soluble vitamins, fatty acids, and electrolytes occurs. At each of these stages, the enzymes contained in the pancreatic juice of the pancreas are of utmost importance. Various conditions associated with enzyme deficiency lead to impaired digestion and absorption of nutrients.

Pathogenetically, enzyme deficiency is divided into gastrogenic and pancreatic. Gastrogenic insufficiency, which develops as a result of hypoacid conditions, is caused by a decrease in the secretion of gastric juice and, as a consequence, a secondary decrease in pancreatic secretion. A concomitant complication of gastrogenic insufficiency is the development of pathogenic microflora, which contributes to the inactivation of enzymes in the small intestine. Pancreatic insufficiency, in turn, is divided into primary and secondary. Primary PN is caused by diseases of the organ and, as a consequence, by the amount of enzymes produced. Secondary PN can be caused by a number of reasons that cause insufficient action of enzymes during their normal secretion:

• cholegenic PN (lipase activation is reduced due to insufficiency of bile acids)
• gastrogenic (insufficient stimulation of the pancreas by gastric juice enzymes)
• enterogenous (caused by microbial contamination of the pancreas and damage to the mucous membrane by endotoxins)
• vascular (occurs when microcirculation in the intestinal wall is disrupted).

But the most common cause of digestive problems is dietary errors - eating too much food and its “heavy” chemical composition. Often a large feast is accompanied by the consumption of significant doses of alcohol, which disrupts the functioning of the pancreas. In this case, despite the adequate secretion of enzymes and their normal activity, symptoms similar to gastrogenic insufficiency occur in the human body (Table 1). It should be remembered that the frequent occurrence and prolonged course of digestive problems requires mandatory consultation with a gastroenterologist.

Digestive insufficiency is dangerous because part of the incoming food remains unchanged in the intestinal cavity, which leads to a change in the internal environment of the intestine (shift in acidity, chemical composition, osmotic pressure). This causes damage to the intestinal mucosa and the development of pathogenic microflora.

IT IS IMPORTANT!

It should be remembered that an obligatory concomitant of digestion disorders is a sharp decrease in absorption (malabsorption) and insufficient intake of fats, proteins, carbohydrates, vitamins, iron, etc. into the body; most often, insufficient absorption of fats and fat-soluble vitamins predominates.

Diagnosis of pancreatic insufficiency should be comprehensive, carried out by laboratory methods and include ultrasound of the abdominal organs, probing, study of the biochemical composition of the blood, urine and stool tests. Enzyme replacement therapy is the main component of treatment for pancreatic insufficiency. The safety and low incidence of side effects makes it possible to select an over-the-counter drug for occasional digestive disorders. The goal of enzyme therapy is to eliminate disturbances in the digestion and absorption of fats, proteins and carbohydrates and restore the normal supply of nutrients and vitamins to the human body. Enzyme preparations, depending on their composition, can be divided into several groups: Pancreatin preparations, mainly obtained from the pancreas of pigs (contain amylase, lipase and trypsin). Combined preparations containing bile components in addition to pancreatin. Plant enzymes containing papain, fungal amylase, protease, lipase, including in combination with simethicone, adsorbents and other substances.

Drugs from different groups, despite their similar composition and pharmacological activity, are not interchangeable and have different indications for use. Pancreatin preparations are a universal means of normalizing digestion and are used as part of complex therapy of any etiology. They contain protease, amylase, lipase in various doses. It should be noted that, as a rule, pancreatin for the production of enzyme preparations is obtained from animal pancreas tissue. However, animal origin does not always guarantee safety for humans. In particular, protein components of cattle tissues can provoke the development of spongiform encephalopathy and other prion infections. In this regard, the most physiological and safe is pancreatin, obtained from the tissues of the pancreas of pigs, so its use does not carry the risk of developing the diseases mentioned above. Pancreatin preparations are produced in the form of various dosage forms - tablets, dragees, capsules with microgranules and mini-tablets. The choice of dosage form is also important for the effective elimination of digestive insufficiency and must be justified in each case. The most common are tableted enzyme preparations coated with an acid-resistant coating. This type of dosage form protects enzymes from destruction under the influence of the acidic environment of the stomach and ensures their action in the intestines. To better mix enzymes with the food bolus and prevent inactivation of substances under the influence of gastric juice, pancreatin preparations are used in the form of gastrosoluble capsules containing mini-tablets coated with an enteric coating. When it enters the stomach, the capsule shell is destroyed and its contents quickly and evenly mix with partially digested food, after which it gradually enters the duodenum. And only there the mini-tablets dissolve, as a result of which the enzymes begin to act. These types of enzyme preparations show maximum effectiveness in correcting various types of enzyme deficiency.

One of these drugs is MEZIM® FORTE 10,000, containing a large number of active components (7500 units of amylase, 10,000 of lipase and 375 of protease). MEZIM® FORTE 10,000 is recommended for people with diseases of the digestive system, accompanied by digestive disorders due to a deficiency of digestive enzymes - cholelithiasis, cholecystitis, chronic hepatitis, irritable bowel syndrome and chronic pancreatitis. It should be noted that MESIM® FORTE 10,000 does not contain bile acids, so it can be prescribed to patients with pathologies of the liver and gastroduodenal zone. It is also important that the composition of MEZIM® FORTE 10,000 does not contain plasticizers and dyes, therefore the drug does not exhibit any associated negative effects on the body and is indicated for use in children over 3 years of age. This drug has proven itself as a remedy for eliminating the consequences of overeating and treating diseases accompanied by digestive disorders due to a deficiency of digestive enzymes. Another drug of choice for correcting enzyme deficiency is PANGROL®, which is presented in several doses, which allows you to select the optimal dosage regimen taking into account the characteristics of the course of the disease. PANGROL® 25,000 is characterized by lipase activity of 25,000 IU, amylase - 22,500 IU, protease - 1250 IU. In PANGROL® 20,000, the activity of lipase is 20,000 IU, amylase - 12,000 IU, protease - 900 IU. PANGROL® 10,000 is characterized by a reduced content of enzymes (lipase activity - 10,000 IU, amylase - 9000 IU, protease - 500 IU). Like MEZIM® FORTE 10,000, this drug does not contain bile, which is important when treating patients with viral liver damage. Indications for the use of PANGROL® are insufficiency of exocrine pancreatic function in adults and children, which is caused by various diseases, including: chronic pancreatitis, cystic fibrosis, pancreatectomy, gastroectomy, etc. The drug should be taken without chewing and with a non-alkaline liquid (water, fruit juices ).

IT IS IMPORTANT!

If the use of a whole capsule is impossible (children, elderly patients), then it can be carefully opened and the mini-tablets contained in the capsule mixed with liquid food that does not need to be chewed and which has a neutral or slightly acidic environment (yogurt, grated apple, apple juice). puree). The resulting mixture must be taken immediately after preparation; it cannot be stored.

Full information on the dosage regimen and features of the use of the above drugs is given in the instructions for use, which should be read before starting therapy. In order to eliminate the symptoms of bloating, flatulence, belching, as well as to relieve spasms, antifoam agents (simethicone) are additionally used. Simethicone belongs to the group of surfactants and has antifoaming properties. A prominent representative of drugs based on simethicone is ESPUMIZAN®. It is important that the drug is physiologically inert: it is not absorbed in the gastrointestinal tract, does not participate in the biochemical processes of digestion, and does not affect the functioning of the liver and kidneys. ESPUMIZAN® exhibits its pharmacological effect only in the intestinal lumen by reducing the force of surface tension at the liquid-gas separation boundary, as a result of which the gas bubbles that formed the foam burst. Thanks to this process, the gas is released from the body and absorbed by the mucous membrane or released outside, excreted unchanged from the body. It is also important that the drug is presented in 2 dosage forms - oral drops, indicated for use in children from birth, pregnant and lactating women, and capsules, which are recommended for adults and children over 6 years of age. A few words about prevention The main factor in the prevention of pancreatic diseases is proper nutrition and the absence of bad habits. Fatty foods and alcohol intake lead to increased production of digestive enzymes and damage to the pancreas. For the normal functioning of the gastrointestinal tract, boiled or baked foods, cereals, lean meat and fish, various soups and lactic acid products are of undoubted benefit. It is advisable to exclude strong black tea, coffee and sugar. It is better to divide all food into several frequent meals. Parsley, raspberries, barberries are useful for the functioning of the pancreas, as well as green tea and hibiscus tea, rosehip decoction, teas based on linden blossom, wild strawberry. Thanks to the development of modern medicine and pharmacy, today, with the help of enzyme replacement therapy, it is possible to achieve almost complete restoration of digestive functions and significantly improve the quality of life. However, it must be remembered that any frequently occurring symptoms of digestive disorders may indicate serious diseases of the gastrointestinal tract. A timely consultation with a gastroenterologist will allow you to fully assess the condition of the pancreas and, by taking the necessary measures, avoid many unpleasant health problems in the future.

– limited secretion or low activity of pancreatic enzymes, leading to impaired breakdown and absorption of nutrients in the intestine. Manifested by progressive weight loss, flatulence, anemia, steatorrhea, polyfecal matter, diarrhea and polyhypovitaminosis. Diagnosis is based on laboratory methods for studying the external secretion of the pancreas, conducting a coprogram, and determining the level of enzymes in the stool. Treatment includes therapy for the underlying disease, normalization of the supply of nutrients to the body, replacement of pancreatic enzymes, and symptomatic treatment.

Diagnostics

Special tests (probe and probeless), often combined with ultrasound, X-ray and endoscopic methods, are of primary importance for identifying pancreatic enzyme deficiency. Probe techniques are more expensive and cause discomfort to patients, but their results are more accurate. Tubeless tests are cheaper and more easily tolerated by patients, but they make it possible to determine pancreatic insufficiency only with a significant decrease or complete absence of enzymes.

The direct probe secretin-cholecystokinin test is the gold standard for diagnosing pancreatic enzyme insufficiency. The method is based on stimulation of pancreatic secretion by introducing secretin and cholecystokinin, followed by taking several samples of duodenal contents at intervals of 10 minutes. In the obtained samples, the activity and rate of pancreatic secretion, the level of bicarbonates, zinc, and lactoferrin are examined. Normally, the increase in secretion volume after the test is 100%, the increase in bicarbonate levels is at least 15%. Enzyme deficiency of the pancreas is indicated by an increase in secretion volume of less than 40% and a lack of increase in the level of bicarbonates. False-positive results are possible with diabetes, celiac disease, hepatitis, and after resection of part of the stomach.

The indirect Lund probe test is similar to the previous method, but pancreatic secretion is stimulated by introducing a test food into the probe. This study is easier to conduct (does not require injection of expensive drugs), but its results largely depend on the composition of the test food. A false positive result is possible if the patient has diabetes, celiac disease, or gastrostomy.

Probeless methods are based on the introduction into the body of certain substances that can interact with enzymes in urine and blood serum. The study of metabolic products of this interaction makes it possible to assess the exocrine function of the pancreas. Probeless tests include bentiramide, pancreato-lauryl, iodolipol, triolein and other methods.

In addition, the level of pancreatic secretion can be determined by indirect methods: by the degree of absorption of plasma amino acids by the pancreas, by qualitative analysis of the coprogram (the content of neutral fats and soap will be increased against the background of normal levels of fatty acids), quantitative determination of fat, fecal chymotrypsin and trypsin in feces , elastase-1.

Instrumental diagnostic methods (radiography of the abdominal organs, MRI, CT, ultrasound of the pancreas and hepatobiliary system, ERCP) are used to identify the underlying and concomitant diseases.

Treatment of enzyme deficiency

Treatment of exocrine pancreatic insufficiency should be comprehensive, including correction of nutritional status, etiotropic and replacement therapy, and symptomatic treatment. Etiotropic therapy is aimed mainly at preventing the progression of death of the pancreas parenchyma. Correction of eating behavior consists of eliminating alcohol consumption and smoking, increasing the amount of protein in the diet to 150 g/day, reducing the amount of fat by at least half the physiological norm, and taking vitamins in therapeutic dosages. If severe malnutrition occurs, partial or total parenteral nutrition may be required.

The main treatment for pancreatic enzyme insufficiency is lifelong enzyme replacement with food. Indications for enzyme replacement therapy for pancreatic insufficiency: steatorrhea with loss of more than 15 g of fat per day, progressive protein-energy deficiency.

The most effective today are microgranulated enzyme preparations in an acid-resistant shell, enclosed in a gelatin capsule - the capsule dissolves in the stomach, creating conditions for uniform mixing of the drug granules with food. In the duodenum, when the pH level reaches 5.5, the contents of the granules are released, providing a sufficient level of pancreatic enzymes in the duodenal juice. Dosages of drugs are selected individually, depending on the severity of the disease and the level of pancreatic secretion. The criteria for the effectiveness of replacement therapy and the adequacy of dosages of enzyme preparations are weight gain, reduction of flatulence, and normalization of stool.

Prognosis and prevention

The prognosis for pancreatic insufficiency is determined by the severity of the underlying disease and the degree of damage to the pancreatic parenchyma. Considering the fact that pancreatic enzyme deficiency develops with the death of a significant part of the organ, the prognosis is usually questionable. The development of this condition can be prevented by timely diagnosis and treatment of pancreatic diseases, abstinence from drinking alcohol, and smoking.

Pancreatic enzyme insufficiency has very different symptoms, depending on the type of malfunction that develops. The pancreas is one of the most important human organs. This organ is responsible for performing a large number of functions that ensure the normal functioning of all body systems.

One of the pathological disorders is pancreatic enzymatic insufficiency.

Reasons for the development of disorders

The organ produces special enzymes in the body, without which the process of digesting food is impossible. Sometimes the normal functioning of the pancreas is disrupted and the amount of components produced decreases; such a pathological failure is called pancreatic insufficiency. The main reasons for the development of the condition in the organ may be the following:

• damage to the tissues that make up the organ;
• the occurrence of vitamin deficiency in the body;
• drop in protein concentration in the blood;
• reduced hemoglobin content in red blood cells;
• incorrect diet, leading to disruptions in the body.

In addition to the listed reasons for the formation of disorders, there are a large number of factors that can influence the formation of malfunctions in the gland. In some cases, a person’s heredity plays a huge role in the development of malfunctions in the glands. In such cases, even with a healthy lifestyle and proper nutrition, pancreatic disorders occur. Malfunctions of the gland can cause various forms of diseases.

Forms of disorder in the organ

To date, four forms of functional failures are known. Each type of disorder has certain characteristics. The main forms of functional failure are:

• exocrine insufficiency;
• exocrine insufficiency;
• insufficiency of enzyme production;
• endocrine insufficiency.

Each type of disorder has its own distinctive features. A disruption in the functioning of an organ is an unpleasant circumstance.

To establish failures in the organ and determine the type of failure, it is necessary to undergo a specialized examination under the supervision of a medical specialist.

After examination and consultation, the medical specialist establishes an accurate diagnosis and prescribes appropriate treatment, the purpose of which is to normalize the functioning of the pancreas.

The most common problem in the functioning of an organ is a failure of secretory activity. Among the different types of secretory insufficiency, the most common is the exocrine type of insufficiency, which consists in a lack of production of secretions involved in the processes of food digestion. This type of deficiency develops due to a decrease in the number of secretory cells that are responsible for the synthesis of secretions.

Development of exocrine insufficiency

Exocrine insufficiency, like other disorders in the body, has a number of specific symptoms and manifestations that make it possible to clearly establish the presence of this type of disorder in the body. The main symptoms of exocrine pancreatic insufficiency are as follows:

• intolerance to fatty and spicy foods;
• the appearance of heaviness in the stomach after eating fatty and spicy foods that are not fully absorbed by the body;
• the presence of fatty, mushy stools;
• the occurrence of bloating;
• the appearance of colic in the abdomen;
• the occurrence of pain in the bones.

In addition to the listed symptoms, malfunctions of the gland are characterized by the occurrence of rapid heart rate, muscle cramps, shortness of breath, abnormalities in the system that ensures the functioning of blood clotting, dry skin and some others. The occurrence of these symptoms is due to a lack of fats and fatty acids in the body. Due to a violation of their digestibility, problems appear that cause enormous discomfort, greater than the disease itself.

Causes of development of disorders in the pancreas

Medical specialists have identified several reasons leading to the development of pathological disorders in the gland. Depending on the influence of certain causes on the body, a certain disorder develops. The main reasons for the development of violations are the following:

• reduction in the mass of exocrine glandular tissue;
• the outflow of secretions into the cavity of the duodenum;
• insufficient participation of enzymes in the process of food processing;
• use of certain medications in the treatment process.

The main way to normalize the functioning of the pancreas is to maintain proper nutrition. The basic principles of proper nutrition, which contributes to the normalization of organ function, are:

• the use of fractional food consumption, in which the number of meals is increased while simultaneously reducing the amount of food consumed at one time;
• limiting the amount of fatty foods you consume;
• limiting food consumption late, before bedtime and in the middle of the night;
• refusal to drink drinks containing alcohol.

The foods that are allowed to be eaten are regulated by the attending medical specialist, who monitors the patient’s diet. If the consumption of fatty foods of animal origin is limited, it is replaced with plant foods containing vegetable fats. A large number of vegetables and fruits are introduced into the diet. For those suffering from exocrine disorder, carbohydrate-containing foods come to the fore in nutrition, which must be consumed in sufficient quantities in order to provide assistance to the body in the fight against the disorder. The main thing that is required is to get carbohydrates from healthy foods, and not from sweets.

With a complete transition to foods of plant origin, increased gas formation in the gastrointestinal tract may be observed.

In addition to dietary nutrition, a patient with this type of disorder is required to use medications during treatment, the action of which is aimed at restoring the functions of the organ. Such medications include Creon, Pancreatin, Mezim and some others. Most often, such drugs are taken simultaneously with food. If this phenomenon occurs, then you should eat bran.

Development of exocrine type of insufficiency

Exocrine pancreatic insufficiency is one of the types of organ dysfunction, which is manifested by a lack of production of juices by the glandular tissue of the organ for digestion.

The main symptoms of the development of this disorder are:

• poor digestion of food;
• increased level of gas formation in the stomach;
• disruption of the process of feces formation;
• feeling of nausea;
• the appearance of a feeling of heaviness.

The reasons for the violation may be the following:

• disruption may be caused by irreversible changes;
• stomach problems;
• dysfunction of the duodenum;
• problems with the gallbladder;
• eating disorders;
• alcohol abuse;