Features of the clinical course of chronic pancreatitis in patients with chronic obstructive pulmonary disease

Authors

DOI:

https://doi.org/10.14739/2409-2932.2024.1.295344

Keywords:

chronic pancreatitis, chronic obstructive pulmonary disease, pain syndrome, exocrine dysfunction

Abstract

Aim. The purpose of the study is to determine the intensity of the manifestation of clinical syndromes in the comorbid course of chronic pancreatitis (CP) in patients with chronic obstructive pulmonary disease (COPD) in comparison with the isolated course of CP and to assess the intensity of the mutual burden syndrome.

Material and methods. A prospective cohort study was conducted, analyzing the medical records of 212 inpatients. The first group comprised 96 individuals with an isolated course of chronic pancreatitis (CP), while the second group included 116 patients with CP and comorbid chronic obstructive pulmonary disease (COPD), categorized as Group E. The study focused on subjective manifestations of pain syndrome in CP, the extent of exocrine pancreatic insufficiency, clinical blood analysis, biochemical research regarding the content of markers indicating pancreatic enzyme deviation in the blood, and the level of elastase-1 in feces. Additionally, ultrasonographic examination of the organs in the abdominal cavity was performed.

Results. Patients in group 2 exhibited manifestations of abdominal pain syndrome 1.2 times more frequently than those in group 1 (p < 0.05). The frequency of pain in the pancreas radiating to the right subcostal region was 1.9 times higher in group 2 compared to group 1 (p < 0.05), along with a 2.1 times increase in the symptom of girdled pain radiating to the back (p < 0.05). Although the frequency of dyspeptic syndrome was slightly higher in group 2 (1.3 times, p > 0.05), astheno-vegetative syndrome was significantly more pronounced, exceeding the frequency in group 1 by 1.7 times (p < 0.05).

Ultrasonography parameters of the pancreas in both groups revealed characteristic signs of chronic pancreatitis (CP). The analysis of pancreatic functional state indicators during exacerbation indicated hyperenzymemia syndrome, with α-amylase activity significantly higher in patients of both groups compared to the control group – by 1.8 and 2.6 times, respectively (p < 0.05).

Conclusions. CP with chronic obstructive pulmonary disease (COPD) is characterized by a significantly lower frequency of paroxysmal abdominal pain syndrome but a higher frequency of constant aching pain in the pancreas area. Additionally, it is associated with the maximum intensity of inflammation, hyperfermentemia, a decrease in the activity of elastase-1 in feces, and a higher intensity of astheno-vegetative, painful, dyspepsia, intoxication syndromes. Moreover, there is a more pronounced exocrine dysfunction of the pancreas and more significant changes in the sonographic structure of the pancreas compared to cases with the isolated course of CP.

Author Biographies

O. S. Khukhlina, Bukovinian State Medical University, Chernivtsi, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Internal Medicine, Clinical Pharmacology and Occupational Diseases

I. V. Dudka, Bukovinian State Medical University, Chernivtsi, Ukraine

MD, PhD, Associate Professor of the Department of Internal Medicine, Clinical Pharmacology and Occupational Diseases

T. V. Dudka, Bukovinian State Medical University, Chernivtsi, Ukraine

MD, PhD, Associate Professor of the Department of Internal Medicine, Clinical Pharmacology and Occupational Diseases

References

Zhelezniakova NM, Pasiyeshvili TM. [Features of clinical manifestation of chronic obstructive pulmonary disease in patients with chronic pancreatitis]. Simeina medytsyna. 2015;(2):69-72. Ukrainian. Available from: http://nbuv.gov.ua/UJRN/simmed_2015_6_23

Hristich T, Hontsariuk D. [Pathogenetic aspects of chronic pancreatitis and chronic obstructive pulmonary disease comorbidity]. Gastroenterology. 2021;53(1):54-61. Ukrainian. doi: https://doi.org/10.22141/2308-2097.53.1.2019.163459

Kandikattu HK, Upparahalli Venkateshaiah S, Kumar S, Yadavalli CS, Mishra A. IL-18-mediated neutrophil recruitment promotes acute lung injury in inflammation-mediated chronic pancreatitis. Mol Immunol. 2023;155:100-9. doi: https://doi.org/10.1016/j.molimm.2023.01.012

Khukhlina OS, Ursul OO, Gaydichuk VS. [Influence of exogenous glutathione on the system of antioxidant protection of the body in case of comorbid course of chronic obstructive pulmonary disease and chronic pancreatitis]. Zaporozhye medical journal. 2015;(4):92-4. Ukrainian. doi: http://dx.doi.org/10.14739/2310-1210.2015.4.50273

Cavalli G, Colafrancesco S, Emmi G, Imazio M, Lopalco G, Maggio MC, et al. Interleukin 1α: a comprehensive review on the role of IL-1α in the pathogenesis and treatment of autoimmune and inflammatory diseases. Autoimmun Rev. 2021;20(3):102763. doi: https://doi.org/10.1016/j.autrev.2021.102763

Lazaruk ТY, Fediv ОІ. [Assessment of the life quality of patients with chronic pancreatitis combined with chronic obstructive pulmonary disease]. Art of Medicine. 2021;(4):51-5. Ukrainian. Available from: https://art-of-medicine.ifnmu.edu.ua/index.php/aom/article/view/590

Ministry of Health of Ukraine. [On approval and implementation of medical and technological documents on the standardization of medical care for chronic pancreatitis]. Order dated 2014 Sep 10 No. 638 [Internet]. 2014 [cited 2024 Jan 2]. Ukrainian. Available from: https://zakon.rada.gov.ua/rada/show/v0638282-14#Text

Ministry of Health of Ukraine. [On approval of the Unified Clinical Protocol of Primary and Specialized Medical Care "Chronic Pancreatitis"]. Order dated 2023 Jul 4 No. 1204 [Internet]. 2023 [cited 2024 Jan 2]. Ukrainian. Available from: https://zakon.rada.gov.ua/rada/show/v1204282-23#Text

Balázs A, Balla Z, Kui B, Maléth J, Rakonczay Z Jr, Duerr J, et al. Ductal Mucus Obstruction and Reduced Fluid Secretion Are Early Defects in Chronic Pancreatitis. Front Physiol. 2018;9:632. doi: https://doi.org/10.3389/fphys.2018.00632

Benjamin O, Lappin SL. Chronic Pancreatitis. 2022 Jun 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.

Forsmark CE. Diagnosis and Management of Exocrine Pancreatic Insufficiency. Curr Treat Options Gastroenterol. 2018;16(3):306-15. doi: https://doi.org/10.1007/s11938-018-0186-y

Frøkjær JB, Akisik F, Farooq A, Akpinar B, Dasyam A, Drewes AM, et al. Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis. Pancreatology. 2018;18(7):764-73. doi: https://doi.org/10.1016/j.pan.2018.08.012

Duggan SN. Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis. Proc Nutr Soc. 2017 Nov;76(4):484-494. doi: https://doi.org/10.1017/S0029665117001045

Gurakar M, Jalaly NY, Faghih M, Boortalary T, Azadi JR, Khashab MA, et al. Impact of genetic testing and smoking on the distribution of risk factors in patients with recurrent acute and chronic pancreatitis. Scand J Gastroenterol. 2022;57(1):91-8. doi: https://doi.org/10.1080/00365521.2021.1984573

Patel HR, Diaz Almanzar VM, LaComb JF, Ju J, Bialkowska AB. The Role of MicroRNAs in Pancreatitis Development and Progression. Int J Mol Sci. 2023;24(2):1057. doi: https://doi.org/10.3390/ijms24021057

Shabanzadeh DM, Novovic S. Alcohol, smoking and benign hepato-biliary disease. Best Pract Res Clin Gastroenterol. 2017;31(5):519-27. doi: https://doi.org/10.1016/j.bpg.2017.09.005

Shuja A, Rahman AU, Skef W, Smotherman C, Guan J, Malespin M, et al. A longitudinal analysis of the epidemiology and economic impact of inpatient admissions for chronic pancreatitis in the United States. Ann Gastroenterol. 2018;31(4):499-505. doi: https://doi.org/10.20524/aog.2018.0262

Singhvi A, Yadav D. Myths and realities about alcohol and smoking in chronic pancreatitis. Curr Opin Gastroenterol. 2018;34(5):355-61. doi: https://doi.org/10.1097/MOG.0000000000000466

Abbott. User manual for the pancreatic exocrine insufficiency questionnaire (PEI-Q) clinical practice version. Adelphi Values UK; 2018. 12 р. Available from: https://acarepro.abbott.com/wp-content/uploads/2022/08/60937.pdf

Min M, Patel B, Han S, Bocelli L, Kheder J, Vaze A, et al. Exocrine Pancreatic Insufficiency and Malnutrition in Chronic Pancreatitis: Identification, Treatment, and Consequences. Pancreas. 2018;47(8):1015-8. doi: https://doi.org/10.1097/MPA.0000000000001137

Johnson CD, Arbuckle R, Bonner N, Connett G, Dominguez-Munoz E, Levy P, et al. Qualitative Assessment of the Symptoms and Impact of Pancreatic Exocrine Insufficiency (PEI) to Inform the Development of a Patient-Reported Outcome (PRO) Instrument. Patient. 2017;10(5):615-28. doi: https://doi.org/10.1007/s40271-017-0233-0

Babinets LS, Kytsai KY. [Comparative analysis of the structure and function of the pancreas in patients with a combination of chronic pancreatitis and metabolic syndrome]. Family Medicine. European Practices. 2023;(2):30-4. Ukrainian. doi: https://doi.org/10.30841/2786-720X.2.2023.281214

Babinets LS, Sabat ZI. [Clinical and pathogenetic aspects of chronic pancreatitisin conjunction with autonomic dysfunction]. Gastroenterology. 2019;53(1):21-5. Ukrainian. doi: https://doi.org/10.22141/2308-2097.53.1.2019.163453

Ministry of Health of Ukraine. [Adapted evidence-based clinical guideline "Chronic obstructive pulmonary disease"]. Kyiv; 2020. 69 p. Available from: http://www.ifp.kiev.ua/ftp1/metoddoc/nastanova_hozl_2020.pdf

Sun J, Su W, Zhao X, Shan T, Jin T, Guo Y, et al. LncRNA PFAR contributes to fibrogenesis in lung fibroblasts through competitively binding to miR-15a. Biosci Rep. 2019;39(7):BSR20190280. doi: https://doi.org/10.1042/BSR20190280

Zhao X, Sun J, Chen Y, Su W, Shan H, Li Y, et al. lncRNA PFAR Promotes Lung Fibroblast Activation and Fibrosis by Targeting miR-138 to Regulate the YAP1-Twist Axis. Mol Ther. 2018;26(9):2206-17. doi: https://doi.org/10.1016/j.ymthe.2018.06.020

Published

2024-02-23

How to Cite

1.
Khukhlina OS, Dudka IV, Dudka TV. Features of the clinical course of chronic pancreatitis in patients with chronic obstructive pulmonary disease. Current issues in pharmacy and medicine: science and practice [Internet]. 2024Feb.23 [cited 2024Jun.21];17(1):52-9. Available from: http://pharmed.zsmu.edu.ua/article/view/295344