CLINICAL VALUE OF THE FECAL ELASTASE-1 IN THE DIAGNOSTIC OF EXOCRINE PANCREATIC INSUFFICIENCY AT THE PATIENTS WITH CHRONIC PANCREATITIS

Tretiak N. G., Petrenko V. A., Pushko O. O., Tretiak I. M., Bulatetsky O. L.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The term «chronic pancreatitis» is recommended to define the chronic inflammation of the pancreas with chronic, irreversible, inflammatory and / or fibrotic changes of the pancreas, which are often characterized by severe pain, which impair the quality of life and the development of exocrine and endocrine pancreatic insufficiency. Currently, the «gold standard» of noninvasive diagnosis of chronic pancreatitis and exocrine pancreatic insufficiency is the detection of fecal pancreatic elastase-1. The diagnosis of chronic pancreatitis is confirmed on the basis of symptoms present in the patient, imaging results in order to determine the structure of the pancreas (ultrasound), tests of exocrine and endocrine functions. The aim of the research was to evaluate the clinical significance of fecal pancreatic elastase-1 in the diagnosis of exocrine pancreatic insufficiency in patients with chronic pancreatitis. The object of the study was the corpus of case histories of 32 patients with chronic pancreatitis in exacerbation stage, who underwent the test to identify fecal pancreatic elastase-1 for the diagnosis of exocrine pancreatic function. The control group consisted of 32 healthy individuals. In the study of fecal pancreatic elastase-1 in group of patients with chronic pancreatitis in 65.62% of patients fecal pancreatic elastase-1 was within the reference values of the norm (398.3±74.8 mcg/g); in 9.38% of patients diagnosed with mild exocrine pancreatic insufficiency (174.2±12.28 mcg/g); in patients diagnosed with moderate pancreatic insufficiency – to 6.25% (121.1±9.12 mcg/g); severe – in 18.75% of patients (78.37±8.23 mcg/g). In persons with chronic pancreatitis in whom according to the results of tests on fecal pancreatic elastase-1 mild to moderate exocrine pancreatic insufficiency was found, clinical manifestations of deficiency were found. Therefore, one can observe the feasibility of method for determining fecal pancreatic elastase-1 for early screening of disorders of exocrine pancreatic function. It has been detected that the tendency to increase exocrine pancreatic insufficiency is directly proportional to the duration of the disease. The fact that in most patients with chronic pancreatitis the level of fecal pancreatic elastase-1 was within the norm, reference values are probably linked to the short history of chronic pancreatitis. The obtained results substantiate the feasibility of the test to determine the fecal pancreatic elastase-1, as the latter can detect or refute exocrine pancreatic insufficiency in chronic pancreatitis, to monitor the condition of the exocrine function of the pancreas for early diagnosis and successful correction of exocrine pancreatic insufficiency by drug-free measures and drug therapy that generally prevent complications of pathology, promote stable remission, thus improving the survival and quality of life.

chronic pancreatitis, exocrine pancreatic insufficiency, pancreatic elastase stool test

• 1. Делягин В. М. Лекции по клинической диагностике внутренних болезней / В. М. Делягин, В. И. Мальцев, А. Г. Румянцев. – К. : МОРИОН, 2007. – 664 с.: ил.
• 2. Класифікації захворювань органів травлення : Довідник / за ред. Н. В. Харченко / О. Я. Бабак, О. А. Голубовська, Н. Б. Губергріц, А. Е. Дорофєєв, Т. Д. Звягінцева, І. М. Скрипник, С. М. Ткач, Г. Д. Фадєєнко, Н. В. Харченко, М. Б. Щербиніна. – Кіровоград : ПП «Поліум», 2015. – 55 с.
• 3. Наказ МОЗ України від 10.09.2014 № 638 «Про затвердження та впровадження медико-технологічних документів зі стандартизації медичної допомоги при хронічному панкреатиті» [Електронний ресурс] / Міністерство охорони здоров’я України – Режим доступу: http://www.moz.gov.ua/ua/portal/dn_20140910_0638.html.
• 4. Передерій В. Г. Основи внутрішньої медицини. Том 1 : [підручник для студентів вищих медичних навчальних закладів] / В. Г. Передерій, С. М. Ткач. – Вінниця : Нова Книга, 2009. – С. 345-359.
• 5. Передерий В. Г. Практическая гастроэнтерология : руководство для врачей / В. Г. Передерий, С. М. Ткач. – Винница : СПД Каштелянов А. И., 2011. – С. 601-631.
• 6. Харченко Н. В. Гастроентерологія / Н. В. Харченко, О. Я. Бабак та ін. – К.: Друкар, 2007. – 720 с.
• 7. Cartmell M. T. Faecal elastase 1 measurement in chronic pancreatitis / M. T. Cartmell, A. N. Kingsnorth, D. A. O’Reilly [et al.] // Clinical Chemical Laboratory Medicine. – 2005. – Vol. 43, N 1. – P. 97-98.
• 8. Layer P. The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis / P. Layer, H. Yamamoto, L. Kalthoff [et al.] // Gastroenterology. – 1994. – Vol. 107. – P. 1481-1487.

«Bulletin of problems biology and medicine» Issue 1 part 1 (126), 2016 year, 212-214 pages, index UDK 616.37-008.6:616.37-002:616-07