Хронический панкреатит: перспективы раннего выявления

Леденева Е.М., Верткин А.Л., Седякина Ю.В., Курджиева С.С., Шамуилова М.М. Хронический панкреатит: перспективы раннего выявления. Consilium Medicum. 2023;25(5):308–312.
DOI: 10.26442/20751753.2023.5.202221

© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.

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Ledeneva EM, Vertkin AL, Sediakina IuV, Shamuilova MM, Kurdjieva SS. Chronic pancreatitis: prospects for early detection: A review. Consilium Medicum. 2023;25(5):308–312. DOI: 10.26442/20751753.2023.5.202221

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Аннотация

За последние 10 лет уровень заболеваемости хроническим панкреатитом (ХП) вырос в 4 раза и насчитывает 27,4–50 случаев на 100 тыс. взрослого населения. В практике амбулаторного врача-гастроэнтеролога больные ХП составляют около 35–45%, в гастроэнтерологическом отделении стационара – до 20–45%. Критерии ХП по данным методов визуализации – фиброз, расширение и деформация протоков, кальцинаты в паренхиме поджелудочной железы или ее атрофия – формируются на поздней стадии заболевания, в то же время диагностика заболевания на стадии с потенциально обратимыми изменениями остается сложной задачей ввиду отсутствия четких диагностических инструментальных и лабораторных маркеров подтверждения минимальных изменений в паренхиме поджелудочной железы. Однако некоторые методы в совокупности с детальным сбором анамнеза, выявлением значимых факторов риска и сопоставлением их с клинической картиной все же представляют собой интерес для ранней диагностики хронического панкреатита.

Ключевые слова: хронический панкреатит, поджелудочная железа, M-ANNHEIM, ранняя диагностика, острый панкреатит, болевой синдром

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Over the last 10 years, the incidence of chronic pancreatitis (CP) has increased 4 times and nowadays is about 27.4–50 cases per 100 000 adults. In the outpatient gastroenterologist practice, patients with CP account for about 35–45%, in the hospital gastroenterology department – up to 20–45%. CP criteria according to imaging methods – fibrosis, duct dilatation and deformation, calcifications in the pancreatic parenchyma or its atrophy – are formed at a late stage of the disease. Simultaneously, diagnosis at the early stage with potentially reversible changes remains difficult, due to the lack of clear instrumental and laboratory findings confirming minimal changes in the pancreas. However, some methods in combination with a detailed history taking, risk factors identification in comparison with the clinical features are of interest for the early diagnosis of chronic pancreatitis.

Keywords: chronic pancreatitis, pancreas, M-ANNHEIM, early diagnosis, acute pancreatitis, pain syndrome

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________________________________________________

1. Maev IV, Kucheriavyi IuA. Bolezni podzheludochnoi zhelezy. Moscow: GEOTAR–Media, 2009 (in Russian).
2. Ge QC, Dietrich CF, Bhutani MS, et al. Comprehensive review of diagnostic modalities for early chronic pancreatitis. World J Gastroenterol. 2021;27(27):4342-57. DOI:10.3748/wjg.v27.i27.4342
3. Beyer G, Habtezion A, Werner J, et al. Chronic pancreatitis. Lancet. 2020;396(10249):499-512.
4. Levy P, Barthet M, Mollard BR, et al. Estimation of the prevalence and incidence of chronic pancreatitis and its complications. Gastroenterol Clin Biol. 2006;30(6-7):838-44.
5. Ammann RW. A clinically based classification system for alcoholic chronic pancreatitis: summary of an international workshop on chronic pancreatitis. Pancreas. 1997;14(3):215-21.
6. Lankisch MR, Imoto M, Layer P, DiMagno EP. The effect of small amounts of alcohol on the clinical course of chronic pancreatitis. Mayo Clin Proc. 2001;76(3):242-51.
7. Maisonneuve P, Lowenfels AB, Müllhaupt B, et al. Cigarette smoking accelerates progression of alcoholic chronic pancreatitis. Gut. 2005;54(4):510-4.
8. Lévy P, Mathurin P, Roqueplo A, et al. A multidimensional case–control study of dietary, alcohol, and tobacco habits in alcoholic men with chronic pancreatitis. Pancreas. 1995;10(3):231-8.
9. Schneider A, Löhr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol. 2007;42(2):101-19. DOI:10.1007/s00535-006-1945-4
10. Witt H, Luck W, Hennies HC, et al. Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis. Nat Genet. 2000;25(2):213-6.
11. Pfützer RH, Barmada MM, Brunskill AP, et al. SPINK1/PSTI polymorphisms act as disease modifiers in familial and idiopathic chronic pancreatitis. Gastroenterology. 2000;119(3):615-23.
12. Witt H, Luck W, Becker M, et al. Mutation in the SPINK1 trypsin inhibitor gene, alcohol abuse, and chronic pancreatitis. JAMA. 2001;285(21):2716-7.
13. Khristenko E, Tjaden C, Klauß M. Pankreas divisum und Pankreatitis. Der Radiologe. 2021;61(6):541-7. DOI:10.1007/s00117-021-00848-w
14. Forsmark CE. Management of chronic pancreatitis. Gastroenterology. 2013;144(6):1282-91.e3.
15. Singh VK, Whitcomb DC, Banks PA, et al. Acute pancreatitis precedes chronic pancreatitis in the majority of patients: Results from the NAPS2 consortium. Pancreatology. 2022;22(8):1091-8. DOI:10.1016/j.pan.2022.10.004
16. Tao H, Chang H, Li N, et al. Clinical Characteristics of Patients With Chronic Pancreatitis With or Without Prior Acute Pancreatitis Are Different. Pancreas. 2022;51(8):950-6. DOI:10.1097/MPA.0000000000002142
17. Machicado JD, Chari ST, Timmons L, et al. A population-based evaluation of the natural history of chronic pancreatitis. Pancreatology. 2018;18(1):39-45. DOI:10.1016/j.pan.2017.11.012
18. Moroz EV, Karateev AE, Krukov EV. Chronic abdominal pain in chronic pancreatitis: pathogenesis, clinical phenotypes and modern concept of therapy. Russian Journal of Pain. 2020;18(2):40-6 (in Russian). DOI:10.17116/pain20201802140
19. Weiss FU, Budde C, Lerch MM. Specificity of a Polyclonal Fecal Elastase ELISA for CELA3. PLoS One. 2016;11(7):e0159363. DOI:10.1371/ journal.pone.0159363.
20. Simanenkov VI, Knorring GIu. Khronicheskii pankreatit – izvestnyi neznakomets. Aqua Vitae. Rossiiskii meditsinskii zhurnal. 2001;1:24-9 (in Russian).
21. Khan A, Vege SS, Dudeja V, Chari ST. Staging exocrine pancreatic dysfunction. Pancreatology. 2022;22(1):168-72. DOI:10.1016/j.pan.2021.11.005
22. Khatkov IE, Tylyaeva EYu, Lesko KA, Dubtsova EA. Early diagnosis of chronic pancreatitis. Almanac of Clinical Medicine. 2022;50(6):349-56 (in Russian).
DOI:10.18786/2072-0505-2022-50-049
23. Vege SS, Chari ST. Chronic Pancreatitis. N Engl J Med. 2022;386(9):869-78. DOI:10.1056/NEJMcp1809396
24. Ivashkin VT, Kriger AG, Okhlobystin AV, et al. Clinical Guidelines of the Russian Society of Surgeons, the Russian Gastroenterological Association, the Association of Surgeons-Hepatologists and the Endoscopic Society “REndO” on Diagnostics and Treatment of Chronic Pancreatitis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022;32(2):99-156 (in Russian). DOI:10.22416/1382-4376-2022-32-2-99-156
25. Tirkes T, Shah ZK, Takahashi N, et al. Reporting Standards for Chronic Pancreatitis by Using CT, MRI, and MR Cholangiopancreatography: The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Radiology. 2019;290(1):207-15. DOI:10.1148/radiol.2018181353

Авторы

Е.М. Леденева*, А.Л. Верткин, Ю.В. Седякина, С.С. Курджиева, М.М. Шамуилова

ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*docled@yandex.ru

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Ekaterina M. Ledeneva*, Arkadiy L. Vertkin, Iuliia V. Sediakina, Marina M. Shamuilova, Svetlana S. Kurdjieva

Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*docled@yandex.ru

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