Фармакотерапия хронического панкреатита с позиций современных клинических рекомендаций

1. Маев И.В., Кучерявый Ю.А., Андреев Д.Н., Дичева Д.Т., Гуртовенко И.Ю., Баева Т.А. Хронический панкреатит: новые подходы к диагностике и терапии: Учебно-методическое пособие для врачей. Москва: ФКУЗ «ГКГ МВД России»; 2014. 32 с. [Maev IV, Kucheryavyy YuA, Andreev DN, Dicheva DT, Gurtovenko IYu, Baeva TA. Khronicheskiy pankreatit: novye podkhody k diagnostike i terapii: Uchebno-metodicheskoe posobie dlya vrachey [Chronic pancreatitis: new approaches to diagnosis and therapy: Teaching-methodological manual for doctors]. Moscow: FKUZ “GKG MIA of Russia”; 2014. 32 p. (In Russ.)].
2. Yadav D, Timmons L, Benson JT, Dierkhising RA, Chari ST. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol. 2011;106:2192-2199. doi: 10.1038/ajg.2011.328
3. Wang LW, Li ZS, Li SD, Jin ZD, Zou DW, Chen F. Prevalence and clinical features of chronic pancreatitis in China: a retrospective multicenter analysis over 10 years. Pancreas. 2009;38:248-254. doi: 10.1097/ MPA.0b013e31818f6ac1
4. Маев И.В., Кучерявый Ю.А. Болезни поджелудочной железы. Москва: ОАО «Издательство «Медицина», издательство «Шико»; 2008. Т. 2. [Maev IV, Kucheryavy YuA. Bolezni podzheludochnoy zhelezy [Diseases of the pancreas]. Moscow: Publishing House “Medicine”, publishing house “Shiko”; 2008. Vol. 2 (In Russ.)].
5. Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis: pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion. 1993;54:148-155.
6. Raimondi S, Lowenfels AB, Morselli-Labate AM, Maisonneuve P, Pezzilli R. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol. 2010;24:349-358. doi: 10.1016/j.bpg.2010.02.007
7. Andersen DK, Andren-Sandberg Å, Duell EJ, Goggins M, Korc M, Petersen GM, Smith JP, Whitcomb DC. Pancreatitis-diabetes-pancreatic cancer: summary of an NIDDK-NCI workshop. Pancreas. 2013;42:1227-1237. doi: 10.1097/MPA.0b013e3182a9ad9d
8. Talar-Wojnarowska R, Wozniak B, Pazurek M, Malecka-Panas E. Outcome of pseudocysts complicating chronic pancreatitis. Hepatogastroenterology. 2010;57:631-634.
9. De-Madaria E, Abad-González A, Aparicio JR. The Spanish Pancreatic Club’s recommendations for the diagnosis and treatment of chronic pancreatitis: part 2 (treatment). Pancreatology. 2013;13:18-28.
10. Ивашкин В.Т., Маев И.В., Охлобыстин А.В., Кучерявый Ю.А., Трухманов А.С., Шептулин А.А., Шифрин О.С., Лапина Т.Л., Осипенко М.Ф., Симаненков В.И., Хлынов И.Б., Алексеенко С.А., Алексеева О.П., Чикунова М.В. Рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению хронического панкреатита. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2014;4(24):70-97 [Ivashkin VT, Maev IV, Okhlobystin AV, Kucheryavy YuA, Trukhmanov AS, Sheptulin AA, Shifrin OS, Lapina TL, Osipenko MF, Simanenkov VI, Khlynov IB, Alekseenko SA, Alekseeva OP, Chikunova MV. Recommendations of the Russian gastroenterological association for the diagnosis and treatment of chronic pancreatitis. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2014;4(24):70-97 (In Russ.)].
11. Ивашкин В.Т., Маев И.В., Охлобыстин А.В., Алексеенко С.А., Белобородова Е.В., Кучерявый Ю.А., Лапина Т.Л., Трухманов А.С., Хлынов И.Б., Чикунова М.В., Шептулин А.А., Шифрин О.С. Клинические рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению экзокринной недостаточности поджелудочной железы. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2017;27(2):54-80 [Ivashkin VT, Maev IV, Okhlobystin AV, Alekseenko SA, Beloborodova EV, Kucheryavyy YuA, Lapina TL, Trukhmanov AS, Khlynov IB, Chikunova MV, Sheptulin AA, Shifrin OS. Clinical recommendations of the Russian gastroenterological association for the diagnosis and treatment of exocrine pancreatic insufficiency. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2017;27(2):54-80 (In Russ.)]. 
doi: 10.22416/1382-4376-2017-27-2-54-80
12. Хатьков И.Е., Маев И.В., Абдулхаков С.Р. и др. Российский консенсус по диагностике и лечению хронического панкреатита. Терапевтический архив. 2017;89(2):105-113 [Khatkov IE, Maev IV, Abdulkhakov SR, et al. The Russian consensus on diagnosis and treatment of chronic pancreatitis. Terapevticheskiy Arkhiv. 2017;89(2): 105-113 (In Russ.)].
13. HaPanEU/UEG Working Group. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United Eur Gastroenterol J. 2017 Mar; 5(2):153-199. doi: 10.1177/2050640616684695
14. Demir IE, Friess H, Ceyhan GO. Neural plasticity in pancreatitis and pancreatic cancer. Nat Rev Gastroenterol Hepatol. 2015;12:649-659.
15. Uc A, Andersen DK, Bellin MD, Bruce JI, Drewes AM, Engelhardt JF, Forsmark CE, Lerch MM, Lowe ME, Neuschwander-Tetri BA, OʼKeefe SJ, Palermo TM, Pasricha P, Saluja AK, Singh VK, Szigethy EM, 
Whitcomb DC, Yadav D, Conwell DL. Chronic pancreatitis in the 21st century – research challenges and opportunities: summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas. 2016;45:1365-1375. doi: 10.1097/MPA. 0000000000000713
16. Gilron I, Bailey JM, Tu D, Holden RR, Jackson AC, Houlden RL. Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomised controlled crossover trial. Lancet. 2009;374:1252-1261.
17. Olesen SS, Bouwense SA, Wilder-Smith OH, van Goor H, Drewes AM. Pregabalin reduces pain in patients with chronic pancreatitis in a randomized, controlled trial. Gastroenterology. 2011;141:536-543.
18. Bouwense SA, Olesen SS, Drewes AM, Poley JW, van Goor H, Wilder-Smith OH. Effects of pregabalin on central sensitization in patients with chronic pancreatitis in a randomized, controlled trial. PLoS One. 2012;7:42096 doi: 10.1371/journal.pone.0042096
19. Brown A, Hughes M, Tenner S, Banks PA. Does pancreatic enzyme supplementation reduce pain in patients with chronic pancreatitis: a meta-analysis. Am J Gastroenterol. 1997;92:2032-2035.
20. Taylor JR, Gardner TB, Waljee AK, DiMagno MJ, Schoenfeld PS. Systematic review: efficacy and safety of pancreatic enzyme supplements for exocrine pancreatic insufficiency. Aliment Pharmacol Ther. 2010;31:57-72.
21. Braganza JM. Pancreatic disease: a casualty of hepatic ‘detoxification’? Lancet. 1983;2:1000-1002.
22. Ahmed Ali U, Jens S, Busch OR, Keus F, van Goor H, Gooszen HG, Boermeester MA. Antioxidants for pain in chronic pancreatitis. Cochrane Database Syst Rev. 2014;(8):8945. doi: 10.1002/14651858. CD008945.pub2
23. Kirk GR, White JS, McKie L, Stevenson M, Young I, Clements WD, Rowlands BJ. Combined antioxidant therapy reduces pain and improves quality of life in chronic pancreatitis. J Gastrointest Surg. 2006;10:499-503.
24. Bhardwaj P, Garg PK, Maulik SK, Saraya A, Tandon RK, Acharya SK. A randomized controlled trial of antioxidant supplementation for pain relief in patients with chronic pancreatitis. Gastroenterology. 2009;136:149-159.e2.
25. Uden S, Schofield D, Miller PF, Day JP, Bottiglier T, Braganza JM. Antioxidant therapy for recurrent pancreatitis: biochemical profiles in a placebo-controlled trial. Aliment Pharmacol Ther. 1992;6:229-240.
26. Маев ИВ, Кучерявый ЮА, Казюлин АН, Самсонов АА. Современные рекомендации по диагностике хронического панкреатита в общеклинической практике. Терапевтический архив. 2013;85(4):84-89 [Maev IV, Kucheryavyy YuA, Kazyulin AN, Samsonov AA. Modern recommendations for the diagnosis of chronic pancreatitis in general clinical practice. Terapevticheskiy Arkhiv. 2013;85(4):84-89 (In Russ.)].
27. Маев ИВ, Кучерявый ЮА, Самсонов АА, Андреев ДН. Трудности и ошибки в тактике ведения больных хроническим панкреатитом. Терапевтический архив. 2013;85(2):65-72 [Maev IV, Kucheryavyy YuA, Samsonov AA, Andreev DN. Difficulties and errors in the management tactics of patients with chronic pancreatitis. Terapevticheskiy Arkhiv. 2013;85(2):65-72 (In Russ.)].
28. Kucheryavyy YuA, Andreev DN. Nutritional Status in Patients with Chronic Pancreatitis. J Nutr Ther. 2014;3(3):122-32. doi: 10.6000/ 1929-5634.2014.03.03.3
29. Маев И.В., Кучерявый Ю.А., Андреев Д.Н., Бидеева Т.В. Статус питания больных хроническим панкреатитом. Терапевтический архив. 2016;88(2):81-89 [Maev IV, Kucheryavyi YuA, Andreev DN, Bideeva TV. Nutritional status in patients with chronic pancreatitis. Terapevticheskiy Arkhiv. 2016;88(2):81-9 (In Russ.)]. doi: 10.17116/ terarkh201688281-89
30. Lindkvist B, Phillips ME, Dominguez-Munoz JE. Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: Prevalence and diagnostic use. Pancreatology. 2015 Nov-Dec;15(6):589-597. doi: 10.1016/j.pan.2015.07.001
31. Hoffmeister A, Mayerle J, Beglinger C, Büchler MW, Bufler P, Dathe K, Fölsch UR, Friess H, Izbicki J, Kahl S, Klar E, Keller J, Knoefel WT, Layer P, Loehr M, Meier R, Riemann JF, Rünzi M, Schmid RM, Schreyer A, Tribl B, Werner J, Witt H, Mössner J, Lerch MM. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol. 2015 Dec;53(12):1447-1495. doi: 10.1055/s-0041-107379
32. Dominguez-Munoz JE, Iglesias-Garcia J. Oral pancreatic enzyme substitution therapy in chronic pancreatitis: Is clinical response an appropriate marker for evaluation of therapeutic efficacy? JOP. 2010 Mar 5;11(2):158-162.
33. Маев И.В., Кучерявый Ю.А. Заместительная ферментная терапия при панкреатической недостаточности. Клинические перспективы гастроэнтерологии, гепатологии. 2005;(5):19-28 [Maev IV, Kucheryavy YuA. Replacement enzyme therapy in pancreatic insufficiency. Klinicheskie Perspektivy Gastroenterologii, Gepatologii. 2005;(5):19-28 (In Russ.)].

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1. [Maev IV, Kucheryavyy YuA, Andreev DN, Dicheva DT, Gurtovenko IYu, Baeva TA. Khronicheskiy pankreatit: novye podkhody k diagnostike i terapii: Uchebno-metodicheskoe posobie dlya vrachey [Chronic pancreatitis: new approaches to diagnosis and therapy: Teaching-methodological manual for doctors]. Moscow: FKUZ “GKG MIA of Russia”; 2014. 32 p. (In Russ.)].
2. Yadav D, Timmons L, Benson JT, Dierkhising RA, Chari ST. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol. 2011;106:2192-2199. doi: 10.1038/ajg.2011.328
3. Wang LW, Li ZS, Li SD, Jin ZD, Zou DW, Chen F. Prevalence and clinical features of chronic pancreatitis in China: a retrospective multicenter analysis over 10 years. Pancreas. 2009;38:248-254. doi: 10.1097/ MPA.0b013e31818f6ac1
4. [Diseases of the pancreas]. Moscow: Publishing House “Medicine”, publishing house “Shiko”; 2008. Vol. 2 (In Russ.)].
5. Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis: pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion. 1993;54:148-155.
6. Raimondi S, Lowenfels AB, Morselli-Labate AM, Maisonneuve P, Pezzilli R. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol. 2010;24:349-358. doi: 10.1016/j.bpg.2010.02.007
7. Andersen DK, Andren-Sandberg Å, Duell EJ, Goggins M, Korc M, Petersen GM, Smith JP, Whitcomb DC. Pancreatitis-diabetes-pancreatic cancer: summary of an NIDDK-NCI workshop. Pancreas. 2013;42:1227-1237. doi: 10.1097/MPA.0b013e3182a9ad9d
8. Talar-Wojnarowska R, Wozniak B, Pazurek M, Malecka-Panas E. Outcome of pseudocysts complicating chronic pancreatitis. Hepatogastroenterology. 2010;57:631-634.
9. De-Madaria E, Abad-González A, Aparicio JR. The Spanish Pancreatic Club’s recommendations for the diagnosis and treatment of chronic pancreatitis: part 2 (treatment). Pancreatology. 2013;13:18-28.
10. [Ivashkin VT, Maev IV, Okhlobystin AV, Kucheryavy YuA, Trukhmanov AS, Sheptulin AA, Shifrin OS, Lapina TL, Osipenko MF, Simanenkov VI, Khlynov IB, Alekseenko SA, Alekseeva OP, Chikunova MV. Recommendations of the Russian gastroenterological association for the diagnosis and treatment of chronic pancreatitis. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2014;4(24):70-97 (In Russ.)].
11. [Ivashkin VT, Maev IV, Okhlobystin AV, Alekseenko SA, Beloborodova EV, Kucheryavyy YuA, Lapina TL, Trukhmanov AS, Khlynov IB, Chikunova MV, Sheptulin AA, Shifrin OS. Clinical recommendations of the Russian gastroenterological association for the diagnosis and treatment of exocrine pancreatic insufficiency. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2017;27(2):54-80 (In Russ.)]. 
doi: 10.22416/1382-4376-2017-27-2-54-80
12. [Khatkov IE, Maev IV, Abdulkhakov SR, et al. The Russian consensus on diagnosis and treatment of chronic pancreatitis. Terapevticheskiy Arkhiv. 2017;89(2): 105-113 (In Russ.)].
13. HaPanEU/UEG Working Group. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United Eur Gastroenterol J. 2017 Mar; 5(2):153-199. doi: 10.1177/2050640616684695
14. Demir IE, Friess H, Ceyhan GO. Neural plasticity in pancreatitis and pancreatic cancer. Nat Rev Gastroenterol Hepatol. 2015;12:649-659.
15. Uc A, Andersen DK, Bellin MD, Bruce JI, Drewes AM, Engelhardt JF, Forsmark CE, Lerch MM, Lowe ME, Neuschwander-Tetri BA, OʼKeefe SJ, Palermo TM, Pasricha P, Saluja AK, Singh VK, Szigethy EM, 
Whitcomb DC, Yadav D, Conwell DL. Chronic pancreatitis in the 21st century – research challenges and opportunities: summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas. 2016;45:1365-1375. doi: 10.1097/MPA. 0000000000000713
16. Gilron I, Bailey JM, Tu D, Holden RR, Jackson AC, Houlden RL. Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomised controlled crossover trial. Lancet. 2009;374:1252-1261.
17. Olesen SS, Bouwense SA, Wilder-Smith OH, van Goor H, Drewes AM. Pregabalin reduces pain in patients with chronic pancreatitis in a randomized, controlled trial. Gastroenterology. 2011;141:536-543.
18. Bouwense SA, Olesen SS, Drewes AM, Poley JW, van Goor H, Wilder-Smith OH. Effects of pregabalin on central sensitization in patients with chronic pancreatitis in a randomized, controlled trial. PLoS One. 2012;7:42096 doi: 10.1371/journal.pone.0042096
19. Brown A, Hughes M, Tenner S, Banks PA. Does pancreatic enzyme supplementation reduce pain in patients with chronic pancreatitis: a meta-analysis. Am J Gastroenterol. 1997;92:2032-2035.
20. Taylor JR, Gardner TB, Waljee AK, DiMagno MJ, Schoenfeld PS. Systematic review: efficacy and safety of pancreatic enzyme supplements for exocrine pancreatic insufficiency. Aliment Pharmacol Ther. 2010;31:57-72.
21. Braganza JM. Pancreatic disease: a casualty of hepatic ‘detoxification’? Lancet. 1983;2:1000-1002.
22. Ahmed Ali U, Jens S, Busch OR, Keus F, van Goor H, Gooszen HG, Boermeester MA. Antioxidants for pain in chronic pancreatitis. Cochrane Database Syst Rev. 2014;(8):8945. doi: 10.1002/14651858. CD008945.pub2
23. Kirk GR, White JS, McKie L, Stevenson M, Young I, Clements WD, Rowlands BJ. Combined antioxidant therapy reduces pain and improves quality of life in chronic pancreatitis. J Gastrointest Surg. 2006;10:499-503.
24. Bhardwaj P, Garg PK, Maulik SK, Saraya A, Tandon RK, Acharya SK. A randomized controlled trial of antioxidant supplementation for pain relief in patients with chronic pancreatitis. Gastroenterology. 2009;136:149-159.e2.
25. Uden S, Schofield D, Miller PF, Day JP, Bottiglier T, Braganza JM. Antioxidant therapy for recurrent pancreatitis: biochemical profiles in a placebo-controlled trial. Aliment Pharmacol Ther. 1992;6:229-240.
26. [Maev IV, Kucheryavyy YuA, Kazyulin AN, Samsonov AA. Modern recommendations for the diagnosis of chronic pancreatitis in general clinical practice. Terapevticheskiy Arkhiv. 2013;85(4):84-89 (In Russ.)].
27. [Maev IV, Kucheryavyy YuA, Samsonov AA, Andreev DN. Difficulties and errors in the management tactics of patients with chronic pancreatitis. Terapevticheskiy Arkhiv. 2013;85(2):65-72 (In Russ.)].
28. Kucheryavyy YuA, Andreev DN. Nutritional Status in Patients with Chronic Pancreatitis. J Nutr Ther. 2014;3(3):122-32. doi: 10.6000/ 1929-5634.2014.03.03.3
29. [Maev IV, Kucheryavyi YuA, Andreev DN, Bideeva TV. Nutritional status in patients with chronic pancreatitis. Terapevticheskiy Arkhiv. 2016;88(2):81-9 (In Russ.)]. doi: 10.17116/ terarkh201688281-89
30. Lindkvist B, Phillips ME, Dominguez-Munoz JE. Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: Prevalence and diagnostic use. Pancreatology. 2015 Nov-Dec;15(6):589-597. doi: 10.1016/j.pan.2015.07.001
31. Hoffmeister A, Mayerle J, Beglinger C, Büchler MW, Bufler P, Dathe K, Fölsch UR, Friess H, Izbicki J, Kahl S, Klar E, Keller J, Knoefel WT, Layer P, Loehr M, Meier R, Riemann JF, Rünzi M, Schmid RM, Schreyer A, Tribl B, Werner J, Witt H, Mössner J, Lerch MM. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol. 2015 Dec;53(12):1447-1495. doi: 10.1055/s-0041-107379
32. Dominguez-Munoz JE, Iglesias-Garcia J. Oral pancreatic enzyme substitution therapy in chronic pancreatitis: Is clinical response an appropriate marker for evaluation of therapeutic efficacy? JOP. 2010 Mar 5;11(2):158-162.
33. [Maev IV, Kucheryavy YuA. Replacement enzyme therapy in pancreatic insufficiency. Klinicheskie Perspektivy Gastroenterologii, Gepatologii. 2005;(5):19-28 (In Russ.)].

И.В. Маев 1, Т.В. Бидеева 1, Ю.А. Кучерявый 1, Д.Н. Андреев 1, А.О. Буеверов 2

1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия

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I.V. Maev 1, Т.В. Bideeva 1, Yu.A. Kucheryavyy 1, D.N. Andreev 1, A.O. Bueverov 2

1 A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
2 I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia