Экзокринная недостаточность поджелудочной железы: клиническое значение и подходы к коррекции с позиций доказательной медицины
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Maev IV, Kucheryavyy YuA, Andreev DN. Exocrine pancreas insufficiency: clinical significance and approaches to correction from evidence medicine. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (4): 509–515.
DOI: 10.26442/00403660.2021.04.200800
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Ключевые слова: экзокринная недостаточность поджелудочной железы, хронический панкреатит, муковисцидоз, заместительная ферментная терапия, мальнутриция, мальдигестия, мальабсорбция, нутритивный статус
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Exocrine pancreatic insufficiency (EPI) is a common complication of both benign and malignant diseases of the pancreas, as well as a consequence of radical surgical operations on the pancreas and a whole range of other variable extra-pancreatic causes. In clinical practice in the adult population, most cases of EPI are associated with chronic pancreatitis, while in the pediatric population – with cystic fibrosis. The regression of the production of digestive enzymes in EPI mediates the development of the syndrome of maldigestion and malabsorption, leading to the progressive development of malnutrition, the importance of which is often underestimated by practitioners. At the same time, the development of nutritional deficiency is not just a complication of EPI, but also has an important effect on the course of the underlying causative disease, worsening the prognosis and quality of life of the patient, and is also a proven risk factor for osteoporosis and sarcopenia. To date, compensation for the absolute deficiency of pancreatic enzymes using enzyme replacement therapy is the only possible way to correct the EPI and prevent nutritional deficiency.
Keywords: exocrine pancreatic insufficiency, chronic pancreatitis, cystic fibrosis, enzyme replacement therapy, malnutrition, maldigestion, malabsorption, nutritional status
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1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия;
2 АО «Ильинская больница», г.о. Красногорск, д. Глухово, Россия
*dna-mit8@mail.ru
________________________________________________
Igor V. Maev1, Yury A. Kucheryavyy2, Dmitry N. Andreev*1
1 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia;
2 Ilyinskaya Hospital, Krasnogorsk, village Glukhovo, Russia
*dna-mit8@mail.ru