Characteristics of Adverse Effects in Patients with Chronic Alcoholic Pancreatitis and Concomitant Alcoholic Liver Cirrhosis Child-Pugh Class A and B

K. M. Skoropad, V. H. Mishchuk

Abstract


Alcohol intoxication is the third leading cause of death, and among alcohol-dependent patients alcohol-related pathology (alcoholic liver disease, acute and chronic pancreatitis, cardiomyopathy, polyneuro-encephalopathy) accounts for 42.6% of fatal cases. In many cases prominent feature of liver damage can be detected in people who consume alcohol in moderation and they can hardly be called alcoholics.

The objective of the research was to study the long-term results of the effectiveness of treating patients with chronic alcoholic pancreatitis and concomitant alcoholic liver cirrhosis Child-Pugh Class A and B as well as to establish prognostically unfavorable parameters of the clinical course of the comorbidity.

Materials and methods. The study included 89 patients with alcohol-related pathology who were observed prospectively for 1 year. 50 patients suffered from chronic alcoholic pancreatitis and concomitant liver cirrhosis Child-Pugh Class A and B; 20 patients were diagnosed with alcoholic liver cirrhosis without damage to the pancreas; 19 patients developed chronic alcoholic pancreatitis. Patients with liver cirrhosis received therapy according to the Order of the Ministry of Health of Ukraine of 06.11.2014, No 826 “Unified clinical protocol of primary, secondary (specialized) medical care “Alcoholic hepatitis”; patients with chronic alcoholic pancreatitis received therapy according to the Order of the Ministry of Health of Ukraine of 10.09.2014, No 638 “On approval and implementation of medical and technical documents on standardization of medical care in chronic pancreatitis”. Patients with chronic alcoholic pancreatitis and concomitant liver cirrhosis Child-Pugh Class A and B were divided into 2 subgroups. Subgroup I (20 patients) received combination therapy according to the Orders of the Ministry of Health of Ukraine mentioned above. Subgroup II (30 patients) received pentoxifylline (Pentoxifylline-Darnitsa) at a dose of 5 ml of 2% solution per 200 ml of 0.9% sodium chloride solution intravenously for 5 days with further transition to oral medications at a dose of 200 mg up to two months including the mixture of essential, conditionally essential and non-essential amino acids (Hepasol-Neo) at a dose of 500 ml of 8% solution intravenously on alternate days 5 times in addition to basic therapy.

Conclusions. Concurrent alcohol-induced injury of the pancreas and liver increases the risk of developing more severe clinical course of this comorbidity with transition of cirrhosis to the decompensated stage, bleeding varicose veins in the esophagus occurring more often, increased pancreatic fibrosis with widening of the ductal system and further development of cysts and pancreatic exocrine insufficiency. The addition of pentoxifylline and mixture of essential, conditionally essential and non-essential amino acids to basic therapy reduces the number of patients developing complications.


Keywords


alcoholic liver cirrhosis; chronic alcoholic pancreatitis; pentoxifylline; Hepasol-Neo

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References


Abrahamovych OO, Dovhan YuP, Ferko MR, et al. Ultrasound Doppler flowmetry in the diagnosis of portal hypertension in patients with liver cirrhosis and importance of its indicators for prognosis. Suchasna hastroenterolohiia. 2013;3:45-52

Baykova IE, Nikitin IG, Gogova LM. Alcoholic liver disease. Rossiyskiy meditsinskiy zhurnal. 2011; 19(17):1067-1071.

Gubergrits NB, Lobas EV. Functional state of pancreatic gland in patients with chronic alcoholic hepatitis and concomitant pancreatitis secondary to obesity. Probl. Viiskovoii okhorony zdorovia. Kyiv. 2006;15:107-110.

Kaziulin AN. Etiology of chronic pancreatitis. Eksperimentalnaya i klinicheskaya gastroenerologiya. 2013;11:3-5.

Moiseev VS. Alcoholic disease, damage to internal organs. GEOTAR-Media. Moscow. 2014;480.

Rachkovskiy MI. New model of predicting mortality in liver cirrhosis of viral and alcoholic etiology. Uralskiy meditsinskiy zhurnal. 2009;1:19-24.

Samohalska OE, Lazaruk TB, Babiak OV, Vitruk IM. Prediction of the effectiveness of therapy for alcoholic liver cirrhosis. Hastroenerolohiia. 2013;3(49):82.

Solomentseva TA. Risk factors for the development and progression of alcoholic liver disease. Suchas. hastroenterol. 2013;2:138-144.

Kharchenko NV, Lishchyshyna OM, Babak OYa, et al. Chronic pancreatitis. Adapted evidence-based clinical guideline. 2014;65.

Shypulin VP, Dolzhenko MM, Potashev SV. Prospective study of survival in patients with liver cirrhosis: state of the cardiovascular system. Web Cardio. 13.05.2016. Available from: www.webcardio.org/

Yakovenko AV. Treatment of chronic pancreatitis. Praktikuyushchiy vrach. 1998;13(2):36-37.

Alvarez MA, Cirera I, Solà R, et al. Long-term clinical course of decompensated alcoholic cirrhosis: a prospective study of 165 patients. J Clin Gastroenterol. 201;45(10):906-911. doi: 10.1097/MCG.0b013e3182284e13.

Bataller R, Brenner DA. Liver fibrosis. J Clin Invest. 2005;115(2):209–218. doi: 10.1172/JCI200524282

Bruha R, Dvorak K, Petrtyl J. Alcoholic liver disease. World J Hepatol. 2012; 4(3):81-90. doi: 10.4254/wjh.v4.i3.81

Burra P, Senzolo M, Adam R, et al. Liver transplantation for alcoholic liver disease in Europe: a study from the ELTR (European Liver Transplant Registry). Am J Transplant. 2010;10(1):138-48. doi: 10.1111/j.1600-6143.2009.02869.x.

Chae HB. Alcoholic liver disease. Korean J Gastroenterol. 2009;53(5):275-282.

Mathurin P, Hadengue A, Bataller R, et al. EASL Clinical Practical Guidelines: Management of Alcoholic Liver Disease. European Association for the Study of Liver. Journal of Hepatology. 2012;57(2):399-420.

doi: 10.1016/j.jhep.2012.04.004.

Mary C. Drinane, Vijay H. Shah. Alcoholic Hepatitis: Diagnosis and Prognosis. Clinical liver disease. 2013;2(2):81-83.

Maryconi M Jaurigue, Mitchell S Cappell. Therapy for alcoholic liver disease. World J Gastroenterol. 2014; 20(9):2143–2158. doi: 10.3748/wjg.v20.i9.2143

Yakshe P. Chronic Pancreatitis. World Medicine. 2005;18(2):77–87.




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