Reactive pancreatitis: causes, symptoms, diagnosis and treatment in adults

What is reactive pancreatitis

What does “reactive pancreatitis” mean? It is clear that pancreatitis is an inflammatory process in the pancreas. But why does he suddenly become reactive? First, let's look at the mechanism of pancreatic inflammation.

Mechanism of pancreatic inflammation

The human pancreas is an elongated lobular formation of a grayish-pinkish hue, located in the abdominal cavity behind the stomach, closely adjacent to the duodenum. The pancreas is the main source of enzymes for digesting fats, proteins and carbohydrates.

Its lobules contain a huge amount of digestive enzymes in an inactive form. Normally, after eating, enzymes are released through the ducts into the duodenum, where they are activated and start digestion.

When the pancreas becomes inflamed, the outflow of its secretions is disrupted and enzymes inside the pancreatic lobules are prematurely activated. As a result, instead of digesting food, the enzymes begin to digest the pancreas itself. This is how acute inflammation develops.

Causes of reactive pancreatitis

Imagine a typical situation: you wake up in the morning, smoke a morning cigarette with a cup of coffee. Then you realize that you don’t have time to have breakfast, and you run out to work. Having barely waited for the lunch break, you rush to the nearest fast food and fill your stomach with spicy, fatty, fried foods, wash it down with soda and eat a portion of ice cream for dessert.

And finally, the working day is over, you come home and have dinner with a hot, fatty piece of meat with a side dish. And with such a good dinner, it’s not a sin to drink a glass of beer or even something stronger. Having filled your stomach to capacity, you sit down to watch TV before bed, and then suddenly - a cutting pain in the left hypochondrium.

Attention! A bilious taste appears in the mouth, hiccups and belching occur. Pain from the left hypochondrium radiates to the back and takes on a girdling character, nausea and vomiting appear.

. If you recognize yourself in the situation described above, know that you have had an attack of reactive pancreatitis

After all, what does the word “reactive” mean? One of the meanings is “capable of responding to external influences, occurring under the influence of external influences.” So, reactive pancreatitis is a reaction of your pancreas to:

If you recognize yourself in the situation described above, know that you have had an attack of reactive pancreatitis. After all, what does the word “reactive” mean? One of the meanings is “capable of responding to external influences, occurring under the influence of external influences.” So, reactive pancreatitis is a reaction of your pancreas to:

the habit of smoking and drinking coffee on an empty stomach;
irregular meals;
disruption of normal motor activity;
abuse of alcohol, spicy, fried and fatty foods.

With the symptoms described above, your pancreas is screaming at you “STOP!” And if you do not listen to it, then reactive pancreatitis can develop into a more complex, acute or chronic form.

How to start treatment for reactive pancreatitis

Let's say you decide to listen to the calls of your pancreas, but you don’t know how to start treating pancreatitis. At the first symptoms of pancreatitis, doctors advise immediately undergoing an ultrasound, gastroscopy and urine and blood tests. Based on the results of the examination, treatment is prescribed.

A concomitant way to effectively treat reactive pancreatitis is a strict diet. It is necessary to exclude spicy, fried, smoked, salty and sweet foods from the diet. Stop drinking alcohol completely. Preference is given to liquid, easily digestible foods with low fat content.

Of course, you can ignore the signals from your pancreas that you have stepped into disease territory and numb the pain with painkillers. But this is only a temporary measure. By ignoring important signals, you thus risk missing the initial stages of serious illnesses. After all, reactive pancreatitis can occur against the background of a stomach ulcer, cirrhosis of the liver, cholecystitis, viral hepatitis, and cholelithiasis.

Symptoms and clinical picture

The disease is dangerous due to its blurred clinical picture in the first days of its onset. The patient may complain of discomfort in the intestines, increased gas formation, flatulence and bloating, heaviness in the stomach after each meal. There is also bitter or rotten belching, hiccups, a bitter taste in the mouth and abdominal pain without clear localization. At first, the pain is subthreshold in nature, the patient relieves it with the usual analgesics.

On the second or third day, the pain intensifies and becomes clearly localized. The patient is restless, cannot find a comfortable position, and nothing can stop the attack of pain. Vomiting occurs, which can appear both at the height of the pain symptom and after it. Distinctive feature: vomiting does not bring any relief to the patient. The patient has a fever (body temperature rises to 38-39 C), weakness and sweating are noted.

Against the background of the above symptoms, there are signs of an underlying disease.

Symptoms of gastric damage: pain in the epigastric region that occurs after eating or on an empty stomach. Hiccups and belching with reflux of gastric contents into the oral cavity, heartburn.
Symptoms of damage to the duodenum: pain in the epigastric region, mainly on the left, radiating to the back and scapula. Pain occurs half an hour after eating or on an empty stomach at night, forcing the patient to wake up. Digestion and absorption disorders, weight loss, dyspeptic disorders (loose stools, flatulence).
Symptoms of gallbladder damage: pain in the left hypochondrium and radiating to the left shoulder blade, occurring immediately after drinking alcohol or fatty, fried foods. Loose, frequent stools, steatorrhea (increased fat content in stool), flatulence.
Symptoms of liver damage: swelling of the legs, abdomen, enlarged veins of the anterior abdominal wall, visible to the naked eye, enlarged liver. Weakness and malaise. Unpigmented feces, dark urine (beer-colored urine).

Treatment

Treatment of reactive pancreatitis is not aimed at the manifestation of inflammation of the pancreas, but rather at the disease that precedes the disease. Various medications help cope with pancreatitis, especially those that replenish the lack of nutrients in the body. The initial disease goes away, and acute pancreatitis goes away.

Once the disease is officially diagnosed, intensive treatment begins.

Therapeutic diet for pancreatitis: general principles

Diet is considered an important component of treatment - if the patient is already following an ascetic diet due to intestinal disease, the regimen is intensified. You will have to go on a hunger strike for some time and drink only water. If the manifestations of the disease are not so serious, it is permissible to simply limit the consumption of fatty foods.

You should eat food in small portions. For example, divide the dish into several servings and eat it completely throughout the day. Remember, the less load on the pancreas, the easier it is for the organ to cope with food for digestion. You will need to drink a lot of water. Prohibited: alcohol, foods with a strong taste - sour or too bitter.

The diet is determined individually; this is decided by the doctor, based on the patient’s condition. Recommended products are perceived differently by individual organisms. For example, patient No. 1 eats bananas without problems, but patient No. 2 develops indigestion from fruits. But patient No. 2 has the opportunity to drink skim milk with tea, and patient No. 1 makes do with other drinks.

If the patient is unable to eat, a diet is not prescribed. The patient is fed parenterally: beneficial substances necessary for the healthy functioning of the body are administered through a vein in an adapted form for subsequent breakdown in the stomach.

Surgery

If an acute attack of pancreatitis develops so rapidly that it begins to quickly absorb the connective tissue of the gland, releasing pus, it is impossible to do without surgical intervention. In addition to purulent formations, false cysts appear, the removal of which is mandatory.

Mechanism and reasons

Food that is crushed in the mouth, soaked in saliva, and then gastric juice, enters the duodenum. At this point, pancreatic juice passes into the intestine and completes the digestion process.

In the case when this does not happen due to swelling of the organ or spasm of the duct, enzymes are supplied in insufficient quantities, and symptoms of pancreatopathy (dyspancreatism) develop with transient swelling of the organ.

The reasons for the development of this pathology are:

poor nutrition and consumption of heavy foods (fatty meat, spices), overeating;
introduction of a new dish (spicy or meat);
untimely or abrupt introduction of complementary foods to children under one year of age;
children drinking grape juice;
poisoning from poor-quality food or food allergies (including hereditary intolerance to a number of foods);
abdominal injuries (bruises, blows, wounds);
infectious diseases;
ARVI, influenza;
use in the treatment of certain types of medicines;
chronic disorders of the liver, gall bladder, upper intestine;
fibrotic changes or congenital abnormalities of the structure of the pancreas.

Important! All of these factors equally influence the formation of reactive pancreatopathy in people of any age. But due to the imperfection of the digestive system, it is children who suffer from it more often.

Clinical picture of the disease

To understand the occurrence of the incident, let’s imagine the daily work of the pancreas. The main function of the organ is to produce pancreatic juice, intended for digesting food. The juice contains enzymes and bicarbonates; the substances create an alkaline environment that can completely neutralize acidic gastric juice. The created juice “floats” into the intestines through special ducts and, reaching its destination, interacts with the substances located there.

By reacting with products that accidentally end up in the pancreatic ducts, the juice begins to negatively affect the pancreas. The organ begins to digest itself, and inflammation begins. Enzyme receptors, not perceiving digestive enzymes, begin to intensify the production of reagents, as the body prompts: there are not enough enzymes.

Pancreas

Inflammation is due to the fact that the pancreatic ducts simply do not have an entrance to the intestine. The juice does not enter the intestines, remains at the site of origin, and the organ becomes ill.

Such pancreatitis always occurs in an acute form and does not become chronic. Chronic reactive pancreatitis awakens on its own, without external irritants.

Sometimes the tail of the gland can become enlarged - the stimulated work of the pancreas causes intensive division of cells rushing to fill the broken space. This has a negative effect on the patient's condition.

What causes pancreatitis to develop?

Reactive pancreatitis in adults is caused by other organs of the digestive system. Blame for the disease:

stomach;
intestines;
liver;
biliary tract.

Often, while in hospital, a patient is prescribed various medications and procedures to ensure that reactive pancreatitis does not develop.

Diseases that cause pancreatitis are:

hepatitis;
gastritis;
gallstones;
hepatic cirrhosis;
cholecystitis;
bile duct dyskinesia;
injury to organs located in the abdominal cavity;
infection in the intestines.

A process that disrupts intestinal function can cause reactive pancreatitis. Only then is the disease diagnosed and treatment selected.

Risk factors

There are known groups of people with the possibility of getting inflammation of the pancreas more often than others. These include:

smokers;
alcoholics;
people who prefer fatty foods in their diet;
people who care little about nutrition and eat irregularly;
patients taking medications despite contraindications.

If the patient seems to have a genetic predisposition to a type of disease, it is better to get rid of bad habits in time, before undesirable events develop.

Prevention

There are no special prophylactic agents for reactive pancreatitis. People are advised to completely give up bad habits, follow nutritional recommendations, and take medications only as prescribed by a doctor with strict adherence to dosage. In addition, the main thing is to promptly eliminate those gastrointestinal diseases that can cause the appearance of such a disease.

The prognosis of the disease with early diagnosis and treatment is favorable. In almost all cases, after starting therapy, all clinical manifestations quickly disappear. There is a possibility of relapse, but only if the diet for reactive pancreatitis is not followed.

Diets and foods for reactive pancreatitis

The danger of this pathology is that it is completely impossible to cure this disease. Minor stress or taking medications for a common cold can already provoke a new sign of the disease. The gland reacts very negatively to the above factors. Therefore, whether a new attack occurs or not depends on the patient himself or on his parents, if this is a child.

The principle of nutrition, regardless of whether it is an adult or a child, is no different. It is necessary to completely remove spicy, salty, fried, and fatty foods from the diet. Sugary drinks with carbonation are strictly prohibited. Only healthy food made from the following products:

lean varieties of meat, boiled or baked;
Fish and seafood;
low-fat fermented milk products;
porridge from rice, oatmeal, buckwheat with vegetable oil;
dried bread;
boiled eggs and baked omelettes;
cauliflower;
pumpkin;
carrot;
beet;
green pea;
parsley dill;
non-acidic berries and fruits;
decoctions of rosehip and rowan.

The diet can be much more varied. But these should be foods low in carbohydrates. The emphasis is on protein nutrition. Food is consumed in small portions in 5-6 meals and only warm. Cold or hot dishes can irritate the organ, disrupt the digestive system, cause inflammation and another acute attack.

Nutrition

Not many doctors tell you what diet you should have if you have inflammation of the pancreas.
Since the digestive system is disturbed, the patient needs to adhere to a gentle diet.

It is necessary to include in the diet:

Crackers, preferably white bread.
Lean meat broths.
Boiled liver.
Porridge: buckwheat or oatmeal.
Compotes.
Boiled vegetables.
Mineral water: Essentuki, Borjomi.

Be sure to consume fermented milk products, but only those with low acid content.

Prohibited products:

Sausages.
Canned fish and meat.
Spices and sweets.
Sour fruits and juices.
Chicken eggs.
Fatty meats and fish.

Also read on our website: Modern classification of chronic pancreatitis

Remember, if you eat right and follow the recommendations of your doctor, you can quickly cure pancreatitis.

Chief gastroenterologist of the Russian Federation: “PANCREATITIS does not go away?! A simple treatment method has already healed hundreds of patients at home! To cure the pancreas forever you need...” Read more »

At home, you can prepare not only a tasty, but also a healthy drink . Take 200 grams of viburnum berries and pour boiling water over them. If you are not allergic to honey, then you can add 1 teaspoon to the drink and drink it instead of tea.

Now you know how to treat this disease. But remember, if you notice the first signs of illness, you must immediately consult a doctor.

Treatment of reactive pancreatitis

Treatment of reactive pancreatitis includes eliminating inflammation of the pancreas, removing intoxication and restoring normal secretion of pancreatic juice. The treatment process must certainly take place under the supervision of a doctor.

Therapeutic fasting can help relieve inflammation, especially in the acute period. It relieves stress from the inflamed pancreas and the entire digestive tract. After the acute phase has passed, it is allowed to eat in small portions, eating crushed foods. But under no circumstances should you adjust your diet on your own. Only a doctor can prescribe a correct and healthy diet, based on the characteristics of your body.

As a rule, those foods that can provoke re-activation of pancreatic enzymes and intensify the inflammatory reaction in tissues are excluded from the patient’s diet for several months.

How to recognize reactive pancreatitis

Sometimes new sensations appear in the patient’s body. To determine your risk of getting sick, look at the symptoms of reactive pancreatitis:

bloating;
the appearance of profuse belching;
feeling of nausea;
feeling of heaviness in the stomach;
heartburn;
pain in the intestines.

The list shows the early symptoms of the disease. It is not difficult to get rid of these signs yourself, at home. Professional treatment of reactive pancreatitis begins from the time of manifestation of secondary symptoms:

a person vomits;
body temperature rises;
there is obvious intoxication of the body.

There are cases when, due to an attack of acute pancreatitis, moreover a reactive one, other diseases were diagnosed - those that became the original cause. The initial diseases are reflected in the expressed symptoms:

pain in the right hypochondrium indicates gallstones;
fever and diarrhea are characteristic of an infection in the intestines;
if the liver swells and increases in size, we are talking about liver cirrhosis.

Therefore, it is important to monitor the occurrence of pain and the nature of the symptoms. Such observation will provide the doctor with an irreplaceable service, and the patient will be relieved of two diseases at the same time.

Symptoms

The first signs of reactive pancreatitis are constant hiccups, periodic retching, vomiting, pain under the ribs. The pain syndrome itself has the ability to decrease or, on the contrary, increase, but this does not mean that everything can be left as is. The resulting pain focus also changes the location of dislocation, which is associated with the gallbladder and its location of damage.

pain in the stomach

The inflamed lower part of the bladder brings pain to the right side of the hypochondrium; with a central focus of inflammation of the gallbladder, pain is felt under the scapular part of the body; with upper focal inflammation, pain is felt in the left part of the hypochondrium. Thanks to palpation, specialists determine the affected area and prescribe certain therapeutic measures.

Symptoms of reactive pancreatitis:

vomit

complete or partial loss of appetite;
a complete aversion to food is possible;
in advanced forms, excessive salivation occurs;
, abdomen, intestines, accompanied by impulsive contractions, pain;
nausea, vomiting with the release of bile.

In childhood, diarrhea, a rise in temperature to 39*C, and a decrease in appetite are added to the above.

Ureactive pancreatitis has its own characteristics and signs of occurrence and requires careful diagnosis of the emerging pathology.

Reactive pancreatitis has similarities and treatment of the pathology begins after a complete diagnosis of the body.

Treatment of the disease with drugs

If a patient has reactive pancreatitis, the symptoms and treatment of the disease are determined by the doctor. Let's figure out how to treat reactive pancreatitis with medication. To eliminate spasms, antispasmodics are prescribed:

Papaverine;
No-shpa.

For pain:

Nurofen;
Ibuprofen.

Medicines containing enzymes:

Festal;
Mezim.

Antibiotics and agents to reduce and eliminate gases are rarely used. In severe cases, surgery is prescribed.

The acute form of severe disease can cause complications:

endotoxic shock;
abscess and phlegmon;
necrosis of neighboring organs.

How is pancreatopathy treated?

A therapeutic plan for eliminating pancreatic insufficiency is prescribed based on a complete examination. As a rule, it consists of the following points:

treatment of the underlying disease, be it a chronic disease of the gastrointestinal tract or an infectious disorder;
replenishing the lack of enzymes with special preparations (pancreatin is most often used);
relief from symptoms with the help of antidiarrheals, antipyretics, antiemetics and antispasmodics;
diet during an attack, then a change in eating habits.

Pancreatopathy is not a death sentence for a child

Unfortunately, modern parents often encounter the vague and overly general term “pancreatopathy”. It is often difficult to guess whether the problem actually threatens to develop into chronic pancreatitis, or whether specialists are playing it safe and deliberately exaggerating the story.

Read: how pancreatic necrosis of the pancreas is treated.

We recommend finding out whether you can eat bread if you have gastritis.

Find out .

By the way, not all doctors recognize pancreatopathy as a “real diagnosis.” There are also those who advise not to panic about periodic complaints of a child’s pain near the navel, unless there are more serious symptoms in the form of fever, vomiting and constant bowel movements. They recommend adhering to the following principles:

do not overfeed the baby;
feed not “when needed”, but “on demand”, that is, when he gets hungry;
Avoid snacking between meals;
reduce the fat content of dishes, do not give “harmfulness” in the form of snacks and smoked and pickled foods;
Make sure your child chews food well.

Pancreatopathy is not considered a serious illness. In most cases, it is not self-medication with medications that helps to overcome its manifestations, but correct eating habits.

Treatment of the disease in children

Treatment of reactive pancreatitis in a child is carried out in a hospital. Treatment consists of:

underlying disease;
pancreatitis;
diet therapy.

Complete recovery without the integrated use of these methods is impossible.

For the first three days, you are only allowed to drink (alkaline drink) - this ensures functional rest for the pancreas. The volume of liquid required for consumption is prescribed by the doctor depending on the age and severity of the child’s condition.

Pancreatitis in children

The problem of pancreatitis in childhood is not new today, but remains, perhaps, the least studied page in pediatric gastroenterology. Its active study began after the introduction of ultrasound into everyday practice, which suggested a relatively high frequency of pancreatitis, including chronic pancreatitis, in the structure of diseases of the digestive organs in children. In the 60–80s. last century, these issues were intensively studied in our country and, perhaps, much more intensively than abroad. In the domestic pediatric literature one can find many articles devoted to pancreatitis in children. These studies were headed by A.V. Mazurin, A.M. Zaprudnoy, I.V. Dvoryakovsky, N.G. Zernov, B.G. Apostolov, G.V. Rimarchuk, Zh.P. Gudzenko. In 1980, Zh. P. Gudzenko’s book “Pancreatitis in Children” was published, which remained the only monograph devoted to this topic. Currently, research into the problem of pancreatitis in childhood continues both in our country and abroad. A special message for the development of this direction was given by the isolation and genetic identification of the so-called. hereditary pancreatitis. However, many questions, both theoretical and directly practical, remain unresolved. In numerous gastroenterology forums, this problem has received relatively little attention, not due to lack of relevance, but due to the lack of tangible progress.

The frequency of pancreatitis in children with diseases of the digestive system, according to various authors, ranges from 5 to 25%. Such a significant scatter is associated both with diagnostic difficulties and with the lack of a clear terminological definition of the subject of study. In everyday practice, there are usually four diagnoses that somehow fit into the topic of this discussion: acute pancreatitis, chronic recurrent pancreatitis, chronic latent pancreatitis, reactive pancreatitis (and/or secondary pancreatitis). The first two diseases are quite unambiguous from a diagnostic and terminological point of view, and their frequency can be reliably determined.

As for chronic latent pancreatitis, its diagnosis is very difficult due to the lack of criteria available for everyday use. The basis for such a diagnosis is usually the identification of compaction of the pancreatic parenchyma (PG) and/or its heterogeneity during ultrasound examination and the absence of corresponding clinical symptoms. However, whether these signs correspond to chronic pancreatitis in all cases is a question that is quite difficult to answer. The widespread introduction of ultrasound into clinical pediatric practice has revealed a fairly large number of such findings. This was a cause for concern, since it indicated a high incidence of chronic latent pancreatitis in children, and also gave reason to doubt the diagnostic significance of such an interpretation of the results due to possible overdiagnosis. The question of reactive pancreatitis causes even more controversy.

Pancreatitis is based on a destructive process in the pancreas, accompanied by microcirculatory disorders (which often precede the destruction itself), an inflammatory process and, to a greater or lesser extent, fibrosis. Against the background of the latter, exocrine and/or endocrine insufficiency of the pancreas can form. To be fair, it should be noted that pancreatic insufficiency with pancreatitis in children develops relatively rarely. The active destructive process in the pancreas is accompanied by the phenomenon of “evasion of pancreatic enzymes into the blood,” an increase in their concentration in the blood due to the destruction of acinar cells and increased permeability of the barrier between the acini and the blood. This phenomenon allows one to reliably identify destruction in the pancreas and diagnose acute pancreatitis or exacerbation of chronic recurrent pancreatitis.

In light of the presented general scheme, acute pancreatitis (as well as exacerbation of chronic) is an active destructive process in the pancreas tissue. Chronic pancreatitis is characterized by fibrosis of the pancreas, against the background of which, from time to time, under the influence of various provoking factors, destructive processes develop, i.e., exacerbations occur. Chronic latent pancreatitis theoretically has the right to exist as fibrosis of the pancreas, also associated with periodic episodes of destruction, which has not manifested itself as documented exacerbations. It is assumed that the destruction of the pancreas in this case occurs gradually, which leads to the absence of a typical clinical picture and the appearance of primary chronic latent pancreatitis. This concept is logical, but we judge the frequency of this condition only from ultrasound data. Computed tomography (not to mention biopsy), which could give us more reliable information, cannot be used on a mass scale for this purpose. There are no other signs of latent pancreatitis and cannot be by definition (aka latent!). This circumstance constitutes the first serious problem facing pediatric gastroenterologists. Moreover, it also applies to the diagnosis of chronic recurrent pancreatitis without exacerbation. And it is precisely because of this that we do not have accurate statistics on pancreatitis in children.

The second question is reactive pancreatitis. This concept often hides two states, sometimes different and sometimes coinciding. Firstly, we can talk about secondary pancreatitis, which was a consequence of any disease, including the digestive organs. Secondly, we can talk about a condition that precedes the destruction of pancreatic tissue in the form of its edema, which is revealed by ultrasound in the form of an increase in the size of one or more parts of the organ and corresponding changes in its parenchyma. This condition is most often secondary, and the term “reactive” in this case is quite appropriate, but it is not actually “pancreatitis”. In addition, this condition is reversible provided that the underlying disease is treated and, perhaps, some auxiliary therapy aimed at improving microcirculation. The appearance of signs of cytolysis, i.e. hyperenzymemia, clearly indicates acute pancreatitis or exacerbation of chronic pancreatitis, and in this case additional terminology is no longer required. Thus, it is necessary to decide whether by the term “reactive pancreatitis” we mean secondary pancreatitis (precisely pancreatitis) or do we mean a reactive state of the pancreas without destruction (which most often occurs in practice), when the term “dyspancreatism” may be more appropriate " However, these issues should be resolved centrally in forums of pediatric gastroenterologists and continue to be spoken “in the same language.” The importance of this problem is determined by the prognosis of the development of this condition, which in some patients will be reversible with adequate treatment of the underlying disease, but in some of them “true” pancreatitis may develop. The mechanism of this process is most likely associated with prolonged ischemia of pancreatic tissue against the background of microcirculatory disorders.

Leaving terminological disputes aside, it should be recognized that pancreatitis, including chronic pancreatitis, is a reality in pediatric practice. The latter (like any chronic process) can have a recurrent or latent course, which is a general pathological pattern.

Also, pediatricians quite often encounter a reactive state of the pancreas, which can evolve both towards restoring the state of the organ and along the path of its destruction.

The reasons for the development of pancreatitis in children are numerous and can be combined into several groups.

Violation of the outflow of pancreatic secretions:

anomalies of the pancreatic ducts, anomalies of the pancreas, compression of the ducts from the outside, obstruction with stones;
pathology of the duodenum (observed in approximately 40% of patients), increased intraduodenal pressure of various origins;
pathology of the biliary tract (observed in approximately 40% of patients).

Increased (absolute or relative) activity of pancreatic enzymes in pancreatic tissue:

excessive stimulation of the pancreas, primarily determined by the nature of nutrition;
hereditary pancreatitis (premature activation of enzymes).

Infectious factor:

mumps virus, hepatitis viruses, enteroviruses, cytomegaloviruses, herpes viruses, mycoplasma infections, salmonellosis, infectious mononucleosis and many others. etc.

This group also includes the development of pancreatitis due to helminthiasis (opisthorchiasis, strongyloidiasis, ascariasis, etc.), as well as pancreatitis due to sepsis.

Pancreatic injury.
System processes:

connective tissue diseases;
endocrine pathology;
hyperlipidemia;
hypothyroidism;
hyperparathyroidism;
hypercalcemia of various origins;
chronic renal failure;
cystic fibrosis.

The last disease is, of course, special in the above list. Fibrosis in cystic fibrosis is associated to a large extent with the characteristics of fibroblast function and is of a congenital (genetic) nature, although the factor of impaired outflow from the pancreas is also important. Whether the processes occurring in the pancreas during cystic fibrosis can be regarded as pancreatitis is a controversial issue and requires separate discussion.

Microcirculation disorders, including systemic ones:

allergic diseases, consumption of foods containing xenobiotics, as well as secondary conditions in diseases of the digestive system and many others.

This group in pediatric practice is very numerous, especially when it comes to the so-called. reactive pancreatitis.

Toxic effects of certain drugs:

corticosteroids, sulfonamides, cytostatics, furosemide, metronidazole, non-steroidal anti-inflammatory drugs, etc.

Pancreatitis of hereditary origin deserves special attention. Described in 1952 by Comfort and Steiberg, it has in recent years become the object of close study throughout the world. Currently, several mutations of several genes responsible for the development of this disease have been identified. In one of the variants of hereditary pancreatitis, the disease is transmitted in an autosomal dominant manner with 80% penetrance. In 1996, the gene responsible for its development, encoding cationic trypsinogen, was identified on chromosome 7 q35. To date, 8 mutations in this gene have been described. Mutations D22G, K23R, N29I, N29T, R122H and R122C lead to increased autoactivation of trypsinogen, mutations N29T, R122H and R122C stabilize trypsin in relation to its inhibitors, while mutations D22G, K23R and N29I are not associated with any known effect . The R122H mutation removes the autolysis point Arg122, the D22G and K23R mutations suppress activation by cathepsin B. In all cases of these mutations, the balance between proteases and antiproteases is disrupted with an increase in intracellular protease activity and cell destruction. Hereditary pancreatitis manifests itself from the first years of life, and in older age, the presence of these mutations is associated with a 50-fold increase in the risk of developing pancreatic cancer. In addition to changes in the trypsinogen gene, mutations in the trypsin inhibitor gene (Serin Protease Inhibitor Kazal type 1 = SPINK1 or PSTI) on chromosome 5, and in the cystic fibrosis gene on chromosome 7 may also be responsible for the development of pancreatitis. In these cases, an autosomal recessive mode of inheritance is assumed.

Secondary dysfunction of the pancreas is observed in many conditions, including intestinal malabsorption syndrome. Thus, with celiac disease and lactase deficiency (LD), it is possible to identify varying degrees of severity of involvement of the pancreas in the pathological process. According to our data, with celiac disease in the active stage of the disease, pancreatic damage is observed in 88% of patients, in the remission stage - in 79%, and with LN - in 76%. An increase in trypsin activity in the blood, indicating a destructive process in the pancreas, is observed in 37% of children in the active stage of celiac disease and in 12% of patients in remission. In LN, high trypsinogenemia was observed only in 7% of patients. As for the increased excretion of triglycerides in feces, indicating exocrine pancreatic insufficiency, we found the opposite picture: a low frequency in the active stage (18%) and a higher frequency in the remission stage (52%). In LN, moderate steatorrhea due to triglycerides was observed in 38% of children. The identified pattern coincided with that when assessing the frequency of detection of signs of chronic pancreatitis according to ultrasound data. Signs of chronic pancreatitis were not detected in the active stage of celiac disease, but were found in 58% of patients with celiac disease in remission and in 32% of sick children with LI. One can assume the gradual formation of chronic pancreatitis as the process progresses, even against the background of persistent remission of celiac disease with a decrease in exocrine pancreatic function.

The mechanisms of pancreatic damage in celiac disease are directly related to the atrophic process in the small intestine. This atrophy is hyperregenerative in nature, which is manifested by significant deepening of the crypts and increased mitotic activity in them. Along with the increase in the number of enterocytes themselves, the number of somatostatin-producing D-cells in the crypts also increases in the active stage of celiac disease with their normalization in the remission stage. Hyperplasia of D-cells is accompanied by an increase in the production of somatostatin and, as a consequence, suppression of the activity of I-cells producing cholecystokinin and S-cells producing secretin, which leads to a decrease in the function of acinar cells of the pancreas.

Another mechanism of damage to the pancreas in celiac disease is associated with a violation of its trophism and, apparently, has more long-term consequences. Severe malnutrition, regardless of the cause, is characterized by dysfunction of all organs, including the digestive glands.

Trophic disturbances and a decrease in the stability of cell membranes, of course, contribute to the development of cytolysis of acinar cells of the pancreas, which are quite sensitive to various unfavorable factors. Destruction is manifested by pancreatic hyperfermentemia and is an essentially implicit reflection (without clear clinical manifestations) of acute pancreatitis or exacerbation of chronic pancreatitis in a patient with celiac disease. In the pathogenesis of these disorders, an autoimmune mechanism cannot be excluded, since it is known that autoantibodies to various organs, including pancreatic cells, appear in the blood in celiac disease, although autoaggression against acinar cells remains unproven. Ischemia of pancreatic tissue, which persists for a long time, can be the cause of sluggish pancreatitis with its chronicity in the future. And although in the remission stage of celiac disease, intestinal absorption and nutritional status are restored, the number of somatostatin-producing cells is normalized, and the level of a number of trophic factors even increases, the damage caused to the pancreas in the active stage remains not always reparable. This is manifested by a high frequency of chronic pancreatitis with exocrine pancreatic insufficiency against the background of well-being in the underlying disease.

Changes in the pancreas with lactase deficiency are milder and transient in nature, however, the possibility of developing chronic pancreatitis in this group of children should also be taken into account by doctors when drawing up an examination and treatment plan.

Food allergies are also often accompanied by damage to the pancreas. According to our data, the frequency of pancreatic hyperenzymemia, which indicates the possibility of pancreatitis, with food allergies in children is observed in approximately 40% of cases, and the frequency of exocrine pancreatic insufficiency of varying severity according to the results of indirect tests (stool lipid profile) approaches 60%. In this case, the frequency of damage correlates with the age of the patient or, essentially, with the duration of the disease. Damage to the pancreas in food allergies is associated with the release of a significant amount of vasoactive mediators with the development, on the one hand, of direct damage to the parenchyma and, on the other hand, disruption of microcirculation in the organ, its ischemia, secondary damage and subsequent sclerosis. The presented mechanisms demonstrate the possibility of development of both acute and chronic processes. True acute pancreatitis with food allergies in children rarely develops, and only isolated cases have been described. Most often, chronic pancreatitis gradually develops, which can manifest itself as exocrine pancreatic insufficiency. At the same time, disruption of the digestion processes contributes to allergies, since it increases the antigenic load in various ways. Thus, allergy and pancreatic damage mutually support each other, which is confirmed by the high frequency of allergies in chronic pancreatitis of other origins.

Diagnosis of pancreatitis, as mentioned above, is difficult when it comes to chronic pancreatitis without exacerbation. Acute pancreatitis and exacerbation of chronic pancreatitis are characterized by a clinical picture in which, as a rule, there are abdominal pain, vomiting, and a general serious condition with symptoms of intoxication. In typical cases, the pain is intense, localized in the paraumbilical area with irradiation to the back or has a girdling nature, however, pain symptoms in children are often blurred without a distinct localization. Vomiting, repeated in typical cases, may be single or even absent. A characteristic laboratory marker of this condition is hyperenzymemia with an increase in the activity of amylase, lipase, trypsin, elastase 1 and a number of other enzymes in the blood. It should be noted that amylase has a low diagnostic value. More informative are the levels of lipase and trypsin activity in the blood. Determination of elastase 1 in the blood is considered an accurate marker of pancreatic tissue destruction, but its determination in our country is carried out only in some laboratories.

Ultrasound examination of the pancreas shows an increase in the size of the organ and signs of edema. As the severity of the process subsides, the size of the pancreas decreases and signs become apparent, usually interpreted as sclerotic changes characteristic of chronic pancreatitis, in the form of compaction and heterogeneity of the parenchyma.

Exocrine pancreatic secretion during pancreatitis in children suffers relatively little, but its assessment can help in the diagnostic process and is of great importance for developing patient management tactics, especially in the remission stage.

To assess exocrine pancreatic secretion in everyday practice, well-known methods such as coprogram and fecal lipidogram, as well as relatively new ones, including determination of elastase 1 activity in stool, which in recent years have become the modern “gold standard” for assessing pancreatic function, can be used. Pancreatic elastase 1 reaches the distal intestine unchanged and is determined by enzyme immunoassay using monoclonal antibodies (Elastase 1 stool test). The method was shown to be highly informative, which in this regard is comparable to the pancreozymin test. At the same time, the determination of elastase 1 in feces is much cheaper and easier to carry out. The norm is considered to be elastase 1 values in feces above 200 mcg/ml feces. Lower values indicate pancreatic insufficiency. It is important that the test results are not affected by the patient’s diet or the use of pancreatic enzyme medications.

On the other hand, this method does not allow assessing the severity of the relatively common relative pancreatic insufficiency, while showing normal values of fecal elastase 1. Only by comparing these data with the results of indirect tests (coprograms or stool lipidograms) can we draw a conclusion about the secondary nature of digestive insufficiency. The only exception is primary lipase deficiency, in which, against the background of severe steatorrhea due to triglycerides, a normal value of fecal elastase 1 will be observed.

Finally, only data from indirect methods of studying the exocrine function of the pancreas make it possible to assess the adequacy of replacement therapy and select the dose of the drug.

Treatment of exacerbation of chronic recurrent pancreatitis begins with bed rest and fasting. Diet is an important component of the treatment complex. Hunger prescribed for no more than one day is subsequently replaced by the gradual introduction of foods from the 5p diet, characterized by mechanical, chemical and thermal sparing of the gastrointestinal tract and the exclusion of pancreatic secretion stimulants.

Therapy is aimed at eliminating microcirculation disorders in the pancreas, ensuring its functional rest, replacing impaired functions and reducing the aggressiveness of damaging factors.

In connection with these tasks, patients are prescribed infusion therapy aimed at eliminating microcirculatory disorders and detoxification. This therapy also includes drugs that have anti-enzyme activity, such as Aprotinin, as well as drugs that affect microcirculation - Trental, Curantil, Dalargin.

Functional rest of the pancreas is ensured by:

a diet that reduces nutritional stimulation of the organ;
antisecretory drugs: M-anticholinergics (selective - pirenzepine), H2-blockers (famotidine) or proton pump inhibitors, which reduce gastric secretion and, accordingly, stimulation of the pancreas with acid;
preparations of pancreatic enzymes that inhibit gastric secretion according to the principle of negative feedback, destroying releasing peptides produced in the mucous membrane of the duodenum.

Somatostatin analogue drugs (octreotide) are highly effective, and have now become key in the treatment of acute pancreatitis and exacerbation of chronic pancreatitis. Somatostatin, produced mainly in the digestive organs and the central nervous system, is one of the most important neurotransmitters in the human and animal body, regulates (suppresses) secretory processes, including in the pancreas, proliferation, contractility of smooth muscles, motility of the digestive organs , intestinal absorption and many other processes.

Complex therapy at the first stage of intensive care may also include glucocorticoid hormones and antibiotics.

An important task for normalizing the condition of the pancreas is to ensure the outflow of pancreatic secretions, the main solution to which is the prescription of antispasmodics and prokinetics. Among antispasmodics, mebeverine (Duspatalin) occupies a special place due to its dual effect: pronounced antispasmodic, on the one hand, and prevention of sphincter hypotension, on the other. Among prokinetics, trimebutine (Trimedat) is preferred, as it has a modulating effect on the motility of the digestive organs.

The optimal way to correct exocrine pancreatic insufficiency in children with chronic recurrent pancreatitis is the administration of microspheres (Creon 10,000) in a dose of 3–6 capsules per day, which quickly eliminates steatorrhea. Moreover, after long-term (1–2 months) therapy, it is possible to discontinue the drug, which indicates the high compensatory ability of the child’s pancreas. As for the treatment of a patient with exacerbation of chronic recurrent pancreatitis, our experience shows the advisability of short-term (in the absence of signs of pancreatic insufficiency) administration of pancreatic enzymes against the background of expanding the diet after a period of intensive therapy in a dose adequate to the volume and nature of nutrition, usually up to 4 capsules of Creon 10,000 per day.

Of course, an integral task in the treatment of pancreatitis is to eliminate the causes that caused its development. This task becomes especially important in reactive states of the pancreas due to their potential reversibility. Additionally, medications that improve microcirculation (Curantil, Trental, etc.) may be prescribed.

Surgical treatment is required in case of progression of destruction, development of pancreatic necrosis and ineffectiveness of conservative therapy.

Despite the certain success of the treatment, much more effort is required to increase its effectiveness. An important promising task is to reduce the activity and stimulate the reverse development of sclerotic changes in the pancreatic parenchyma, which today is practically impossible to solve.

In general, the problem of pancreatitis in children requires further study at the current level of knowledge and technical capabilities, including aspects of terminology and associated epidemiology, etiology and pathogenesis, as well as diagnosis and treatment. The achievements available in this direction only highlight the variety of still unresolved problems.

S. V. Belmer , Doctor of Medical Sciences, Professor T. V. Gasilina , Candidate of Medical Sciences, Russian State Medical University , Moscow

General information about pathology

Reactive pancreatitis is a condition that is characterized by a sudden onset and is acute. Its distinctive feature is the fairly rapid elimination of symptoms after the start of therapy. The patient’s recovery time depends on how timely diagnosis and treatment measures are carried out.

Reactive pancreatitis is accompanied by spasms inside the ducts of the gland. As a result of this process, the substances necessary for the digestion of food that are produced by the organ are not released, but remain in its tissues. Enzymes destroy the mucous membrane, causing painful symptoms.

Reactive pancreatitis itself does not have a code according to ICD-10. However, there are several varieties of this pathology. Experts divide it into types according to the characteristics of the course and the factors that caused the disease. Inflammatory processes of this kind occur in approximately thirty-five people out of 100,000 Russian citizens. Most patients with this diagnosis are representatives of the stronger sex.

Diagnostics

If one or more symptoms appear, the patient should immediately contact a medical facility. The basis of diagnostic measures for such a disorder is instrumental and laboratory examinations.

Of no small importance is the gastroenterologist’s study of the patient’s medical history and life history. In addition, it is necessary to perform a thorough examination with mandatory measurement of pressure, temperature and pulse, as well as palpation of the abdomen. Such activities, together with a survey, will enable the doctor to determine the causes of the disease, as well as find out the first time of onset and intensity of symptoms.

The second stage in establishing the correct diagnosis is performing laboratory tests, which include:

general and biochemical blood and urine tests - this is necessary to detect changes in blood composition, as well as to measure the amount of pancreatic enzymes;
microscopic examination of feces.

The main diagnostic value is provided by instrumental examinations of the patient, which are aimed at performing:

Ultrasound is a fairly informative technique for detecting pathologies of the gland and biliary tract. Makes it possible to determine the presence of stones, swelling and enlargement of the gland;
X-rays using a contrast agent - for more detailed visualization of the source of pathology;
MRI AND CT – to obtain an overview image of all abdominal organs;
FEGDS - study of the mucous membrane of the gastrointestinal tract;
diagnostic laparoscopy – prescribed for severe disease or when other methods are insufficiently informative;
RCP is an endoscopic procedure for examining the biliary tract.

After studying all the examination results, the gastroenterologist prescribes the most effective treatment method.

Clinical manifestations

Symptoms of reactive pancreatitis make themselves felt a few hours after the influence of a negative factor. The initial stage of the disease includes a combination of symptoms of the nature of dyspepsia: the patient suffers from bloating and flatulence, belching with an unpleasant aftertaste, attacks of nausea and heartburn. As the underlying pathology progresses, the course of reactive pancreatitis worsens—pain syndrome occurs.

The pain during reactive inflammation is severe and girdling in nature. Location: upper abdomen with transition to the left hypochondrium. The pain often radiates to the back and shoulder blades. The exact location depends on the size of the inflamed area of the pancreas. Reactive pancreatitis is characterized by increased pain after eating, which is associated with excessive release of enzymes.

In the absence of treatment, the patient's condition sharply worsens due to proteolytic enzymes entering the blood - signs of poisoning of the body develop, the temperature rises (low-grade readings 37°-37.3°), blood pressure drops, and the pulse quickens. Clinical manifestations of reactive pancreatitis can be supplemented by a set of symptoms of the primary pathology - sharp pain in the right side due to gallstones, fever and diarrhea due to intestinal infection, enlarged liver due to cirrhosis.

The course of pathology in children

Reactive pancreatitis in children can occur at any age, including infants up to one year old. The reasons are varied and commonplace - ordinary respiratory infections can become the starting point for reactive processes in the pancreas. In infants, the disease often develops due to congenital pathologies of the structure of the organ and its ducts. Poor nutrition, early introduction to adult food, lack of a routine provokes inflammation of the pancreas.

The clinical course of the disease in children resembles reactive pancreatitis in adults - severe pain, dyspepsia, signs of intoxication. Additionally, a sick child experiences:

stool disorder - constipation, diarrhea, stool becomes yellow, mucus appears, steatorrhea often develops;
urine becomes deeply dark in color;
the skin may turn yellow;
Newborns and infants experience periods of sudden crying and screaming.

If the child has the slightest complaint of pain in the upper abdomen and left side, or episodes of night restlessness (between 3 and 5 a.m.), parents should consult a doctor. The course of reactive pancreatitis in children is severe and requires emergency care.

Provoking factors

That negative effect on the human body that contributes to the development of a pathological process that has an inflammatory nature in the area of a parenchymal organ is called a primary factor.

There is a huge variety of factors that cause reactive pancreatitis in adults, the most common of which are:

excessive consumption of alcoholic beverages;
the development of pathological processes of a chronic nature in the area of the digestive tract, among which there are ulcerative lesions of the duodenum and stomach, colitis, gastritis and many other pathologies;
frequent overeating and the presence of a large number of extra pounds;
unbalanced diet, including frequent consumption of fast foods, fatty, fried, spicy, salty and smoked foods;
prolonged and chaotic use of medications;
regular exposure of the body to nervous and stressful situations that cause chronic overstrain of the central nervous system;
traumatization of a parenchymal organ with damage to the integrity of its tissue structures.

It is also worth noting that reactive pancreatitis can begin to develop against the background of the following pathologies developing in the digestive tract organ system:

chronic form of cholecystitis;
gastritis or gastric ulcer;
infestation by helminth representatives;
viral hepatitis;
food intoxication of the body;
cirrhosis;
dyskinesia of the gallbladder;
obstruction of the bile ducts.

The negative impact of these factors causes symptoms of reactive pancreatitis, the therapeutic treatment of which must be comprehensive, eliminating the cause of the development of the pathology, restoring the normal level of functionality of the damaged organ and normalizing the general well-being of the patient.

Do they take you into the army if you have reactive pancreatitis?

The fitness category for service of a conscript with pancreatitis is taken into account in Article 59 of the Schedule of Diseases.

Point “a”: category “D”. Patients with a chronic recurrent form of pancreatitis with frequent exacerbations; a military ID is issued, a stamp is affixed to the passport, exempting from military service in times of peace and war.

Point “b”: category “B”. Frequent exacerbations of the disease in a chronic form (more than 2 times a year); a conscript is considered exempt from military service in peacetime; he is enlisted in the reserves, but is not subject to conscription in wartime.

Point “c”: category “B”. The conscript suffers from a chronic form of the disease with rare exacerbations (less than 2 times a year); conscription service in peacetime.

A conscript is exempt from military service upon receipt of fitness category “D” or “B”, if the severity of the pathology is documented.

Traditional recipes for reactive pancreatitis

You can treat reactive pancreatitis, as recommended by traditional medicine, with the help of herbal preparations and decoctions. Here are some recipes:

The herbal mixture consists of the following ingredients: take 1 part chamomile flowers for 200 ml of boiling water, 2 parts boyarka and 3 parts mint, plus dill seeds. Place on low heat for 25 minutes, cool and filter. Drink 100 ml 2 times a day, morning and evening.
You need to take 1 part of crushed St. John's wort, field fir, nettle and 2 parts of rose hips. Add 2 tbsp to 0.5 liters of boiling water. l. collection, pour into a container, then filter. Take 100 ml 3 times a day after meals.
They take crushed anise, celandine, knotweed, violet, dandelion, and corn silk. Then add 1 tbsp to 200 ml of boiling water. l. collection, cool for 25 minutes, filter. Drink 1 glass 3 times a day.
You need to take 1 tbsp. l. plantain, corn silk, calendula, chamomile. The resulting dry mixture is poured into 1 liter of boiling water and boiled in a water bath for 15 minutes. You need to take this medicine 0.5 cups 2 times a day after meals.
Viburnum berries (200 g) should be poured with boiling water (500 ml), cook for 10 minutes over low heat. You should drink it like tea. You can add 2 tsp. honey
Take golden mustache leaves and pour boiling water (500 ml). Boil the resulting composition for 5 minutes in a water bath. Then the broth is cooled and filtered. Use this remedy 3 times a day before meals.

Important information: What fruits can you eat if you have pancreatitis?

If the patient has reactive pancreatitis, treatment can also be carried out with juices. You need to grate the carrots and potatoes, squeeze the juice out of the vegetables. Then mix 75 ml of carrot and potato juice, add 1 tsp. olive oil. Drink one glass 3 times a day, before meals.

Once inflammation is detected, therapy is immediately prescribed; if this is not done, the disease will become chronic. Also, irreversible changes in the gland occur due to improper treatment. Mild forms of the disease are treated at home or in a hospital. Treatment is symptomatic: diet, elimination of factors causing attacks.