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

摘要

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.