Assessment of the exocrine function of the pancreas in patients with chronic hepatitis C

Abstract

Introduction. Diseases of the biliary system cause chronic pancreatitis (CP) in 25–40% of cases. The combination of CP with chronic hepatitis C (CHC) is a common manifestation of multiorgan pathology. It is extremely difficult to establish the prevalence of CP in patients with CHC, especially in the case of a latent or mildly symptomatic course, as well as in its secondary forms. The purpose of the study. To assess the exocrine function of the pancreas and to reveal the features of the clinical course of CHC in these patients. Object and research methods. The study included 148 patients who were divided into: 1 group – 72 patients with CHC+CP, group 2 – 48 patients with CHC and group 3 – 28 patients with CP. The exocrine function of the pancreas was evaluated based on the results of fecal coproscopy and pancreatic fecal elastase-1 (FE-1), which was studied by means of ELISA, using the test systems of ScheBo® Biotech AG (Germany). The interpretation of the results was carried out according to the following gradation: the level of FE-1 in feces is more than 200 μg/g of feces – the exocrine secretory function of the pancreas is preserved; 150–200 μg/g of feces – a mild degree of exocrine pancreatic insufficiency (EPI); 100–150 mcg/g of feces – moderate EPI; less than 100 μg/g of feces – severe EPI. Research results. According to the results of coproscopy, steatorrhea was found in 27.8% (20/72) and creatorrhoea in 29.2% (21/72) of patients with CHC + CP, which is significantly more often than in patients with CHC (p=0.027 and p=0.002) and patients with CP. In 72.2% (52/72) of patients with CHC+CP, lower than normal levels of FE-1 were diagnosed, corresponding to: EPI of mild degree in 40.3% (29/72) of cases, moderate – in 23.6% (17/72) and severe – in 8.3% (6/72) of people. 27.8% (20/72) of CHC patients were diagnosed with CP with preservation of exocrine function. Among the clinical symptoms in patients with CHC+CP, complaints of bloating after meals were observed in the first place in terms of frequency, which were found in 75.0% (54/72), in contrast to patients with CHC without CP, where this complaint was registered in 22.9% (11/48). With CHC without CP, heaviness and pain in the right hypochondrium, which is associated with hepatomegaly, is the most frequently noted in 64.6% (31/48) cases. 52.1% (25/48) of CHC patients without CP had other symptoms characteristic of biliary pathology. Most patients with CHC+CP had defecation disorders: propensity to diarrhea was observed in 16.7% (12/72); constipation – in 29.2% (21/72); alternating constipation and diarrhea – in 22.2% (16/72) of cases and in 31.9% (23/72) of cases, bowel movements were normal. In patients with CHC without CP, such disorders were registered in 22.9% (11/48) of people: propensity to diarrhea was observed in 4.2% (2/48); constipation – 12.5% (6/48); in 6.3% (3/48) of cases – alternating constipation and diarrhea. The following disorders were registered in patients with CP: tendency to diarrhea – in 36.0% (9/25); constipation – 14.3% (7/48); in 24.0% (6/25) of cases – alternating constipation and diarrhea. Conclusions. 1. In 40.3% of patients with CHC combined with CP, a mild degree of exocrine insufficiency of the pancreas is observed, and in 27.8% of patients, CP is latent with preserved exocrine function of the pancreas. 2. Among the clinical symptoms in 75.0% of patients with CHC combined with CP, flatulence and pain in the projection of the head of the pancreas are the most frequent, while in patients with CHC without CP, heaviness and pain in the right hypochondrium prevail, which 91.4% of people complain of. Defecation disorders are characterized by the prevalence of constipation in 29.2% of patients with CHC combined with CP versus 12.5% and 14.3% in patients with CHC and CP, respectively.