DOI: https://doi.org/10.22141/2224-0551.13.6.2018.143158

Premorbid disorders of pancreatic functional state in children with chronic gastroduodenal pathology

T.V. Sorokman, V.G. Ostapchuk

Abstract


Background. Secondary pancreatic insufficiency in pediatric practice happens increasingly frequently and can occur at any age, both against the background of nutritional deficiencies, and various inflammatory diseases of the upper parts of the digestive tract. The purpose was to investigate the pancreatic functional state in children with chronic gastroduodenal pathology. Materials and methods. The study was conducted on the basis of the gastroenterology unit of the Chernivtsi Regional Clinical Children’s Hospital during 2013–2018. The basic clinical group consisted of 64 children aged 8–18 years with chronic gastroduodenal pathology: 29 patients had chronic gastritis, 30 persons had chronic gastroduodenitis, 5 people had peptic ulcer. All children underwent general clinical studies, ultrasound of the abdominal organs, fibrogastroduodenoscopy, pH-metry, 3-fold coprologic exa­mination; there were determined the activity of a-amylase, serum lipase, urine diastase, feces elastase (FE-1) concentration in feces, serum C-peptide, blood glucose level, and an oral glucose-tolerant test was performed. Statistical proces­sing of the obtained data was carried out by means of the programs Statistics 6.0. Results. The key manifestations were pain (93.7 %), dyspepsia (90.6 %), astheno-neurotic syndromes (57.8 %), a violation of the motor-evacuation function of the stomach and duodenum as a gastroesophageal and duodenogastric reflux. 35.9 ± 3.7 % of the patients developed the signs of pancreatic lesion: thickening of the tail of the pancreas and ultrasonic hyperechoic, amylorrhea, creatorrhoea, type I and II steatorrhoea, changes in the a-amylase level, FE-1, ‘flat’ curves of glucose tolerance test, that indicated the initial disturbances of carbohydrate metabolism. Median C-peptide for children of the basic group was 1.29 ng/ml (CI 1.11–3.42), for children of the comparison group 0.89 ng/ml (CI 0.23–1.12). The tendency to C-peptide level increasing was registered in 12 over-weighted children. These children have a ‘flat’ glucose test curve, as well as a violation of the exocrine function of pancreas manifested with ultrasonic changes. Conclusions. The revealed changes in the pancreatic functional state in the examined children indicate the need to determine the functional state of the gland and its control in the dynamics of treatment of gastroduodenal pathology.


Keywords


pancreatic dysfunction; gastroduodenal pathology; children

References


Nikolaeva OV. Pathogenesis of exocrine pancreatic dysfunction in children with chronic diseases of the gastroduodenal zone. Tavrycheskyi medyko-byolohycheskyi vestnyk. 2012;15(3-2):187-190. (in Russian).

Sorokman TV, Sokolnyk SV, Gingulak MG, Pidvysots`ka NO. Clinical-psychological and paraclinical features of chronic gastroduodenitis in children. Klinicna ta eksperimentalʹna patologia. 2014;13(2):127-130. (In Ukrainian).

Della Corte C, Faraci S, Majo F, Lucidi V, Fishman DS, Nobili V. Pancreatic disorders in children: New clues on the horizon. Dig Liver Dis. 2018 Jun 27. pii: S1590-8658(18)30803-X. doi: 10.1016/j.dld.2018.06.016.

Coffey MJ, Nightingale S, Ooi CY. Predicting a biliary aetiology in paediatric acute pancreatitis. Arch Dis Child. 2013 Dec;98(12):965-9. doi: 10.1136/archdischild-2013-304462.

Párniczky A, Abu-El-Haija M, Husain S, et al. EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis. Pancreatology. 2018 Mar;18(2):146-160. doi: 10.1016/j.pan.2018.01.001.

Faraci S, Majo F, Lucidi V, Fishman DS, Nobili V. Pancreatic disorders in children: New clues on the horizon. Dig Liver Dis. 2018 Jun 27. pii: S1590-8658(18)30803-X. doi: 10.1016/j.dld.2018.06.016.

Conwell DL, Lee LS, Yadav D, et al. American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: evidence-based report on diagnostic guidelines. Pancreas. 2014;43(8):1143-62. doi: 10.1097/MPA.0000000000000237.

Bian Y, Wang L, Chen C, et al. Quantification of pancreatic exocrine function of chronic pancreatitis with secretin-enhanced MRCP. World J Gastroenterol. 2013 Nov 7;19(41):7177-82. doi: 10.3748/wjg.v19.i41.7177.

Mekitarian Filho E, Carvalho WB, Silva FD. Acute pancreatitis in pediatrics: a systematic review of the literature. J Pediatr (Rio J). 2012 Mar-Apr;88(2):101-14. doi: doi:10.2223/JPED.2163.

Su WJ, Chen HL, Lai HS, Ni YH, Chang MH. Pancreaticobiliary anomalies is the leading cause of childhood recurrent pancreatitis. J Formos Med Assoc. 2007 Feb;106(2):119-25. doi: 10.1016/S0929-6646(09)60227-8.

Alam U, Asghar O, Azmi S, Malik RA. General aspects of diabetes mellitus Handb Clin Neurol. 2014;126:211-22. doi: 10.1016/B978-0-444-53480-4.00015-1.

Párniczky A, Mosztbacher D, Zsoldos F, et al. Analysis of Pediatric Pancreatitis (APPLE Trial): Pre-Study Protocol of a Multinational Prospective Clinical Trial. Digestion. 2016;93(2):105-10. doi: 10.1159/000441353. 

Trout AT, Preet-Singh K, Anton CG, et al. Normal pancreatic parenchymal thickness by CT in healthy children. Pediatr Radiol. 2018 Jun 27. doi: 10.1007/s00247-018-4190-0.




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