Chronic pancreatitis: the mechanisms of development and progression that are taken into account during treatment and rehabilitation

The article reveals the mechanisms that determine the clinical picture and severity of chronic pancreatitis. These include the intensity of oxidative processes (peroxidation of lipids and proteins), the activity of the antioxidant defense system, the intensity of low-grade chronic systemic inflammation, impaired permeability of the mucous barrier of the small intestine, and the degree (stage) of intestinal dysbiosis. The authors draw attention to the importance of malnutrition and malabsorption during chronic pancreatitis, since the syndrome is characterized by an imbalance between the body’s needs and the supply of nutrients from food and may be a consequence of a combination of exocrine and endocrine pancreatic insufficiency, chronic pain syndrome, constant alcohol abuse, delayed gastric emptying, and metabolic disorders. Symptoms appear months (or even years) after the first symptoms of chronic pancreatitis. Malnutrition and malabsorption significantly impact the function and structure of muscles, fat, and bone tissue, resulting in the development of sarcopenia and osteosarcopenia, which are considered risk factors for mortality. In addition, a decrease in myocardial mass, a deficiency of microelements (zinc and magnesium) and electrolytes in patients with chronic pancreatitis with malnutrition syndrome contribute to a decrease in the ejection fraction, a decrease in perfusion and a decrease in glomerular filtration rate. Zinc deficiency affects the formation of endocrine pancreatic insufficiency and diabetes mellitus, while magnesium deficiency, in addition to impairing the functional ability of the myocardium, determines the increase in mental disorders, which affects the quality of life. Dysfunction of the diaphragm and respiratory muscles, intestinal circulation, villi architecture, intestinal permeability, and loss of the colon's ability to reabsorb water and electrolytes are significant factors. In surgical patients with chronic pancreatitis and malnutrition, wound healing slows down due to disturbances in the functioning of the immune system. In addition, apathy, depression, anxiety, and indifference develop, which significantly reduces the quality of life.