How to treat the pancreas - Gastroenterology, proctology

Antienzyme drugs (proteolysis inhibitors) are a group of drugs that block the action of digestive pancreatic enzymes and are used to treat acute pancreatitis.

The pancreas is an organ of mixed secretion. Its endocrine part, which is represented by the islets of Langerhans, produces hormones directly into the blood that affect carbohydrate metabolism - insulin and glucagon. The exocrine part of the pancreas produces pancreatic juice, which is critically necessary for normal digestion, which is secreted through the duct into the lumen of the duodenum.

Pancreatic juice is a mixture of enzymes that can break down all the main components of food - proteins, fats and carbohydrates - into simple compounds that can be further absorbed in the small intestine.

Pancreatic enzymes (pancreatic enzymes) have extremely powerful “digestive” powers, so the pancreas synthesizes them in an initially inactive (zymogenic) form. Under normal conditions, the transition of pancreatic enzymes to an active form occurs only in the lumen of the duodenum, when interacting with food components.

In case of disruption of the outflow of pancreatic juice, for example, in acute diseases of the pancreas, enzymes are activated directly in the tissue of the gland itself. This, in turn, leads to so-called autolysis - “self-digestion” of the pancreas and enzymatic “melting” of surrounding tissues.

Autolysis of the pancreas is an acute condition that threatens human life. In the absence of adequate assistance measures, there is a high risk of death for the patient.

One of the basic groups of drugs that are used for the prevention and treatment of autolysis of the pancreas includes anti-enzyme drugs - proteolysis inhibitors.

Types of pancreatitis

In acute form of pancreatitis

a person experiences pain in the upper abdomen. Usually the pancreas hurts after fatty foods and alcohol. Pain in acute pancreatitis can be barely noticeable or severe (sometimes even radiating to the shoulder blade or chest). During an attack of acute pancreatitis, there may be nausea, vomiting, diarrhea, or constipation. The skin may turn yellow due to poor bile flow.

For chronic pancreatitis

pain in the upper abdomen, radiates to the back, left side of the chest, and lower abdomen. The pancreas hurts after fatty foods, alcohol or frequent stress. With chronic pancreatitis, nausea (sometimes vomiting), bloating, loss of appetite, and problems with stool (diarrhea or constipation) appear.

In chronic pancreatitis, periods of exacerbation alternate with periods of remission. If pancreatitis is not treated, exacerbations occur more often, intestinal disorders are observed, food ceases to be digested normally, and the person loses weight sharply.

Often, with chronic pancreatitis, various complications develop: bleeding in the stomach, abscesses and cysts, liver damage, enterocolitis, diabetes mellitus and even oncology. That is why, at the slightest problem with the pancreas, you need to consult a doctor as soon as possible.

Why does pancreatitis develop?

Pancreatitis begins when the tissue of the pancreas becomes inflamed. Causes of pancreatitis

- such:

smoking and alcoholism;
surgical operations and abdominal injuries;
prolonged and uncontrolled use of certain medications (hormones, antibiotics, corticosteroids, some diuretics);
food or chemical poisoning;
heredity;
poor nutrition (abundance of fatty and spicy foods, rare meals).

Diet features

What foods does the pancreas love?

If you have pancreatitis, you need to add more whole grains, fruits, vegetables and low-fat dairy products to your diet.

At the same time, you need to avoid eating fatty, fried, spicy foods and alcohol. It is also necessary to regularly monitor the condition of the digestive organs using various diagnostic methods.

Symptoms of pancreatitis

Symptoms of pancreatitis differ between acute and chronic forms.

Acute pancreatitis

has the following symptoms:

Cutting, dull, constant and intense pain.
Increased body temperature and pressure surges (can be both high and low). The reason is the rapid development of inflammation.
The skin of the face becomes pale or yellowish.
There is often nausea and vomiting, dry mouth, and a white coating on the tongue. With such symptoms, you need to fast so as not to worsen the situation.
With pancreatitis, both diarrhea and constipation are possible. With diarrhea, the stool is often foamy, with particles of undigested food, and a foul odor. With constipation, the abdominal muscles are tense and bloating is felt (during an attack of pancreatitis, the intestines and stomach stop contracting).
Shortness of breath, which occurs from dehydration when a person vomits frequently.

Chronic pancreatitis

has the following symptoms:

The pain in the abdomen is either girdle, or in one point, but radiates to the back. The pancreas usually hurts immediately after eating.
Poisoning of the body (intoxication) is expressed in general weakness, poor appetite, accelerated heartbeat, increased temperature, and decreased blood pressure.
Endocrine problems – diabetes mellitus, risk of hypoglycemia and ketoacidosis. Red spots may appear on the skin of the abdomen, chest and back (if you press on them, they do not disappear).

If pancreatitis is not treated, a person begins to lose weight, develops anemia, vitamin deficiency, brittle hair and nails, and constant fatigue.

How to treat pancreatitis

In case of acute pancreatitis, the patient must be urgently hospitalized - this is a life-threatening condition, so self-medication is not acceptable here. Typically, antispasmodics are used to treat pancreas; if the case is serious, the contents of the stomach are pumped out to reduce the load on the pancreas. During the first week of hospital stay, the patient is monitored daily for blood counts, water balance, leukocyte and enzyme levels. In the first few days, a person will have to completely give up food and take alkaline solutions every two hours.

For chronic pancreatitis in the acute stage, the treatment regimen is the same as for acute pancreatitis. A person with chronic pancreatitis must adhere to a special diet all his life, take antispasmodics and pills to normalize the secretory ability of the pancreas. A diet for pancreatitis means avoiding fatty and fried foods.

Read also How to treat gastritis: 8 best drugs The best drugs for gastritis: reducing acidity, eliminating excess acid and fighting Helicobacter pylori.

Medicines for the treatment of pancreas

Everyone knows that when drinking alcohol, fatty and smoked foods, the pancreas suffers. The main symptom is pain, most often girdling, in the upper third of the abdomen, just below the ribs. Also, with diseases of the organ, nausea, vomiting appear, and stool becomes loose. In severe cases, complications from the lungs and heart occur.

Medicines for the pancreas should be prescribed by a doctor after examination. Only a specialist decides whether there is an acute process or whether these are symptoms of a chronic exacerbation. In the first case, to save life, mandatory hospitalization in the surgical department and injectable drugs are required, in the second, you can be treated at home.

Treatment of acute pancreatitis

The process with enlargement, swelling, and sometimes death of the gland area is treated with injectable drugs in the surgical department. Surgeons monitor the patient’s condition, monitor his blood and urine tests for the level of pancreatic enzymes. If necessary, surgical intervention is performed.

The following medications are used to treat the pancreas:

Antispasmodics

These are drugs that reduce or eliminate pain due to pancreatitis. They do this by eliminating spasm of the smooth muscles of the ducts through which the juice produced by the pancreas is excreted. To completely eliminate pain, these drugs often need to be combined with painkillers - non-steroidal anti-inflammatory drugs or even narcotic analgesics.

“Pure” antispasmodics include: No-shpa, Papaverine, Mebeverine, Buscopan.

Combined antispasmodics - drugs for the treatment of the pancreas - are: Baralgetas, Spazgan, Spazmalgon.

Anticholinergic drugs

These drugs reduce the production of pancreatic juice, which, together with the inflammatory exudate, increases the volume of fluid secreted through the ducts of the gland.

These include: Atropine, Platiphylline. When the process subsides, you can use combined antispasmodics, which also include anticholinergic (antisecretory) drugs: Spazgan, Spazmalgon.

Nonsteroidal anti-inflammatory drugs

They are aimed at reducing pain and inflammation. These are the names of drugs for the pancreas, such as Diclofenac, Ibuprofen. Along with them, to protect the stomach, be sure to take the following 2 groups of drugs.

Antacids

These are medications that, interacting with hydrochloric acid in gastric juice, neutralize it. This reduces the activity of the inflamed pancreas.

Antacids include Almagel, Phosphalugel, Maalox, Sekrepat.

Blockers of hydrochloric acid production

These medications are extremely necessary for the pancreas: a decrease in the production of hydrochloric acid by the stomach reflexively reduces the production of pancreatic juice, that is, the pancreas is given the opportunity to “rest” and recover.

2 groups of drugs inhibit the formation of HCl:

histamine receptor blockers: Kvamatel, Rantak;
proton pump inhibitors - a more modern type of drugs: Pantoprazole, Omeprazole, Rabeprazole, Nolpaza.

In acute pancreatitis, injectable forms of these drugs are administered.

Proteolytic enzyme inhibitors

You also cannot do without these drugs, since they effectively relieve swelling of the pancreas and reduce the degree of breakdown of the organ’s own tissues by enzymes. These drugs are administered intravenously by drip or intravenous micro-jet. These include: Kontrikal, Gordoks.

Hypothalamic hormones

This is the drug Sandostatin (Octreotide, Octrestatin), which will require from 1 to 5 ampoules per day, administered intravenously by drip or micro-jet. The essence of the hormone’s action is to inhibit the production of enzymes in the pancreas itself, as well as in the stomach and intestines, which can provoke additional work of the inflamed pancreas.

Remedies for nausea and vomiting

For nausea and vomiting, the following are used: Cerucal (Metoclopramide), Mosid. If the symptom is severe, the injection drug Osetron is prescribed at a dose of 2 to 16 mg per injection.

Diarrhea remedies

Frequent loose stools due to pancreatitis cannot be stopped with medication. You just need to replenish the electrolyte-rich fluid that is lost through bowel movements. This is done either orally - with solutions made from Regidon, Humana Electrolyte, Oralit, BioGaia ORS powders, or (if there is severe nausea or preparation for surgery) solutions of sodium chloride, glucose 5%, Ringer's, Acesol, Trisol are administered intravenously.

Antibacterial therapy

There is evidence that acute pancreatitis is of microbial (bacterial) origin. The following antibiotics are used to treat it (in some cases - 2 or 3 at once):

Metronidazole;
Ornidazole;
Ceftriaxone;
Ceftazidime;
Augmentin;
Levofloxacin;
Ciprofloxacin.

Treatment of chronic pancreatitis

In the acute stage, that is, with the appearance of pain, nausea, diarrhea with the release of fatty stools, treatment is similar to therapy for an acute process, but taking tablet drugs is allowed (except for proteolytic enzyme blockers):

Antispasmodics (preferably combined): Baralgetas, Spazmalgon;
Proton pump blockers: Rabeprazole, Nolpaza, Contraloc;
Antacids: Almagel, Maalox;
Antiemetic (anti-nausea) agents: Mosid, Metoclopramide;
Proteolysis inhibitors: Contrical, Gordox.

When the pain subsides, a medicine to restore the pancreas - an enzyme preparation - is added to treatment. The ideal option is a product that does not contain bile acids - Creon 8000 IU or 25000 IU. As an alternative, you can use Pancreatin, Wobenzym, Adzhizym, Ermital. Medicines are also used when the exacerbation subsides, with food. Course – up to 6-12 months.

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Pancreatin

The active ingredient in these pancreatic tablets is pancreatin. “Pancreatin” is an enzyme preparation that is prescribed not only for pancreatitis, but also for other diseases of the pancreas. Enzymes help digest food if the body does not have enough of its own enzymes. “Pancreatin” for the pancreas relieves heartburn, reduces heaviness in the stomach and relieves other unpleasant sensations. Patient reviews of the drug are good, although many doctors prefer to prescribe more expensive Pancreatin analogues, explaining this by their greater effectiveness.

Pancreatin

Tyumen Chemical Plant, Russia

Replacement therapy for exocrine pancreatic insufficiency: chronic pancreatitis, pancreatectomy, condition after irradiation, dyspepsia, cystic fibrosis.
Flatulence, diarrhea of non-infectious origin, Roemheld syndrome (gastrocardiac syndrome). Impaired digestion of food (condition after resection of the stomach and small intestine); to improve food digestion in people with normal gastrointestinal function in case of errors in nutrition (eating fatty foods, large amounts of food, irregular meals) and in cases of chewing dysfunction, sedentary lifestyle, prolonged immobilization. Preparation for x-ray and ultrasound examination of the abdominal organs. from 18

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Causes of digestive disorders

Sometimes stomach problems begin after a heavy dinner or, conversely, after hunger. But besides these reasons, there are others that are associated with food consumption:

Poor nutrition, namely abuse of smoked meats, pickles, fatty foods that are difficult to digest, as well as the presence of large quantities of sweets in the diet
Binge eating. Doctors say that you need to leave the table half-starved, because with this feeling it is impossible to overeat. Often, the stomach is already full, but this signal has not reached the brain, and therefore the person thinks that he wants to eat. If you eat food slowly, you can avoid overeating, which can cause digestive problems.
Poor chewing of food. Many people eat in a hurry and, because of this, chew food poorly, especially hard food. And it is much harder to digest
Dinner at a late time. Many people are used to eating after 9 pm, which is very bad not only for the stomach, but also for the whole body. The biological clock works in such a way that by the evening all processes slow down, and late meals can simply lead to indigestion
Drinking large amounts of water during meals. Almost all nutritionists recommend drinking a lot of water, but there is one caveat. This should be done exclusively between meals, as water dilutes the enzymes in the stomach and their action becomes less effective.

Everyone knows what causes digestive problems, but few people adhere to a healthy lifestyle, and with it, nutrition.

Mezim Forte

These tablets for the pancreas are relatively inexpensive, the active substance here is also pancreatin. Mezim Forte helps with poor pancreatic function and is prescribed for the treatment of pancreatitis. “Mezim” can be taken simply if you have overeaten or have a lot of fatty foods in your diet - the tablets help the pancreas cope with the increased load. Sometimes this drug is prescribed for a long course or on an ongoing basis. And although there are many more affordable drugs based on pancreatin, Mezim Forte is the one that is most often purchased.

Mezim Forte

Berlin-Chemie/Menarini, Germany

Insufficiency of exocrine pancreatic function (chronic pancreatitis, cystic fibrosis);
chronic inflammatory-dystrophic diseases of the stomach, intestines, liver, gall bladder. Conditions after resection or irradiation of these organs, accompanied by impaired digestion of food, flatulence, diarrhea (as part of combination therapy); to improve digestion of food in patients with normal gastrointestinal function in case of errors in nutrition; preparation for x-ray and ultrasound examination of the abdominal organs. from 48

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Enzistal

“Enzistal” has a combined effect because, in addition to pancreatin, it contains ox bile extract and hemicellulose. Enzistal is prescribed for many diseases of the gastrointestinal tract, including inflammation of the pancreas. These tablets for pancreatitis improve the digestion of food, relieve pain, heaviness and any discomfort in the pancreas. "Enzistal" can be taken as a course, or it can be taken once when overeating. These tablets for pancreatitis have a special coating that dissolves in the small intestine - exactly where the remedy should work.

Enzistal

Torrent Pharmaceuticals, India

An enzyme preparation used for: Exocrine insufficiency of the pancreas, stomach, intestines, liver, gall bladder (chronic inflammatory-dystrophic diseases of these organs, condition after resection or irradiation);
flatulence, diarrhea of non-infectious origin; cystic fibrosis. To improve the digestion of food in persons with normal gastrointestinal function in case of errors in nutrition (eating fatty foods, large amounts of food, irregular meals); in case of disorders of chewing function (damage to teeth and gums, during the period of getting used to an artificial jaw); sedentary lifestyle; long-term immobilization. Preparation for X-ray examination and ultrasound of the abdominal organs. As an auxiliary drug for the rapid absorption of certain medications (PAS, sulfonamides, antibiotics). from 55

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Creon 10,000

These are German capsules with small granules for the pancreas. In the stomach, the gelatin capsule dissolves and the granules are mixed with food. This action significantly increases the positive effect of the drug and reduces the load on the pancreas. You can buy Creon in a pharmacy with different dosages: 5000, 25,000 and 40,000. But only a doctor should tell you which dosage is suitable in your case. Many patients taking Creon note that this is the best drug based on pancreatin.

Creon

ABBOTT, France

Creon is a gelatin capsule consisting of mini-microspheres with pork pancreatin.
Gelatin capsules tend to dissolve quickly in the stomach, releasing microspheres that have an enteric coating and are easily mixed with gastric contents. After dissolution, Creon, together with the food bolus, enters the small intestine, where the shell of the microspheres dissolves and the active substance is released. from 231

5.0 1 review

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Forms of release of drugs

Not everyone knows that depending on how the drug is released, its immediate effect will depend. Today, all enzyme-based drugs are available in two forms:

Capsules. More recently, drugs began to be produced in capsules, and for some time people were afraid to purchase them until the results of the study were publicly published. So, each capsule has all the shells. The first dissolves in the stomach, and the second only in the intestines. Thus, the effect of the drug taken in capsule form extends to the entire gastrointestinal tract
Pills. It just so happens that consumers trust pills more. Their effect extends exclusively to the stomach, since under the influence of gastric juice it dissolves and is absorbed there.

The choice of the best form to take depends solely on the doctor and the patient. Some people, having purchased a capsule, for some reason open it and take only granules, thereby preventing the drug from penetrating the intestines. Under no circumstances should this be done with capsules. As for the tablets, they can be crushed, split into two parts, etc. This will not reduce the effect.

Buscopan

This drug for pancreatin is an antispasmodic, it is an analogue of “No-Shpa”, because it relieves spasm of the smooth muscles of internal organs. "Buscopan" perfectly relieves pain due to pancreatitis. Literally 15 minutes after taking the pill you will feel relief. Buscopan is extremely rarely prescribed as a course, because there is a possibility of side effects due to long-term use of antispasmodics. But a one-time effective remedy for pain in the pancreas is an ideal drug. Buscopan is very popular in America and Europe, but in our country it is not prescribed so often because of its high cost.

Buscopan

Boehringer Ingelheim, Germany

- spastic conditions of the gastrointestinal tract, biliary tract, genitourinary tract (including renal colic, biliary colic, intestinal colic, cholecystitis, pylorospasm);
- spastic dyskinesia of the biliary tract and gallbladder; - peptic ulcer of the stomach and duodenum in the acute phase (as part of complex therapy); - algodismenorrhea. ICD-10 code Indication K25 Gastric ulcer K26 Duodenal ulcer K31.3 Pylorospasm, not classified elsewhere K80 Gallstone disease [cholelithiasis] (including hepatic colic) K81.0 Acute cholecystitis K81.1 Chronic cholecystitis K82.8 Other specified diseases of the gallbladder and cystic duct (including dyskinesia) N23 Renal colic, unspecified N94.4 Primary dysmenorrhea N94.5 Secondary dysmenorrhea R10.4 Other and unspecified pain in the abdominal area (colic) from 268

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Methods for diagnosing pancreatitis

The greatest difficulty is in diagnosing chronic pancreatitis.

Chronic pancreatitis often develops as an independent disease, and not as a complication of acute pancreatitis. At the same time, it is better to start treatment of chronic pancreatitis at an early stage, without leading to acute attacks.

For timely detection and diagnosis of chronic pancreatitis, it is necessary to undergo an annual preventive examination, as well as consult a gastroenterologist at the first suspicion of the disease.

The following diagnostic methods can be used to diagnose pancreatitis:

General blood analysis

A general blood test for pancreatitis reveals an increase in leukocytes (tens of times), a significant increase in ESR.