The review article provides up-to-date information on the complications of pancreatitis that are important for the tactics and strategy of patient management both at the inpatient and outpatient stages of observation. The purpose of the review was to emphasize the importance of complications for the course and life of patients with chronic pancreatitis. The authors draw the attention of internists to the course of such complications as pseudocysts, cysts, fistulas, thrombohemorrhagic, cholestatic syndromes, compression syndrome of adjacent organs, pancreatic encephalopathy (acute and chronic). The symptomatology of complications of chronic pancreatitis is discussed in detail, which is very important for differential diagnosis with the corresponding diseases. Such complications include the formation of erosive and ulcerative lesions, varicose veins of the esophagus and bleeding from varicose veins of the esophagus and stomach, portal hypertension syndrome with pancreatic ascites and chronic pancreatic encephalopathy, idio­pathic non-cirrhotic portal hypertension, pancreatic cancer. The authors emphasize the need to analyze the corresponding symptoms, indicating the possibility of complications, negative consequences with each recurrence or exacerbation of chronic pancreatitis, since it concerns the prognosis and life of the patient.

In this article, the authors analyze a number of known and probable mechanisms involved in the formation of metabolic disorders upon chronic pancreatitis in comorbidity with metabolic syndrome. The issue of involvement of pancreatic endocrine apparatus in development of insulin resistance upon chronic pancreatitis, namely, the role of such a hormone as insulin, is highlighted. The role of this hormone in development of disorders of fat metabolism, obesity and arterial hypertension is presented. The authors emphasize the role of adrenal hormones, estrogen in the pathogenesis of both diseases. The issue of effect of endocrine function disorders on the state of external pancreatic secretion with subsequent development of disorders in the microbiota composition is considered (which also contributes to the progression of both diseases). The data on presence of a possible relationship between the composition, functional activity of the intestinal microbiota and development of metabolic syndrome, chronic pancreatitis are given. The significance of intestinal microbiota in the maintenance of various vital processes of a healthy person, food digestion, as well as synthesis, metabolism, recycling, utilization of various biologically active substances (vitamins, hormones, steroids, immunoglobulins) and elimination of toxins is revealed. The role of microorganisms in the formation of feeding behavior via axis “intestinal microbiome — intestine — brain” is analyzed. Modern ideas on the ability of microorganisms to provoke formation of metabolic disorders upon chronic pancreatitis are presented. The data confirming connection of certain dysbiotic changes (increased ratio of Firmicutes/Bacteroidetes, reduced number of Bacteroidetes and increased number of Firmicutes) with development of obesity, overweight, type 2 diabetes mellitus (known risk factors of metabolic syndrome) is given. It is suggested to prevent formation of metabolic syndrome in chronic pancreatitis by increasing the number of specimens of Bifidobacterium genus and Faecalibacteriumprausnitzii strains in the intestine.

Хронічний панкреатит (ХП) – одне з поширених гастроентерологічних захворювань, яке становить близько 8–10 % у структурі усіх захворювань органів травлення. Нерідко це захворювання діагностують пізно (алкогольної природи – до 30 місяців, іншої етіології – до 60 місяців від початку розвитку захворювання). За останні роки збільшилася частота захворювання на ХП, який супроводжується структурними змінами, що призводить до екзо- та ендокринної недостатності ПЗ, характеризується значним погіршенням якості життя і достатньо високим ризиком розвитку цукрового діабету й пухлин підшлункової залози. Через 10 років після встановлення діагнозу ХП приблизно 25 % пацієнтів змушені залишити свою професійну діяльність або стають інвалідами. При цьому розвивається зовнішньосекреторна недостатність ПЗ, страждає травлення завдяки формуванню мальдигестії (синдром порушеного перетравлювання) та мальабсорбції (синдром зниженого всмоктування). Знання етіологічних чинників (куріння, алкоголізм, інфекційні, вірусні, гельмінтозні чинники, спадковість, метаболічний синдром, ендокринні захворювання, холелітіаз, хронічна ниркова недостатність тощо) при цьому мають значення не тільки для діагностики, але й для перебігу, диференційного діагнозу, лікування, реабілітаційних заходів та прогнозу перебігу захворювання.

Studying the significance of the immune response to damage and adipokine levels is urgent regarding the development of both chronic pancreatitis and type 2 diabetes mellitus. Our objective was to study the indices of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), adiponectin, leptin, and resistin as links for triggering the mechanisms of development and progression of the low-grade chronic systemic inflammatory response in chronic pancreatitis (CP) patients with type 2 diabetes mellitus (T2DM). The study groups consisted of 87 patients: 47 patients with isolated CP (group I), 40 with CP combined with T2DM (group II), and 41 practically healthy persons. It has been established that in patients with isolated CP, the TNF-α concentration showed a reliable 1.57-fold (p <0.05) increase compared to practically healthy persons (PHP) and a 1.32-fold increase in patients who also had T2DM (p<0.05). CP patients with type 2 diabetes mellitus had the highest CRP indices (5.5-fold, p <0.05. TNF-α and C-reactive protein indices were higher in patients with chronic pancreatitis and T2DM than those with isolated chronic pancreatitis, characterizing the persistence of chronic systemic inflammation in case of the combined clinical course of these diseases.

The article provides information about classifications of pancreatitis (both chronic and acute) close to clinical practice. The issue directly related to medical practice is highlighted, such as classification of diseases and causes of death (ICD-11), with appropriate headings for pancreatic diseases.The analysis of the general provisions indicated in the M-ANNHEIM classification (2007) and in the Marseilles-Rome classification with amendmentsbyYa. S. Tsimmerman and N. B. Gubergrits (2002), used by the Ukrainian physicians, is analyzed. The authors drew attention of gastroenterologists, therapists, family doctors to the need for predictionof the development of complications that threaten patients’ life.