The aim: Is to determine the peculiarities of changes in the gastric acid secretion against the background of diabetic autonomic neuropathy and autonomic dysfunction in patients with chronic pancreatitis (CP) and type 2 diabetes (T2DM). Materials and methods: We investigated 64 patients with CP and T2DM, who were included in the first group of the patients examined; Group II consisted of 40 patients with T2DM; and Group III of the patients examined consisted of 34 patients with CP. Results: Differences were found in assessing the degree of autonomic nervous system (ANS) dysfunction in the examined patients, namely – the most pronounced ANS dysfunction according to the Wayne questionnaire was diagnosed in patients Group I, while patients of Group III. Analysis of gastric acid secretion indicates that no patients of Group III had normal acidity. Normal acidity is more often found in the second group of subjects. Both in patients with CP and T2DM, and in isolation with CP, moderate hyperacidity was more often determined. Conclusions: The predominance of the parasympathetic division of the ANS, as well as manifestations of severe ANS dysfunction, are observed in patients with CP and T2DM. The prevalence of gastric hyperacidity on the background of DAN was established in patients with CP and T2DM. In this case, the absence of clinical symptoms or their minimal severity is determined, which indicates the lesion of the digestive tract in these patients.

The aim: To determine the peculiarities of changes in the homocysteine levels in the patients with chronic pancreatitis and type 2 diabetes blood serum depending on the vitamin status. Materials and methods: We investigated 36 patients with chronic pancreatitis and type 2 diabetes, who were included in the first group of the patients examined; Group 2 consisted of 34 patients with chronic pancreatitis; and Group 3 of the patients examined consisted of 40 patients with type 2 diabetes. Results: All patients examined were diagnosed with type 2 diabetes mellitus of moderate severity. Also, the diagnosis of chronic pancreatitis was confirmed in all patients with type 2 diabetes, which was manifested by exocrine pancreatic insufficiency according to the results of clinical, laboratory and instrumental methods of examination. There was a significant decrease in the level of all B vitamins and 25-(OH)D in patients with chronic pancreatitis and type 2 diabetes (Group I). An increase in the concentration of homocysteine in the serum in all examined groups of patients was established, with the maximum deviation from the norm in patients with chronic pancreatitis and type 2 diabetes (up to 32.7 ± 0.8 μmol / L <0.01). The correlation analysis revealed a strong direct relationship between the level of homocysteine and vitamins B12, B6, 25-(OH)D and an inverse correlation between vitamin B9 in the group of patients with chronic pancreatitis and type 2 diabetes. Conclusions: Patients with chronic pancreatitis and type 2 diabetes have a decreased levels of B vitamins (B1, B6, B9, B12) and 25-(OH)D, which is accompanied by an increase in serum homocysteine. In patients with chronic pancreatitis and type 2 diabetes, the level of homocysteine in the blood serum directly depends on the decrease in the levels of vitamins B6, B12 and 25-(OH)D in blood serum, as well as inverse depends on vitamin B9 levels in these patients.

Підшлункова залоза (ПЗ) виробляє більш ніж 20 травних ферментів за добу. При захворюваннях ПЗ ця функціональна активність знижується, внаслідок чого відбувається порушення травлення з розвитком трофологічної недостатності. Мета – визначити особливості трофологічного статусу у хворих на хронічний панкреатит (ХП) та цукровий діабет (ЦД) 1-го та 2-го типів. Матеріал і методи. Обстежено 126 хворих на ХП та ЦД. Хворих на ХП поділено на 2 групи: в І групу увійшли 62 хворих на ЦД 1-го типу, а ІІ групу склали 64 пацієнти з ЦД 2-го типу. Усім обстеженим пацієнтам проведені загальноклінічні дослідження, а також біоімпедансометрія. Результати. Серед хворих І групи переважали пацієнти з нормальною вагою тіла та дефіцитом маси тіла (42,0 % та 29,0 %; р<0,01), тоді як серед пацієнтів з ХП та ЦД 2-го типу – особи з ожирінням І ст. та надмірною вагою тіла (31,2 % (р<0,01) та 28,1 % (р<0,05)). У хворих І групи встановлено дефіцит м’язової та кісткової маси, а також нестачу вмісту рідини в організмі, тоді як у хворих ІІ групи діагностовано виражене накопичення жирової маси в організмі та зниження м’язової маси, а також перевантаження організму вмістом рідини. Висновки. Антропометричне дослідження вказує на переважання пацієнтів з дефіцитом маси тіла та нормальною вагою у групі хворих на ХП та ЦД 1-го типу, тоді як серед хворих на ХП та ЦД 2-го типу переважають особи з ожирінням І ступеня та надмірною вагою. У хворих на ХП та ЦД 1-го типу дослідження складу тіла вказує на дефіцит м’язової та кісткової маси, а також відносне зменшення вмісту рідини, тоді як у хворих ІІ групи (поєднання ХП та ЦД 2-го типу) діагностовано збільшення жирової маси та рідинного компонента при тенденції до зменшення м’язової маси.

The study of the combined course of chronic pancreatitis and diabetes mellitus present a particular interest. The purpose of the study was to determine the effectiveness of correction of exocrine pancreatic insufficiency of the pancreas in patients with chronic pancreatitis and diabetes mellitus types 1 and 2 with using of different forms and doses of polyenzyme drugs. Material and methods. 126 patients with diabetes mellitus and chronic pancreatitis were examined. The patients were divided into 2 groups: 1 group included 62 patients with type 1 diabetes mellitus, and 2 group comprised 64 patients with type 2 diabetes. All surveyed patients underwent general clinical, anthropometric, instrumental and laboratory methods of investigation. Patients of both groups were divided into subgroups depending on the method of correction of exocrine pancreatic insufficiency, namely 1.1 and 2.1 subgroups received tableted polyenzyme preparation with minimal lipase activity of 10000 IU as enzyme therapy, and 1.2 and 2.2 subgroups received mini-tableted polyenzyme preparation with minimal lipase activity of 25000 IU. Results and discussion. The use of mini-tableted polyenzyme preparation with minimal lipase activity of 25000 IU according to the results of C13-mixed triglyceride and C13-amylase breath tests was an effective method for the correction of exocrine insufficiency of the pancreas in patients with chronic pancreatitis and diabetes mellitus types 1 and 2. We detected a statistically significant increase of the maximally concentration of 13CO2 between 150 and 210 minutes of the study (up to 9.2±0.4% 1.2 subgroup and up to 9.7±0.5% in patients 2.2 subgroup), as well as the total concentration of 13CO2 in at the end of 360 minutes of the study (up to 19.7±0.6% and up to 27.3±1.1%) according to the results of C13-mixed triglyceride breath tests, p<0,05. Conclusion. The use of a mini-tableted polyenzyme preparation with a minimum lipase activity of 25000 IU was a more effective method for correction of exocrine pancreatic insufficiency in patients with chronic pancreatitis and type 1 and 2 diabetes mellitus, than using a tableted polyenzyme preparation in a dose of 20000 IU per main meal. The study results showed that using C13-mixed triglyceride and C13-amylase breath test were highly informative methods for evaluating the effectiveness of enzyme replacement therapy in exocrine pancreatic insufficiency in patients with chronic pancreatitis and type 1 and 2 diabetes. The use of a mini-tablet polyenzyme drug in patients with chronic pancreatitis and type 1 and 2 diabetes mellitus is an effective means to normalize the manifestations of malabsorption in terms of α1-antitrypsin clearance

Aim: To investigate the effectiveness of complex therapy using “Polyana Kvasova” mineral water in patients with GERD and osteochondrosis (OH) of the cervical and thoracic spine. Materials and Methods: The examined patients included 56 Helicobacter pylori (HP)-positive patients with GERD and OH of the cervical and thoracic spine. The examined patients were divided into 2 groups depending on the scheme of complex treatment. All HP-positive patients with GERD and OH underwent standard triple anti-helicobacter therapy and itopride hydrochloride. Group I patients (n=26) received only the above-mentioned regimen. Patients of the II group (n=30) were additionally prescribed 100-150 ml of “Polyana Kvasova” carbonated bicarbonate-sodium mineral water (MW) as a natural antacid, warm, still 4 times a day (1.5 hours before meals and after 45 minutes after – both in the morning and evening) within 1 month. Results: The complex therapy carried out had a positive effect on the endoscopic picture of GERD in patients with cervical and thoracic OH. The decrease in the severity of RE was accompanied by an increase in the number of GERD patients in whom the erosive form of reflux esophagitis was not detected during repeated fibroesophagogastroduodenoscopy (FEGDS) (mainly in the II group of examined patients – 10.0% of patients, p<0.05). The additional prescription of “Polyana Kvasova” MW to the complex treatment increased the frequency of eradication of HP infection by 9.2% – p<0.05 at the background of more pronounced normalization of clinical and endoscopic signs of GERD. Conclusions: 1. GERD is often manifested by atypical extraesophageal symptoms (up to 25.0-27.3% of cases) in patients with OH of the cervical and thoracic spine. 2. The use of standard triple AHT in combination with itopride hydrochloride is an effective method of correcting esophageal and extraesophageal clinical manifestations of GERD in patients with cervical and thoracic spine OH. 3. The additional prescription of “Polyana Kvasova” MW as part of the complex therapy of patients with GERD and OH of the cervical and thoracic regions is a safe, effective method for reducing clinical symptoms, the severity of esophageal lesions with repeated FEGD, and also contributes to increasing the frequency of HP infection eradication in the data patients.