Published December 29, 2022 | Version v1
Journal article Open

Effectiveness of Differentiated Hepatotrophic Therapy in Complex Management of Patients with Comorbidity of Chronic Pancreatitis and Chronic Viral Hepatitis С

Creators

  • 1. I. Horbachevsky Ternopil National Medical University, Ternopil Regional Clinical Hospital, Ukraine
  • 2. I. Horbachevsky Ternopil National Medical University, Ukraine

Description

An important problem of the combined course of chronic pancreatitis (CP) and chronic hepatitis C virus (HCV) is the study of the effects of chronic HCV, even after the treatment, in particular for the condition of the pancreas and liver in patients with CP. Often hepatotrophic therapy is used for this purpose, which should be differentiated depending on the needs of patients with comorbidity of CP and chronic HCV.

The objective: to analyze the functional and structural condition of the pancreas and liver in patients with CP after the chronic HCV treatment by the proposed complex treatment with additional inclusion of hepatotrophic drugs.

Materials and methods. 80 patients with a combined course of CP and chronic HCV were examined. According to the methods of treatment the patients were divided into three groups. The 1st group included 20 patients with CP and chronic HCV, who received a common complex for treatment (CCT) by protocol for 3 months. In the 2d group 25 patients with CP and chronic HCV received CCT with additional inclusion of hepatotrophic agent for 3 months. The 3d group included 35 patients with CP and chronic HCV with CAGE≥2.0, who took CTC with additional inclusion of hepatotrophic agent for 3 months and metadoxine for 3 months.

Results. The more significant level of efficiency of therapeutic complex with the additional inclusion of hepatotrophic agent was determined when metadoxine was prescribed. It was found that the content of fecal α-elastase increased by 19.6 %, 37.5 % and 66.9 %, glucose level decreased by 13.4 %, 11.0 % and 28.4 %, glyconized hemoglobin – by 12.3 %, 22.1 % and 25.8 %, HOMA index – by 16.3 %, 21.9 % and 56.0 %, coprogram score – by 12.8 %, 18.3 % and 88.7 %, the total index of the pancreas structure – by 7.2 %, 15.1 % and 85.7 %, and the total indicator of liver structure – by 11.7 %, 17.5 % and 44.7 %, respectively in groups (p<0.05).

It was established that the inclusion of the hepatotrophic medicine in the standard therapy of CP with chronic HCV improved the results of treatment for the restoration of the functional and structural condition of the pancreas.

Conclusions. The additional prescription of the hepatotrophic agents combination significantly increased the effectiveness of treatment according to the dynamics of the functional capacity of pancreas and restoration of its structure (p<0.05). It was confirmed that a complex medical program with additional use of polysubstrate hepatoprotector exceeded the efficiency of the protocol treatment for the structural condition of the liver by 36.0 %, and with a combination of hepatotrophic agents – by 51.9 %; regarding the pancreas condition – by 22.3 % and 38.3 %, respectively (p<0.05). The combined use of hepatotrophic agents was also more effective than monotherapy with one drug.

Files

Effectiveness_of_Differentiated_Hepatotrophic_Therapy_in_Complex_Management_of_Patients_with_Comorbidity_of_Chronic_Pancreatitis_and_Chronic_Viral_Hepatitis_С.pdf

Files (1.7 MB)

Additional details

References

  • Babinets LS, Kryskiv OI, Shaygen OR, Khomin GO. Analysis of the influence of various etiological factors on the occurrence of chronic pancreatitis. Bulletin of the Vinnytsia State Medical University. 2013;7(2/1):444–5.
  • Babinets LS. The effectiveness of the bioregulatory approach in the complex correction of endogenous intoxication in chronic lesions of the pancreatohepatobiliary system. Gastroenterol. 2020;(2);84–7.
  • Babinets LS, Palikhata MV, Sasyk GM. Possibilities of comprehensive rehabilitation of patients with chronic pancreatitis at the stage of primary medical care (literature review). Bulletin of the Pancreatol Club. 2018;2(39):4–11.
  • Babinets LS, Sasyk GM. Analysis of the functional capacity of the pancreas in the comorbidity of chronic pancreatitis with type 2 diabetes. Family medicine 2020;5-6(91-92):47–50.
  • Babinets LS, Sasyk GM. Optimization of correction of enteropancreatic syndrome in complex rehabilitation of patients with chronic pancreatitis combined with type 2 diabetes. Ukrainian therapeutic journal. 2020;(2):37–42.
  • YuM Mostovoi, editor. Modern classifications and standards of treatment of widespread diseases of internal organs: 21st edition. add. and processing.. Vinnytsia; 2022. 1011 p.
  • Abdel AS, Elsharkawy A, Fouad R, Adel E, Abdellatif Z, Musa S, Nagy A, Hussein MS, Yosry A, Esmat G. Improvement of glycemic state among responders to Sofosbuvir-based treatment regimens: Single center experience. J Med Virol. 2017;89(12):2181–7. doi: 10.1002/jmv.24897.
  • Babinets LS, Sasyk HM, Halabitska IM, Mykuliak VR. Possibilities of complex rehabilitation of patients with type 2 diabetes and concomitant chronic pancreatitis in ambulatory practice. Balneol. 2021;(1):12–5.
  • Babinets LS, Shaihen OR, Homyn HO, Halabitska IM. Specific aspects of clinical course in case of combination of chronic pancreatitis and concomitant viral hepatitis C. Wiad Lek. 2019;72(4):595–9.
  • Bitton S, Pettei MJ. Exocrine pancreatic insufficiency. Pediatr Rev. 2016;37(2):85–7. doi: 10.1542/pir.2015-0084.
  • Chevaliez S, Soulier A, Poiteau L, Bouvier-Alias M, Pawlotsky JM. Clinical utility of hepatitis C virus core antigen quantification in patients with chronic hepatitis C. J Clin Virol. 2014;61(1):145–8. doi: 10.1016/j.jcv.2014.05.014.
  • Dominguez-Munoz JE, Lucendo A, Carballo LF, Iglesias-Garcia J, Tenias JM. A Spanish multicenter study to estimate the prevalence and incidence of chronic pancreatitis and its complications. Rev Esp Enferm Dig. 2014;106(4):239–45.
  • Drazilova S, Janicko M, Skladany L, Kristian P, Oltman M, Szantova M, et al. Glucose Metabolism Changes in Patients with Chronic Hepatitis C Treated with Direct Acting Antivirals. Can J Gastroenterol Hepatol. 2018;2018:6095097. doi: 10.1155/2018/6095097.
  • European Association for Study of Liver. EASL Recommendations on Treatment of Hepatitis C 2015. J Hepatol. 2015;63(1):199–236. doi: 10.1016/j.jhep.2015.03.025.
  • European Union HCV Collaborators. Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modeling study. Lancet Gastroenterol Hepatol. 2017;2(5):325–36. doi: 10.1016/S2468-1253(17)30045-6.
  • Foster GR, Dore GJ, Wang S, Grebely J, Sherman KE, Baumgarten A, et al. Glecaprevir/pibrentasvir in patients with chronic HCV and recent drug use: An integrated analysis of 7 phase III studies. Drug Alcohol Depend. 2019;194:487–94. doi: 10.1016/j.drugalcdep.2018.11.007.
  • Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol. 2014;61(1):45–57. doi: 10.1016/j.jhep.2014.07.027.
  • Hagström H. Alcohol Consumption in Concomitant Liver Disease: How Much is Too Much? Curr Hepatol Rep. 2017;16(2):152–7. doi: 10.1007/s11901-017-0343-0.
  • Indolfi G, Easterbrook P, Dusheiko G, El-Sayed MH, Jonas MM, Thorne C, et al. Hepatitis C virus infection in children and adolescents. Lancet Gastroenterol Hepatol. 2019;4(6):477–87. doi: 10.1016/S2468-1253(19)30046-9.
  • Lévy P, Domínguez-Muñoz E, Imrie C, Löhr M, Maisonneuve P. Epidemiology of chronic pancreatitis: burden of the disease and consequences. United European Gastroenterol J. 2014;2(5):345–54. doi: 10.1177/2050640614548208.
  • Lew D, Afghani E, Pandol S. Chronic pancreatitis: current status and challenges for prevention and treatment. Dig Dis Sci. 2017;62(7):1702–12. doi: 10.1007/sl0620-017-4602-2.
  • Lohr JM, Oliver MR, Frulloni L. Synopsis of recent guidelines on pancreatic exocrine insufficiency. United Eur Gastroenterol J. 2013;l(2):79–83. doi: 10.1177/2050640613476500.
  • Nahon P, Bourcier V, Layese R, Audureau E, Cagnot C, Marcellin P, et al. Eradication of Hepatitis C Virus Infection in Patients With Cirrhosis Reduces Risk of Liver and Non-Liver Complications. Gastroenterol. 2017;152(1):142–56. doi: 10.1053/j.gastro.2016.09.009.
  • Soulier A, Poiteau L, Rosa I, Hezode C, Roudot-Thoraval F, Pawlotsky JM, et al. Dried Blood Spots: A Tool to Ensure Broad Access to Hepatitis C Screening, Diagnosis, and Treatment Monitoring. J Infect Dis. 2016;213(7):1087–95. doi: 10.1093/infdis/jiv423.
  • Younossi ZM, Zheng L, Stepanova M, Venkatesan C, Mir HM. Moderate, excessive or heavy alcohol consumption: each is significantly associated with increased mortality in patients with chronic hepatitis C. Aliment Pharmacol Ther. 2013;37(7):703–9. doi: 10.1111/apt.12265.