Stages of chronic pancreatitis development

Aim. To ascertain correlations between pancreatic secretion disturbances and stage and complications of chronic pancreatitis (CP). Material and methods. The examination covered 81 CP patients (32 females, 49 males, mean age 55.9±1.8 years). Alcohol pancreatitis (AP) was diagnosed in 52 of them, biliary pancreatitis - in 29, complicated pancreatitis - in 25 patients. The control group consisted of 22 patients without symptoms of gastrointestinal disease. Results. By the results of clinical, device, laboratory and morphological tests we recognize 3 variants of CP course. Variant A: duration under 5 years, distinct pain syndrome, pancreatic fecal elastase (E-1) level insignificantly decreased, elevated blood levels of acetylcholine (Ac), serotonin (5-NT), cholecystokinin (CCK), secretin is subnormal. Pancreatic tissue is inflamed and swollen. Variant B: duration 5-10 years, E-1 under 100 mcg/g, moderate pain syndrome, prevalence of 5-NT as a stimulator of pancreatic secretory activity. CCK is high and secretin is low. Further progress of fibrous changes by ultrasound investigation, abdominal CT leads to calcinosis in pancreatic tissue. Variant C: duration 10 years and longer, weak pain syndrome, further rise of 5-NT concentration, decompensation of regulatory mechanisms of secretory pancreatic activity, CCK is high, secretin is subnormal. Conclusion. Changes in correlations between neuromediators and hormones in CP reflect adaptation aimed at retension of secretory pancreatic activity in significant fibrous changes of pancreatic tissue.