Functional disorders of the pancreas - Causes

The main predisposing factors for the development of functional disorders of the pancreas in peptic ulcer disease are the pronounced dyskinesia of the duodenum characteristic of this disease, the development and progression of duodenitis, a significant duration of peptic ulcer disease and its frequent recurrence. The nature of functional changes in the pancreas in peptic ulcer disease in different patients is ambiguous, but most often there is a decrease in the activity of pancreatic enzymes (amylase, trypsin, lipase) in the duodenal contents (this is determined by duodenal intubation) and their moderate increase in the blood. Some researchers have observed "dissociation of pancreatic enzyme secretion": an increase in the activity of amylase in the duodenal contents, a decrease in the activity of lipase and other changes. In some cases, the endocrine function of the pancreas is somewhat reduced. In chronic atrophic gastritis with secretory insufficiency, a decrease in the exocrine function of the pancreas is also often observed: a decrease in the production of the total amount of juice secreted per unit of time, both before and after stimulation of the pancreas, a decrease in the content of bicarbonates and enzymes in the pancreatic juice (some authors also noted the presence of "dissociation of enzyme secretion"), an increase in the content of pancreatic enzymes in the blood. Moderate hyperamylasuria is observed; minor disturbances are often noted in the endocrine function of the pancreas.

Functional disorders of the pancreas in peptic ulcer disease and chronic gastritis are more often detected when the disease has been going on for a long time and are usually not accompanied by symptoms of damage to the gland, are often reversible, disappearing with the improvement of the course of these diseases under the influence of treatment (for example, in the remission stage of peptic ulcer disease), are not accompanied by morphological changes in the pancreas determined by modern diagnostic instrumental methods (for example, echography or scanning). Functional disorders in these diseases are explained by the close functional relationship of the digestive system organs, disruption of the nervous and humoral (gastrointestinal hormones) regulation of the pancreas. In rare cases, chronic pancreatitis develops with these diseases. The development of pancreatitis is natural with the penetration of peptic ulcers into the pancreas, as well as with concomitant diseases of the biliary system. In atrophic duodenitis, the production of pancreatic juice is disrupted due to a decrease in the production of natural stimulants of pancreatic secretion by the mucous membrane of the duodenum - the hormones secretin and pancreozymin.

Some authors have found functional changes in the pancreas in chronic hepatitis and liver cirrhosis. In some cases, morphological changes such as chronic pancreatitis and even fibrosis of the pancreas are found in liver cirrhosis. Functional disorders of the pancreas in chronic colitis, especially in nonspecific ulcerative colitis, have been described: dissociation of enzymes in the duodenal contents (increased amylase activity, decreased lipase and trypsin), increased activity of ataxyl-resistant lipase in the blood serum. Approximately one third of patients had minor disorders of the endocrine apparatus of the pancreas, also reversible.

In case of functional disorders of the pancreas, however, if a decrease in pancreatic juice secretion is observed, it is usually not very significant. Only in case of organic lesions of this organ can the exocrine function of the pancreas be sharply impaired. Pancreatic achylia (or a sharp decrease in the secretion of pancreatic juice) can occur in severe infectious diseases, in cancer cachexia (in any tumor localization, in this case we are not talking about pancreatic cancer) and in any other severe intoxication.

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