Reactive pancreatitis in adults and children

The term "reactive pancreatitis" is used if we are talking about the initial phase of an acute inflammatory reaction in the pancreas, which develops rapidly, but is easily treated with timely therapeutic measures. Reactive pancreatitis is accompanied by characteristic pain, digestive disorders, signs of general intoxication. After eliminating the main cause of acute inflammation, the problem usually disappears. However, it is important to take measures in time to avoid the transformation of reactive pancreatitis into a chronic pathology. [1]

Epidemiology

Reactive pancreatitis is more commonly referred to as reactive pancreatopathy. Such terms experts call the inflammatory reaction that occurs with damage to the pancreas against the background of other pathological conditions or diseases of the digestive organs.

Some of the most common causes of reactive pancreatitis include: poor diet, alcohol abuse, frequent stress and nervous disorders.

The most frequent symptom of the disorder: pain in the area of pancreatic projection, often shingles and/or contraction-like.

Since reactive pancreatitis does not belong to the number of proven independent nosologic units, statistics of this disorder are not kept. The fact is that the concept of reactive pancreatitis often hides two pathological processes: it is secondary pancreatitis, which is the result of an existing disease, and a pathological condition preceding destructive changes in pancreatic tissues (e.g., edema). The above condition is predominantly secondary, and the use of the term "reactive" is appropriate, although we are not yet talking about direct inflammation of the pancreas. In contrast to the chronic process, reactive pancreatitis is a reversible disorder, provided that the underlying pathology is affected and appropriate adjuvant therapy (diet, improvement of microcirculation, etc.) is carried out. A clear increase in the level of enzymes in the blood already indicates the development of acute pancreatitis directly, or exacerbation of chronic, and in this case, the prefix "reactive" is no longer used. To avoid errors, many specialists use "pancreopathy" or "dyspancreatism" instead of the term "reactive pancreatitis".

According to some data, pancreatic lesions can occur at almost any age, including in children. Men are somewhat more often affected than women, which may be due to the peculiarities of diet and lifestyle, the presence of a greater number of bad habits. [2]

Causes of the reactive pancreatitis

The main reason for the development of reactive pancreatitis is the untimely triggering of enzyme activity, which occurs before the pancreatic enzymes reach the intestine. Such occurs, for example, in the narrowing of the duct of the gland, in chronic digestive disorders or alcohol abuse, as well as in other disorders accompanied by pancreatic stasis. As they accumulate, the enzymes begin to damage the glandular tissues directly, causing the development of a rapidly increasing inflammatory process and the entry of toxins into the blood (intoxication).

Among the most common initial causes of reactive pancreatitis are the following disorders:

• relapses of chronic diseases - in particular, peptic ulcer disease, viral hepatitis, cholelithiasis;
• frequent consumption of fatty, fried food, alcoholic beverages;
• intestinal infectious lesions;
• food toxic infections, intoxications;
• biliary endoscopy;
• abdominal trauma.

Taking pancreatotoxic medications such as antibiotics, sulfonamides, indirect anticoagulants, glucocorticosteroids, estrogens, sodium diuretics, nonsteroidal anti-inflammatory drugs, and first-generation _H2-receptor blockers may play a provocative role in the development of reactive pancreatitis. [3]

Also hereditary predisposition to the disorder is not excluded. Specialists point to the possibility of hereditary pancreatitis - an autosomal dominant pathology caused by a gene mutation in one of the chromosomes, which leads to a change in the trypsin molecule and a disorder of its protection against intracellular activation. [4]

Risk factors

There are a number of factors that have a negative impact on digestive function and contribute to the development of a reactive inflammatory process in the area of the parenchymatous organ. The most common such factors are considered to be:

• alcohol abuse (including low-alcohol drinks and beer);
• chronic inflammatory reactions of any organ of the gastrointestinal tract, including 12-perintestinal ulcers, colitis, gastritis, duodenitis, etc.;
• Improper eating habits, frequent overeating, obesity;
• Improper diet with frequent consumption of fast food, fatty and spicy dishes, smoked foods, snacks and convenience foods;
• prolonged self-medication, unjustified and incorrect intake of medicines;
• regular or severe stress, anxiety;
• abdominal trauma with structural damage to organs.

Often reactive pancreatitis is a consequence of such diseases:

• chronic cholecystitis, gastritis, peptic ulcer disease;
• parasitic infestations;
• viral hepatitis;
• poisoning (food, industrial intoxication);
• cirrhosis of the liver;
• cholelithiasis, biliary dyskinesia;
• Improper development of bile ducts, other parts of the digestive tract.

It is important to understand that the elimination of provoking factors and causes of the development of reactive pancreatitis usually leads to the restoration of the normal level of functionality of the pancreas and normalization of the patient's general well-being.

Pathogenesis

In healthy people, the pancreas produces enzymes, which are subsequently transported as pancreatic fluid to the duodenum. There the enzymes are activated and directly participate in the digestion of proteins, carbohydrates and fats from food. One of the leading roles in the breakdown of carbohydrates is played by amylase, and lipase helps to break down fats.

In addition, the pancreas synthesizes the hormones glucagon and insulin to regulate blood glucose levels.

With the development of reactive pancreatitis, enzyme activation does not occur in the duodenum, but directly in the gland. This can happen under the influence of alcoholic beverages, when the pancreatic duct is blocked (e.g., by a stone), as well as as as a result of trauma, viral infections and so on. As a result, the process of "self-digestion" of the organ begins, which gives rise to inflammation, edema and further - impaired function.

Absence or improper treatment of reactive pancreatitis contributes to its transformation into a chronic course.

Repeated attacks of the disease lead to a decrease in the number of functioning structures in the gland, which negatively affects the digestion of food: fecal masses become heterogeneous, with a large amount of undigested fat. If the number of cells producing insulin decreases, diabetes develops. [5]

Symptoms of the reactive pancreatitis

One of the main symptoms of reactive pancreatitis is pain, quite intense, with a tendency to increase after eating, with irradiation to the right or left subcostal region, sometimes - shingles.

Other symptoms include:

• nausea, hiccups;
• less often - vomiting (in vomit masses there is a large amount of mucus and bile);
• spastic abdominal pain (mainly in the epigastrium);
• slight fever, chills;
• increased gas;
• sometimes a drop in blood pressure.

The first signs appear quite quickly: reactive pancreatitis makes itself known in a few hours after exposure to the provoking (irritating) factor. The sooner action is taken and treatment is started, the better the chances of quickly restoring the function of the digestive system and preventing further development of the disease.

Temperature in reactive pancreatitis is not the main sign, as in many patients it may be within normal limits. However, sometimes it is slightly elevated, up to 37-37.5°C, which indicates that the body is starting to become intoxicated. Temperature rise is often accompanied by discomfort, chills, headache.

With the beginning of adequate therapeutic measures, the patient's condition improves quite quickly. [6]

Reactive pancreatitis in children

The development of reactive pancreatitis indicates some unfavorable effect on the pancreas. This may be an infectious-inflammatory process, viral infection, food intoxication, reaction to other disorders of the gastrointestinal tract (gastritis, enterocolitis, duodenitis).

It is important that close people of the sick child timely paid attention to the first signs, went to the doctors, thus preventing the chronic course of pancreatitis. Most often in the development of reactive pancreatitis, children complain of the appearance of nausea, abdominal pain. Parents may also notice an unpleasant odor from the oral cavity (despite the fact that the child regularly brushes his teeth). The act of defecation is also suspicious: the stool is unstable, undigested food particles are found in the feces.

To confirm the diagnosis of reactive pancreatitis in childhood, among other things, a urinalysis is prescribed, in which a small amount of diastase, a derivative of amylase produced in the pancreas, is detected. In healthy individuals, amylase should only enter the intestines to allow for the breakdown of carbohydrates. In reactive pancreatitis, this enzyme is partially absorbed into the blood and then passes into the urine, transforming into diastase.

The fecal examination reveals excessive presence of starch, muscle fibers, fats, vegetable fiber, which indicates insufficient digestion of food and under-receipt by the intestine of some enzymes from the pancreas. We are talking about trypsin, lipase and amylase. Such enzyme deficiency leads to the fact that the pancreas begins to produce these enzymes, but they still do not get into the intestine, being absorbed into the blood. Thus, intoxication increases, the patient's condition becomes increasingly worse.

To sooner achieve success in the treatment of the child, along with medication, a diet is necessarily prescribed in order to stabilize the enzyme activity of the gland. Dishes are cooked exclusively on steam (for at least 10 days). The diet is freed from raw vegetable products, broths, sausages and offal, beans, canned food, black bread, sweets. Recommended use of dairy products, well-cooked cereals and vegetables, boiled white meat and fish, sours and non-concentrated compotes. As recovery gradually expand the diet. [7], [8], [9], [10], [11]

Stages

The stages of reactive pancreatitis can vary depending on the severity of the disease. However, the following stages can usually be distinguished:

1. Initiation phase: In this initial phase, the pancreas is exposed to an irritant such as alcohol, surgery, or other irritants. This can trigger an inflammatory response from the body.
2. Inflammation Activation Phase: In response to an irritant, the pancreas begins to produce more enzymes than usual. This can lead to inflammation of the gland tissue.
3. Inflammation Escalation Phase: In this phase, inflammation increases and it can spread to neighboring tissues and organs. This can lead to more serious symptoms and complications.
4. Complication phase: If the inflammation continues to get worse and spread, complications such as abscesses (pustules), cysts, or necrosis (tissue death) of the pancreas may occur. These complications may require surgery.

It is important to note that reactive pancreatitis can vary in severity and its stages may manifest differently in different patients.

Forms

Several classifications of inflammatory pancreatic disease are known, taking into account the morphologic and etiologic features of the disease.

According to the nature of the course, a distinction is made:

• Acute pancreatitis (includes fermentative phase, acute reactive pancreatitis, sequestration, and outcome phase);
• chronic course (with stages of exacerbation and remission).

Chronic reactive pancreatitis in this situation can be considered as one of the phases of pathology relapse.

By the nature of the lesion distinguish edematous and destructive form. The first represents necrosis of individual cells of the organ without the formation of islet foci. But destruction is also called pancreonecrosis, which can be small, medium or large foci, or total-subtotal, with the lesion of all glandular compartments.

Complications and consequences

Reactive pancreatitis already in 6-14 days can be transformed into an acute or chronic pathological process, if you do not start treatment of the disease in time. In turn, such a transformation can cause other unfavorable consequences:

• diabetes;
• weight loss, emaciation;
• dysfunction of the biliary system and intestines;
• vitamin and mineral deficiencies;
• malignant degeneration, pancreatic cancer.
• Some of the consequences may pose a direct threat to the patient's health and life. Particular danger is acute pancreatitis, which is often complicated by peritonitis, cysts, renal failure.

Other possible complications include:

• fluid accumulation in the pancreas and peripancreatic space, splenic vein thrombosis, pseudoaneurysm formation and gastric gatekeeper dysfunction;
• shock, organ failure.

As the process becomes more chronic, the cells of the pancreas are replaced by connective tissue, which leads to the loss of functional abilities of the organ. Enzyme activity decreases, less insulin is produced, disorders of the entire digestive system occur, and the risk of diabetes mellitus increases.

Since the pancreas is closely adjacent to the gallbladder, the inflammatory process can spread, resulting in cholecystitis, biliary dyskinesia, biliary stone disease. In such a situation, it is often necessary to carry out surgical treatment. [12]

Chronic inflammation can lead to malignant cellular transformation - pancreatic cancer, which often ends lethally for the patient. [13]

Diagnostics of the reactive pancreatitis

If reactive pancreatitis is suspected, the doctor prescribes these types of tests:

• blood, urine, stool tests;
• ultrasound, including endoscopic ultrasonography (endoscopic ultrasonography).

Endoscopic ultrasound uses a special endoscope with an ultrasound transducer at the end. The use of the transducer allows you to get a detailed picture of the digestive tract, duodenum and pancreas.

Reactive pancreatitis on ultrasound is manifested by swelling and initial signs of inflammation of the pancreas, and in the chronic process foci of calcification of tissues are detected. At the same time it is possible to detect stones in the gallbladder and ducts, or pseudocysts and other neoplasms.

Additional instrumental diagnostics:

• Computed multispiral tomography with obtaining a layer-by-layer X-ray image of tissues with further processing on a computer. During diagnosis, the patient is placed on a special table, after which the device moves along the body, performing images. Tomography makes it possible to detail the structure of the pancreas and nearby tissues.
• Magnetic resonance imaging is similar to CT, but involves the use of magnetic nuclear resonance rather than X-rays.
• X-ray of the biliary tract and pancreas - endoscopic retrograde pancreatocholangiography - involves the introduction of a radiopaque contrast agent through a tube into the 12-intestine under observation through an endoscope. The study helps to visualize the common bile duct and the pancreatic duct, to detect damage or narrowing.
• Pancreatic enzyme production function testing (administration of special irritants that activate enzyme production with further quantification).

If the patient complains of severe pain in the area of the pancreas, the first thing to suspect is acute pancreatitis. In this case, the determination of pancreatic enzymes in the blood and urine has a certain diagnostic value. The indicator of amylase tends to increase with pancreatitis. Thus, in the acute inflammatory process, it increases within 2-10 hours from the moment of manifestation of the disease and remains at a high level for several days (the norm can be exceeded by 5-20 times). However, the amylase indicator does not always respond to reactive pancreatitis, and in the chronic process and may remain within normal limits.

Amylase in the urine is usually detected in accordance with the amylase value in the blood, but its increase occurs somewhat later - after 6-10 hours.

Lipase is also elevated within 1-2 days of the manifestation of reactive pancreatitis. The elevated level persists for several days. In addition, the level of another enzyme, elastase, may increase.

C reactive protein in pancreatitis indicates the presence of an active inflammatory phase, but this value cannot be called specific only for this pathology.

The coprogram method helps to determine the quality of digestion. For example, in chronic pancreatitis, the feces usually contain particles of undigested fats and proteins. [14]

Differential diagnosis

Differential diagnosis is carried out with acute pancreatitis, exacerbation of chronic pancreatitis, pancreatic tumors (in particular, cancer of the head of the pancreas, cyst and false cyst), with mechanical intestinal obstruction, intestinal infarction, perforated ulcer, ectopic pregnancy.

The diagnosis of acute pancreatitis is confirmed by elevated amylase and lipase activity. Although amylase may be elevated in some other pathologies, including intestinal obstruction or perforated ulcer. Since amylase is excreted by the kidneys, its plasma activity is also increased in renal failure. In acute pancreatitis, the level of amylase reaches peak activity after 24 hours and stabilizes after 48-72 hours. In this case, lipase activity should also be determined to confirm the diagnosis.

In chronic pancreatitis with necrotic changes in the pancreas, amylase and lipase activity does not always change. For example, changes are absent in fibrosis of the organ.

If the blood amylase activity rises above 2000 U/liter, we can think about the development of calculous pancreatitis.

Since the pancreas and the biliary system are in close proximity to each other, cholecystitis and reactive pancreatitis often develop almost simultaneously, which also requires attention from doctors. Bile stagnation leads to increased pressure in the bile ducts, bile is thrown into the pancreas, resulting in the onset of edema and inflammation of tissues. Reactive biliary pancreatitis develops, which quickly acquires a chronic course. Diagnosis is made after ultrasound of the hepatobiliary system, tomography of the abdominal cavity, functional tests.

Treatment of the reactive pancreatitis

Treatment measures consist in the elimination of the inflammatory process and intoxication, with further restoration of normal pancreatic enzyme activity. Treatment is necessarily carried out by a doctor, controlling all indicators. Self-treatment is not allowed.

A prerequisite for successful recovery is diet. It is optimal to fast for the first 1-2 days, which helps to reduce the load from the affected organs and the entire digestive system. Then the patient is prescribed a gentle diet, with the use of small portions of food (chopped, easily digestible). The diet restricts and excludes the use of certain foods: the specifics of the diet will be described below.

Drug treatment includes taking enzymes, analgesics and antispasmodics. It is possible to use drugs that optimize the composition of intestinal microflora and increase immunity. [15]

An important step is to take enzyme preparations based on pancreatin. The activity of enzyme production by the pancreas is severely affected, which leads to poor quality digestion of food, improper course of digestive processes. Taking enzyme preparations helps to stabilize the function of the pancreas, prevent failure in the intestine. [16]

Medications

To relieve pain in reactive pancreatitis use analgesics - for example, Tramadol intramuscularly or intravenously 1-2 capsules or 1 ml of injectable solution. The dose is single, if necessary, it is repeated after 1 hour. Possible side effects include hypotension, tachycardia, visual disturbances, agitation and hallucinations.

Other medications may also be used:

• analgesic Metamizole sodium intramuscularly 1 ml of 25% solution up to three times a day;
• m-cholinolytic Atropine intramuscularly 1 ml 0.1% or Pyrenzipine 50 mg twice daily;
• myotropic antispasmodic Papaverine intramuscularly 1 ml three times a day, Platifylline subcutaneously 1-2 ml of 0.2% solution, Drotaverine 1-2 tablets up to three times a day, or Mebeverine 200 mg morning and evening, or Platifylline orally 3-5 mg up to three times a day.

In order to reduce the secretory activity of the stomach and pancreas, proton pump inhibitors are prescribed:

• Omeprazole 40-80 mg per day intravenously;
• Lansoprazole 30 mg twice daily orally;
• Omeprazole 20 mg twice daily;
• Pantoprazole 40 mg once daily;
• Rabeprazole 20 mg morning and evening;
• Esomeprazole 40 mg once daily.

Taking such drugs is usually safe, in rare cases there are allergic reactions, drowsiness and lethargy, nausea, dizziness.

Histamine H2-receptor antagonists are used for the same purpose:

• Famotidine 40 to 80 mg once daily orally;
• Ranitidine 300 mg once a day.

In case of heartburn, antacids are prescribed (aluminum phosphate orally 1-2 sachets up to three times a day, or Simaldrate 1 sachet or 1 tablet up to six times a day, or Sucralfate 500-1000 mg up to four times a day).

As a substitute treatment and improvement of pancreatic function, enzyme drugs are necessarily used. Thus, pancreatin is taken orally with food, the dosage is selected individually, with an initial dose of 10 thousand - 25 thousand units of lipase.

If the motor function of the digestive tract is reduced, prokinetic drugs are indicated - for example, Domperidone 10 mg up to four times a day orally, or Metoclopramide 10 mg 3-4 times a day.

Physiotherapy treatment

Warm non-carbonated mineral waters of medium mineralization with calcium and magnesium hydrogen carbonates are indicated. Waters are consumed in small volumes, 50-100 ml two to three times a day, between meals. Duration of intake - 3 weeks.

Widespread use of mineral baths - carbon dioxide, radon, coniferous, sodium chloride. Baths are taken for 10 minutes daily for 10 days.

UHF therapy, inductothermia are prescribed with caution. Procedures are performed every other day, their duration is up to 10 minutes.

Ultrasound is also used, affecting the projection zone of the pancreas. Intensity - 0.4-0.6 W/cm, duration - 5 minutes. The course of treatment consists of 8-10 sessions, which are carried out every other day.

To activate secretory activity, DMV with 40 W power, 10 minutes each, is indicated. The course consists of 8-10 procedures.

Electrophoresis of novocaine, magnesium sulfate, zinc is prescribed

Contraindications to physical procedures: acute stage of the inflammatory process, impaired patency of pancreatic ducts.

Herbal treatment

In reactive pancreatitis, the doctor prescribes appropriate drug therapy and adjusts the diet. In addition, the treatment scheme can include phytotherapy - of course, after prior consultation with a specialist.

The following folk methods may be helpful:

• Freshly squeezed potato juice is taken in the morning on an empty stomach (50 ml is enough). The juice must be fresh, it must not be stored.
• Chopped dill is poured boiling water, insist under a lid for an hour, filter and drink a little at a time during the day.
• A spoonful of cumin seeds poured boiling water, insist in a thermos for two hours, filtered and take 100 ml three times a day before meals.

Medicinal herbal collections such as:

• Grind and mix 1 part of nettle leaves, 1 part of St. John's wort and the same amount of horsetail with two parts of rosehip fruit. Take two spoons of the resulting mixture, pour 0.5 liters of boiling water, kept under cover for an hour, then filtered. Infusion drink 100 ml before each meal.
• Grind equal amounts of crushed burdock and elecampane roots, add equal amounts of sage leaves, wormwood, St. John's wort, chamomile, calendula, witch hazel and succession. Take 2 tbsp. Of the resulting mixture, pour 0.4 ml of boiling water. Infuse under a lid for an hour, strain, drink 100 ml half an hour before meals.
• Grind and mix equal amounts of anise, bird's throat, celandine, corn stigmas, dandelion rhizome. One tablespoon of the resulting mixture is poured 250 ml of boiling water, insist for half an hour, filter and drink 30 minutes before meals. It is recommended to drink about 500 ml of this infusion daily.

It should be remembered that phytotherapy is not intended for self-treatment. Any of the methods should be coordinated in advance with the attending physician.

Diet for reactive pancreatitis

Nutritional intervention helps prevent malnutrition and is key to reducing inflammation, complications and mortality in acute pancreatitis. Evidence supports the benefits of early enteral nutrition in severe pancreatitis. [17]

Reactive pancreatitis is an indication for a mandatory change in diet and eating habits. So-called "fractional" meals (relatively frequent and small meals), five or six times a day, are established. It is desirable to eat at approximately the same time, which will help to establish enzyme activity faster. During the period of acute symptoms it is necessary to exclude the use of salt.

Such products also fall under the ban:

• animal fats (fatty meat - lamb and pork, goose or duck meat, lard, any by-products, as well as dishes containing them);
• fried and high-calorie foods;
• raw fruits and vegetables;
• nuts, seeds;
• sweets, pastries, fresh baked goods;
• pearl and corn groats, barley and wheat groats;
• sorrel, bell peppers, rhubarb, horseradish;
• carbonated beverages;
• mushrooms;
• any legumes (peas, beans, mung beans, chickpeas, lentils);
• white and red cabbage, radishes, garlic, tomatoes;
• cocoa, coffee, strong tea, chocolate;
• strong broths, cold cuts, canned goods;
• alcoholic beverages.

Authorized for consumption:

• light vegetable soups, vermicelli;
• dried bread, breadcrumbs, cookies, crackers;
• buckwheat and oat groats, semolina and rice groats;
• boiled fruits and vegetables;
• herbal teas, rosehip decoction;
• some white meat or sea fish.

Diet should not be ignored. It is as important as drug therapy. Thanks to dietary correction, in almost all cases it is possible to avoid further aggravation and recurrence of reactive pancreatitis, quickly eliminate the whole range of symptoms of pathology (abdominal pain, nausea, etc.).

The dietary pattern should look like this: a minimum of fats (a small amount of vegetable oil is allowed) and a maximum of easily digestible proteins. Preference should be given to steamed and boiled dishes, grated, without salt and spices. The optimal option is soups, liquid porridge, mashed potatoes. In addition, it is important to control the freshness and quality of the products used - in particular, milk, cottage cheese, meat and fish.

Avoid both overeating and a pronounced feeling of hunger. However, many experts advise the first 24-48 hours from the moment of manifestation of reactive pancreatitis do not eat at all to relieve the pancreas. During this time it is recommended to drink herbal teas, rosehip decoction, light (highly diluted) vegetable broths.

Of course, rigorous dietary changes require a high level of self-control. However, they are necessary to stop the disease and avoid the development of complications, which in most cases are already irreversible. [18], [19], [20]

Prevention

Prevention of reactive pancreatitis consists in the exclusion of provoking factors that can cause the development of the disease. Patients who already have chronic and autoimmune pathologies, it is important to regularly see a doctor, monitor the function of the entire digestive system and, in particular, the pancreas.

People at risk of developing pancreatitis should undergo systematic examinations by a gastroenterologist, even if there are no complaints and symptoms.

Alcohol abuse is considered to be the most common and proven cause of reactive pancreatitis. Therefore, it is necessary to give up or severely limit the intake of alcohol. Some experts also point out that both the quantity of drinks consumed and the duration of their intake matter. The type of alcohol does not play a determining role - that is, the function of the pancreas is impaired by vodka, wine and beer.

Smoking, especially malicious, or combined with the use of alcoholic beverages, also contributes to the development of various pancreatic disorders. Smoking cessation is one of the important conditions for the prevention of such diseases.

Other preventive measures include:

• timely referral to doctors for treatment of biliary system pathologies, adequate therapy (if necessary - surgical intervention), with further observation by a gastroenterologist;
• following healthy eating recommendations, adding enough vegetables, fruits, greens, whole grain products to the daily diet, avoiding overeating and controlling weight;
• avoiding self-medication, consulting with doctors about the appropriateness of prolonged medication;
• periodic checks of the state of the pancreas in persons suffering from metabolic disorders, or have a hereditary predisposition to pathologies of the digestive tract;
• Prophylactic diagnosis in patients suffering from autoimmune diseases (e.g. Primary sclerosing cholangitis, gastroenterocolitis, etc.).

The success of preventive measures depends largely on the timeliness of seeking medical help. It is recommended to consult gastroenterologists as soon as possible in case of the following symptoms:

• abdominal pain, bloating;
• nausea, a feeling of discomfort and heaviness in the stomach;
• alternating between constipation and diarrhea;
• drastic weight loss;
• An unpleasant taste in the mouth that is not related to dental problems;
• the appearance of foreign impurities in the feces.

Prevention also consists in feasible (not excessive) physical activity. It is necessary to develop stress resistance, for which it is recommended to use yoga practices, meditation, use the services of a psychologist, rest more often (including active rest). [21]

Forecast

Reactive pancreatitis usually responds well to treatment. The main condition is the timely elimination of provoking factors or the primary disease, one of which may be cholelithiasis. In such cases, after the elimination of acute signs of reactive pancreatitis to avoid recurrences, the doctor may refer the patient for surgery - cholecystectomy, to remove stones.

To avoid the reoccurrence of the pathological process, the patient is recommended to adjust the lifestyle, stop smoking and drinking alcoholic beverages. It is important to eat properly, do not overeat, do not abuse salt, smoked and fatty foods, drink enough clean water, regularly examine and take tests to assess the state of the digestive system.

If you carefully follow all the recommendations of specialists, then after reactive pancreatitis you can recover quickly enough. At the same time, doctors remind that after treatment is completed, it is necessary for some time to adhere to a gentle diet, refuse to drink alcohol and smoking.

Reactive pancreatitis and the army.

Pancreatitis that runs in a severe form, with frequent exacerbations and lack of periods of stable remission, with a clear impairment of pancreatic function and failure of secretory and secretory activity, can be a limitation to military service. As for reactive pancreatitis, it is different: this disorder is not accompanied by exacerbations, is successfully treated, and is usually not an obstacle to military service.

Medical specialists necessarily take into account the peculiarities of the course of the disease and the frequency of exacerbations when determining the category of eligibility. Therefore, when visiting the military recruitment center, you should take with you all the supporting medical documentation indicating the regularity of visits to doctors, stay in hospital treatment. If the conscript was treated independently and does not have such documents, he will be called up for military service without any restrictions. In some cases, reactive pancreatitis existing at the time of conscription can be a reason for deferment.

Literature used

1. "Pancreatitis: Medical and Surgical Management" - David B. Adams, Peter A. Banks (2010).
2. "Acute Pancreatitis" - Vikesh K. Singh (2019).
3. "Chronic Pancreatitis: Research and Clinical Management" - Vikesh K. Singh, Jonathan E. Clain (2017).
4. "Pancreatitis and Its Complications" - Chris E. Forsmark (2018).
5. "Handbook of Pancreatitis" - Suresh T. Chari, George P. Aithal (2019).
6. "Acute Pancreatitis: New Insights for the Healthcare Professional" - Q. Ashton Acton (2012).