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Recently, in medicine, the influence of infectious, hepatobiliary, gastric and duodenogenic factors for the formation and course of chronic pancreatitis (CP) and chronic hepatitis C virus (CHCV) which was treated etiotropically is increasingly being studied. Hepatitis C virus (HCV) is an important infectious factor in CP, for which the ability to chronic course has been proven. The condition of the mucous membrane of the organs in the gastroduodenal zone (GDZ) in the combined course of CP and HCV is important for the patient's quality of life, as well as for assessing the safety of the performed and planned restorative complex treatment of such patients. The objective: to analyze the dynamics of morphological changes of the mucous membrane in the gastrointestinal tract of patients with CP in comorbidity with etiotropically treated HCV under the influence of a protocol therapeutic complex with the additional inclusion of hepatotrophic drugs. Materials and methods. We analyzed the data of 55 patients with CP in comorbidity with HCV after etiotropic treatment of HCV, who were examined according to generally accepted algorithms and received a generally accepted complex of treatment according to the CP protocol. The patients were divided into two groups: the 1st group - 20 patients who received a generally accepted complex of treatment according to the protocol (PC) for 3 months; the 2nd group - 35 patients who received treatment according to the PC with the additional inclusion of a hepatotrophic agent for 3 months. In all the patients before and after treatment a morphological study of biopsies of the mucous membrane of the stomach and duodenum was performed. Results. In the course of the study, a significant improvement in the mucous membrane morphology of the GDZ of patients with a combination of CP and HCV was established after a course of treatment with the use of hepatoprotectors, namely: a decrease in lymphohistiocytic infiltration - by 3.97 times, restoration of the gland structure that did not undergo complete non-metaplastic atrophy - by 5,13 times, increased proliferation of the glandular epithelium as a sign of morphological restoration of the epithelium - 3.9 times, decrease in signs of epithelial dysplasia - 10.35 times, decrease in the number of erosions of the mucous membrane of the organs of the gastrointestinal tract - 2.6 times. Conclusions. The higher efficiency and safety of the complex treatment with the additional inclusion of a combination of hepatotrophic agents on the morphological condition of the mucous membrane of the organs of the gastroduodenal zone have been substantiated. [ABSTRACT FROM AUTHOR]

Background. Viral hepatitis C (HCV) is not only as a liver disease but also as a systemic (generalized) infection that affects other organs, in particular, the pancreas and gastroduodenal zone. The state of the gastrointestinal mucosa in combined course of chronic pancreatitis (CP) and chronic HCV is little studied, but extremely relevant, as it is important for the clinical course, the quality of life of patients, as well as for assessing the safety of the performed (etiotropic, etc.) and planned restorative comprehensive treatment of such patients. The purpose is to evaluate the morphological changes of the gastroduodenal mucosa of patients with chronic pancreatitis associated with chronic viral hepatitis C who were treated etiotropically. Materials and methods. Thirty patients with CP and 65 patients with CP in comorbidity with chronic HCV after etiotropic treatment of HCV were examined. Regardless of the HCV genotype, they received a course of treatment with sofosbuvir at a dose of 400 mg and velpatasvir 100 mg in the morning after meals for 3 months (some patients took daclatasvir at a dose of 60 mg also in the morning after meals for 3 months instead of velpatasvir). The period after diagnosed and treated HCV before the examination was on average (2.35 ± 0.61) years. All patients underwent a morphological study of gastric and duodenal biopsy samples obtained by esophagogastroscopy. The prepared samples were evaluated according to the international OLGA and OLGIM systems based on the evaluation of 5 gastric biopsies (1 from the corner of the stomach, 2 from the body, and 2 from the antrum) with a description of the main pathomorphological changes evaluated on a visual analog scale. Alcian yellow and toluidine blue were used to detect H.pylori. An own system for assessing the morphological state of the gastroduodenal mucosa was also proposed. Results. The detected structural changes indicate the presence of chronic atrophic gastritis with moderate dysplasia of the glandular epithelium. Stage of chronic gastritis according to the OLGA system was III. Stage of chronic gastritis according to the OLGIM system was III. Thus, the practically asymptomatic course of quite significant gastroduodenal changes in CP combined with chronic HCV requires additional therapeutic influence, as well as an assessment of comprehensive treatment based on the effect on the gastroduodenal mucosa. In case of changes in gastroduodenal mucosa in CP on the background of chronic HCV, in contrast to those with isolated CP, a significantly higher level of inflammatory infiltrate density (moderate (2+) vs. mild (1+)) is determined, which is accompanied by moderate neutrophilic infiltration (2+) vs. mild (1+) and mild lymphohistiocytic infiltration (1+) versus no such infiltration (0), the appearance of intestinal metaplasia (2+) and moderate non-metaplastic glandular atrophy (2+) versus the absence of metaplasia (0) and mild non-metaplastic glandular atrophy (1+), as well as zones of metaplastic atrophy (1+), which was manifested by the appearance of Paneth cells and goblet cells. In CP with chronic HCV, mucosa has atrophic changes. Metaplasia is manifested by a change in cellular phenotype: complete intestinal metaplasia type I–II is manifested by the appearance of Paneth cells and goblet cells; incomplete — by the presence of columnar epithelium and goblet cells; colonic metaplasia — by enlargement of the glands and the absence of Paneth cells. Conclusions. It was proved that the state of the gastric and duodenal mucosa in the group of patients with CP and chronic HCV was significantly severe than that in isolated CP: lymphohistiocytic infiltration of the mucous membrane was detected 2.68 times more often, non-metaplastic infiltration glandular atrophy (there was practically no glandular atrophy in the group of isolated CP) — 12.65 times more often, metaplastic atrophy (it was not detected in the group of CP) — 10.64 times more often, acute leukocyte infiltration — 2.31 times more often, dysplasia of the mucosal epithelium (with isolated CP, mild dysplasia was detected) — 7.30 times more often, erosion of the mucosal epithelium — 3.07 times more often, focal hyperplasia of the glands — 3.88 times more often, intestinal metaplasia — 12.89 times more often, which was practically absent in CP. In general, the total number of pathological signs of the mucous membrane in the group of CP with comorbid chronic HCV was found to be 2.76 times higher than that in isolated CP. [ABSTRACT FROM AUTHOR]

Background. It was found that in 35–56 % of patients, hepatobiliary diseases are considered to be a factor causing the formation or exacerbation of chronic pancreatitis (CP) while reducing the share of pancreatitis of alcoholic etiology, as it was previously believed. However, the role of the alcohol factor and its consideration in the treatment strategy for CP and comorbidity with chronic viral hepatitis C (HCV) also needs to be clarified, because it is known that excessive alcohol consumption and smoking increases the risk of developing pancreatitis by 8–17 times. The purpose is to conduct a comparative analysis of parameters of the structural and functional state of the liver and pancreas in patients with chronic pancreatitis associated with chronic viral hepatitis C treated etiotropically, depending on the results of testing according to the international CAGE questionnaire. Materials and methods. We have examined 100 ambulatory patients with CP and concomitant HCV, treated etiotropically. All patients were examined according to generally accepted algorithms. To clarify the effect of alcohol on the formation of CP and the state of patients with treated HCV, latent craving for alcohol was verified using the international CAGE questionnaire. The study on the density of the liver parenchyma and the pancreas was carried out not only according to the ultrasound data in the B-mode, but also with the simultaneous shear wave elastography on the Ultima PA scanning ultrasound device with the further measurement of the median of the parameters in kilopascals. Determination of the presence and depth of exocrine pancreatic insufficiency was carried out by the content of fecal elastase-1 evaluated using the enzyme immunoassay method. Results. Screening-testing of patients with CP on the background of HCV treated etiotropically using the CAGE scale made it possible to state that 65.0 % of them had a latent craving for alcohol, and 21.0 % of this cohort were women, which needs to be taken into account in the management of such patients. It has been proven that in the group with CAGE ≥ 2.0, functional and structural changes in the liver and pancreas were significantly more severe (deepening of the exocrine pancreatic insufficiency with a decrease in fecal α-elastase by 13.01 %, an increase in the total index of the coprogram by 15.11 % and the total ultrasound indicator of the pancreatic structure by 28.06 %, and the total ultrasound indicator of the liver structure by 40.68 % (р < 0.05)) and corresponded to the average degree of severity of the process in the pancreas according to the criteria of the Marseille-Cambridge classification, and in the group with CAGE < 2.0 — only to a mild degree. Conclusions. The negative effect of the factor of increased alcohol use according to the CAGE was proven by increased density of pancreatic echotexture by 5.73 % (p < 0.05), and of the hepatic echotexture by 5.16 % (p < 0.05). According to the results of the correlation analysis on the dependence of the structural state of the liver and pancreas on the CAGE score, which were R = 0.713, p < 0.05, and R = 0.686, p < 0.05, respectively, there was found a strong direct dependence of the structural state of the liver and pancreas on the CAGE score, which proved an independent, reliably significant role of alcohol consumption for patients with a comorbid course of CP and HCV. [ABSTRACT FROM AUTHOR]