Some aspects of the development and correction of secondary exocrine insufficiency of the pancreas in children
Abstract
Based on the analysis of literature sources, the main causes and mechanisms of the secondary exocrine pancreatic insufficiency in children are highlighted. The main mechanisms of regulation and peculiarities of functional activity of the pancreas in children are discussed. The importance of pancreatic enzymes for physiological digestion of food nutrients as well as for ensuring satisfactory nutritional status of a child is noted. It is shown that the main reason for the development of secondary exocrine insufficiency of the pancreas in children is a violation of the pancreatic enzymes activity in the duodenum. Factors that adversely affect the effectiveness of pancreatic enzymes by disrupting their activation or inactivation in the duodenum have been listed. They include: 1) motility disorders of the gastrointestinal tract; 2) bile acid deficiency; 3) violation of entero-pancreatic regulation of the pancreas; 4) hyperacidic conditions of the stomach and duodenum; 5) intestinal dysbacteriosis; 6) violation of the outflow of pancreatic juice into the duodenum. The mechanisms of negative influence of these factors on the activity of pancreatic enzymes are also revealed. It is noted that the increase in the prevalence of secondary exocrine pancreatic insufficiency is due to the peculiarities of diseases of the digestive system, namely, the combined nature of the lesions of different parts of the gastrointestinal tract. The effective properties of the mini-tablet enzyme preparation, as well as indications for its use are analyzed; the dosage of enzyme preparations for children in accordance with domestic and foreign recommendations was discussed. The list of pathological conditions in which it is advisable to use enzyme preparations, as well as the requirements that must be met when using enzyme preparations to achieve maximum effectiveness during enzyme replacement therapy.
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