gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1732Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГОВ, ГЕПАТОЛОГОВNATIONAL COLLEGE OF GASTROENTEROLOGISTS, HEPATOLOGISTSВнешнесекреторная недостаточность поджелудочной железы при сахарном диабетеExocrine pancreatic insufficiency at diabetes mellitusГубергрицН. Б.GubergritsN. B.ФоменкоП. Г.FomenkoP. G.КолкинаВ. Я.KolkinaV. Ya.2009051020091956167Copyright © Губергриц Н.Б., Фоменко П.Г., Колкина В.Я., 20092009Губергриц Н.Б., Фоменко П.Г., Колкина В.Я.Gubergrits N.B., Fomenko P.G., Kolkina V.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1732

Цель обзора. Дать характеристику внешнесекреторной недостаточности поджелудочной железы (ПЖ) при сахарном диабете (СД).Основные положения. Внешнесекреторная функция поджелудочной железы снижена у 40–80% больных инсулинзависимым и у 15–73% больных сахарным диабетом 2-­го типа. Экзокринная панкреатическая недостаточность чаще бывает легкой или умеренной, тяжелая степень со стеатореей развивается редко. Механизм снижения внешней секреции ПЖ при СД связан с дисбалансом ингибирующих и стимулирующих панкреатическую секрецию гормонов, с фиброзом железы в результате диабетической ангиопатии, а также с иммунными расстройствами, автономной невропатией, нарушением продукции гастроинтестинальных регуляторных медиаторов (мотилина, панкреатического полипептида и др.), ингибирующим влиянием на внешнюю секрецию ПЖ диабетического ацидоза. При СД 2-­го типа в патогенезе внешнесекреторной панкреатической недостаточности принимают участие механизмы, являющиеся следствием метаболического синдрома.Клинические проявления со стороны органов пищеварения при сахарном диабете обусловлены как диабетической гастро-­, энтеро­-, колопатией, так и внешнесекреторной недостаточностью поджелудочной железы. В лечении основное значение имеют адекватная заместительная ферментная терапия и коррекция гипергликемии.Заключение. Внешнесекреторная недостаточность ПЖ играет большую роль в развитии болевого синдрома, диспепсии, нарушений стула у больных СД.

The aim of review

The aim of review. To give the characteristic of exocrine pancreatic insufficiency in diabetes mellitus (DM).

Original positions

Original positions. Exocrine function of the pancreas is reduced in 40–80% of patients with insulindependent and in 15–73% of patients with 2nd type diabetes mellitus. Exocrine pancreatic insufficiency is more frequently of mild or moderate degree, severe insufficiency with development of steatorrhea occurs rarely. Mechanism of decrease of exocrine pancreatic secretion at DM is related to disbalance of hormones inhibiting and stimulating pancreatic secretion, fibrosis of the gland as a result of diabetic angiopathy as well as immune disorders, autonomous neuropathy, disorders of production of gastrointestinal regulatory mediators (motilin, pancreatic polypeptide, etc.), inhibiting effect of diabetic acidosis on exocrine secretion of pancreas. At DM of the 2nd type mechanisms, secondary to metabolic syndrome are involved in pathogenesis of exocrine pancreatic failure. Clinical manifestations related to digestive organs in diabetes mellitus are caused by diabetic gastro-, entero-, colopathy, as well as by exocrine pancreatic insufficiency. In the treatment adequate enzyme supplementation therapy and treatment of hyperglycemia play major role.

Conclusion

Conclusion. Exocrine pancreatic insufficiency plays major role in development of pain syndrome, dyspepsia, disorders of stool at patients of DM.

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The authors declare that there are no conflicts of interest present.