A new diagnostic predictor for prophylaxis of the development of severe complications of acute pancreatitis

Abstract

Introduction. Acute pancreatitis is one of the most pressing problems of modern medicine due to the development of severe complications that cause mortality in the range of 40 - 70%. The most common causes of death in patients with acute pancreatitis are purulent-septic complications, which in turn cause the development of sepsis, erosive bleeding, pancreatic and gastrointestinal fistulas, mechanical jaundice, etc. At late diagnosis of these complications mortality reaches more than 85% owing to multiorgan insufficiency. There are many rating scales for the severity of acute pancreatitis, but known screening methods are ineffective. Thus, the issue of timely diagnosis of purulent-septic complications of acute pancreatitis, as a method of preventing the development of multiple organ failure, remains relevant today. Objective. Study of the role of Helicobacter pylori (HP) as an etiological factor of acute pancreatitis and a marker of the development of its purulent-septic complications. Маterials and methods. The study involved 124 patients who were divided into the main group (66 patients with moderate severity and severe course) and the comparison group (58 patients with mild course). There were 71 men (57,3%), women - 53 (42,7%). All patients underwent a screening study of HP in feces and a serological blood test to detect antibodies, namely immunoglobulin M to HP (determination of the phase of the disease - acute or chronic). Results. The fecal rapid test was positive in 84,7% of patients. During serological examination, a positive result was obtained: 24 hours after hospitalization - in 13,8% of patients in the comparison group, in 34,8% of patients in the main group; after 7 days - in 15,5% of patients and 63,3% of patients, respectively. HP is sensitive to most of the antibiotics used to treat purulent-septic complications of acute pancreatitis. After completing the course of antibiotic therapy, patients underwent a second study of HP (eradication was achieved in 37 (94,9%) patients). Conclusion. An increase in the number of positive results of serological examination by 28,5% (P <0.001) in patients of the main group 7 days after hospitalization proves that HP is not only one of the etiological factors of acute pancreatitis, but also a possible marker of the development of its purulent-septic complications. The use of this marker makes it possible to quickly, objectively and timely predict the occurrence of purulent-septic complications of acute pancreatitis and prevent the development of multiple organ failure, and thus reduce mortality in this pathology.