Peculiarities and new prospects of management of patients with NSAID-gastropathy on the background of chronic pancreatitis in general-therapy practice
Authors: Babinets L. S. , Halabitska I. M. 
Published: July 2020

Introduction. The main pharmacological effects of NSAIDs are anti-inflammatory, the onset and conduction of a pain signal, the aggregation of blood elements, neoangiogenesis, cell apoptosis, etc. — make them indispensable in the treatment of inflammatory and degenerative diseases of the joints and spine, in particular osteoarthritis. NSAIDs account for 25% of all medical complications, including bleeding rates (25–40%), which is a serious medical and important socio-economic problem. The risk of developing NSAIDs-gastropathy is determined both by severity of COX-2 inhibitory effect and non-prostaglandin systemic and local effects. Use of proton pump inhibitors, histamine blockers (mainly children and adolescents), and synthetic analogues of prostaglandins, as well as drugs of cytoprotective action, is pathogenetically justified in the treatment of NSAIDs-gastropathy. One of the newest and most economically available, most metabolically high-technological is the vitamin drug Doctovit.

Aim: to study the effectiveness of Doctovit in the complex therapy of patients with NSAIDs-gastropathy on the background of chronic pancreatitis by analyzing the morphological parameters, indices of antioxidant protection system and endotoxicosis system.

Materials and methods. 42 patients with NSAID-gastropathy on the background of chronic pancreatitis were examined. Patients, comparable by clinical, gender criteria, severity of NSAID-gastropathy and treatment received — were divided into two groups: I control group (20 patients), 10-day treatment regimen: PPI pantoprazole (Controlok, Nolpase, Pantasan, etc.) 40 mg×2; cancellation of NSAIDs; II main group (22 patients), 10-day treatment regimen: PPI pantoprazole (Controlok, Nolpase, Pantasan, etc.) 40 mg×2; cancellation of NSAIDs; Doctovit 2 tablets per day after meals for 2 months. Compulsory components of medical complexes were outpatient regimen and normotrophic nutrition. All patients with NSAID-gastropathy underwent standardized clinical laboratory examination. At the beginning of the study and two months after the start of treatment EGDS + biopsy from 5 places with histological examination was performed. The level of endotoxicosis was defined by the level of sorption capacity of erythrocytes, which was determined according to A. A. Togaibayev technique. The state of lipid peroxidation was evaluated by the level of malonic aldehyde, the state of antioxidant protection system — by the levels of superoxide dismutase, catalase, SH-groups.

Results and discussion. Morphological examination of gastric EGD biopsy specimens before and after treatment in the comparison groups showed statistically significant efficacy of the proposed treatment complex with the inclusion of Doctovit in influencing the established pathological features of NSAID-gastropathy. There was a statistically significant improvement in endotoxicosis in both study groups after treatment, but in the II group the positive effect was statistically more significant. The proposed correction programs had a positive effect on the lipid peroxidation, but the correction program used in II group had a statistically significantly better effect.

Conclusion. In the complex treatment of NSAID-gastropathy on the background of chronic pancreatitis, it is advisable to use the vitamin complex Doctovit 2 tablets per day after meals for 2 months, which has a positive effect on the condition of the gastric mucosa, indices of lipid peroxidation and endotoxicosis.