Smandych V. Features of the clinical course of chronic pancreatitis combined with obesity and osteoarthritis, factors of mutual aggravation, optimization of treatment

The dissertation deals with the problem of peculiarities of the clinical course and the common parts of pathogenesis, optimization of diagnosis of chronic pancreatitis in obese patients with osteoarthritis on the basis of a complex evaluation and correction of morpho-functional changes in the pancreas, metabolic background of the development and mutual aggravation, resulting in the optimization of the method of their comprehensive treatment. Comprehensive therapy of patients with chronic pancreatitis combined with osteoarthritis and obesity with the addition to the complex therapy of antioxidant (L-glutathione) and a stabilizer of metabolism (L-carnitine) led to a faster achievement of clinical remission of chronic pancreatitis (elimination of clinical syndromes, hyperfermentemia, inflammation, reduction of the pancreas sizes, optimization of its structure with a decrease in the degree of steatosis of the pancreas and increased homogeneity of the parenchyma), osteoarthritis (decrease in the intensity of pain in restless and movement, reducing the time to overcome the distance in a straight line and in the stairs, reducing the circumference of the joints, decreasing the indexes of Leken, WOMAC, CRP), a decrease in the body mass index, normalization of glycemia, optimization of blood lipid spectrum, reduction of insulin and leptin resistance, normalization of oxidant-antioxidant homeostasis, reduction of endotoxemia and inhibition of apoptosis inducers, balancing the process of synthesis and degradation of collagen and glycoproteins, proteinase-inhibitory system with decreased risk of the major and comorbid diseases progression, which gave the opportunity to increase the efficiency of treatment of the main and concomitant diseases.