Pancreas in the elderly and senile age

Abstract

A rise in the incidence of age-related maladies, which coincides with an increase in life expectancy, is the most significant issue in clinical medicine. These include pancreatic injury, which manifests primarily as progressive exocrine pancreatic insufficiency (EPI). Chronic abdominal ischemic syndrome is the etiological and pathogenetic basis of the syndrome of “aging digestive organs,” including the “aging” pancreas.

Age-related changes in the pancreas include a decrease in the volume of juice and the secretion of pancreatic enzymes due to the progression of fibrosis and atrophy of the pancreas parenchyma caused by the development of chronic ischemia as a result of arterial wall thickening and a decrease in blood flow in the pancreas. Lipoidosis, in which adipose tissue is primarily located around the lobules, and steatosis (fat droplets within the acinar cell) are among the potential causes of the “aging” pancreas.

The pancreas develops cystic dilatation of the ducts as it ages. The diameter of the ducts increases with age not only at the pancreas periphery but also at the head, body, and tail.

General age-related changes, such as atherosclerotic decrease in perfusion, cause specific changes in the pancreas, including a decrease in the volume of functionally active parenchyma, a decrease in the production of enzymes, and a decrease in the volume of secretions, which are manifested by EPI symptoms. EPI and specific age-related changes in the form of a decrease in food intake contribute to maldigestion with a deficiency of fat-soluble vitamins and the development of secondary clinical consequences, such as osteoporosis, which is both age-related and associated with vitamin D deficiency and changes in calcium metabolism.

In the elderly and senile age, patients have both EPI and endocrine insufficiency — diabetes mellitus — since both acinar and islet tissue of the pancreas are affected due to chronic abdominal ischemia.

Clinical manifestations of chronic ischemic pancreatopathy include unstable defecation, diarrhea or constipation, flatulence, malabsorption, decreased tolerance to food load, and weight loss due to decreased pancreatic function. It is important to observe that the pain syndrome is either absent or mildly manifested in these patients.

To treat EPI, a minimum number of medications corresponding to level A of evidence-based medicine must be administered. Mini-microsphere double-coated enzyme preparation Creon^® 10 000, 25 000 FIP (the “gold standard” of replacement therapy) meets these requirements. Creon^® capsules dissolve in the stomach, which enables the Creon minimicrospheres^® to be released from the capsules in the stomach and then freely pass through the pylorus and enter the duodenum, where the coat of the Creon minimicrospheres^® dissolves rapidly and enzymes begin to act, contributing to the hydrolysis of nutrients.