Author/Editor		Dajčman, Davorin
Title		Vloga dodajanja pankreasnih encimov pri bolnikih po resekciji želodca
Translated title		The role of adding pancreatic enzymes after gastric resections
Type		članek
Source		In: Potrč S, Hazabent M, Gajzer B, editors. 2. Mariborski onkološki dan: simpozij z mednarodno udeležbo na temo Maligna obolenja želodca; 2009 nov 27; Maribor. Maribor: Oddelek za abdominalno in splošno kirurgijo, Kirurška klinika UKC,
Publication year		2009
Volume		str. 181-7
Language		slo
Abstract		This review article addresses the problems resulting from disturbances in exocrine pancreatic function and adaptation following partial or total gastrectomy, the ability to diagnose them and some options for their treatment. Patients who have had gastric or pancreatic surgery frequently develop a maldigestion syndrome which significantly affects their quality of life and their professional and social rehabilitation. One major cause of maldigestion in these patients is exocrine pancreatic insufficiency, with a synchrony of gastrointestinal hormone release. The principal associated symptoms are steatorrhea, meteorism and weight loss. If maldigestion occurs, the exocrine pancreatic function should be measured by indirect or direct pancreatic function tests, and, if necessary, pancreatic enzyme treatment can be initiated. Pancreatic enzyme substitution, used in combination with a high-energy diet and distributed over 6-8 meals per day, may improve the postoperative nutritional status and the often non-specific symptoms in these patients, although randomized cross-over studies with larger patient populations proving a benefit of enzyme substitution are still missing and there is evidence that many patients with maldigestion and exocrine pancreaticinsufficiency after gastrectomy do not respond adequately to pancreatic enzyme substitution. The required dose of the pancreatic enzyme must be individually adjusted in order to prevent underestimation or overestimation, and it must be kept in mind that there exists no linear relationship between the dose of the pancreatic enzyme and the symptoms of maldigestion. Restriction of the daily amount of fat ingested, or addition of intestinal motility inhibitors and gastric acid blockers in patients with partial gastrectomy might improve the efficiency of pancreatic enzyme substitution in these patients.
Summary		V prispevku avtor predstavi posledice v delovanju trebušne slinavke nastale kot posledica delne ali popolne kirurške odstranitve želodca, njeno sposobnost prilagoditve novim razmeram, možnosti odkrivanja motenj v delovanju in nekaj priporočil zdravljenja. Pri večini bolnikov, ki so bili operirani na želodcu ali trebušni slinavki, se sčasoma pojavi sindrom podhranjenosti, kar močno vpliva na njihovo telesno pripravljenost, zmožnost za delo in možnost rehabilitacije. Eden pomembnejših vzrokov slabše prehranjenosti teh bolnikov je popuščanje delovanja eksokrinega dela trebušne slinavke in porušenega ravnovesja med sproščanjem prebavnih hormonov. Pojavijo se prekomerna količina maščob v blatu, obilno sproščanje prebavnih plinov in izguba telesne teže. Ob pojavu naštetih težav je potrebno oceniti delovanje eksokrinega dela trebušne slinavke, z direktnimi ali indirektnimi testi, ter v slučaju oslabljenega delovanja organa bolniku nadomeščati encime. Nadomeščanje encimov običajno le dopolnjuje sicer energijsko bogato hrano, razdeljeno na 6-8 dnevnih obrokov. Kljub temu, da nekatere večje študije niso dokazale občutnega izboljšanja pri bolniki v zgodnjem pooperativnem obdobju po odstranitvi želodca, pa obstajajo tudi izsledki, na podlagi katerih lahko pričakujemo predvsem hitro izboljšanje prehranjenosti takšnih bolnikov. Odmerek nadomeščenih encimov se prilagodi vsakemu bolniku posebej, pri čemer pa je treba upoštevati, da odmerek in izboljšanje stanja prehranjenosti nista v linearni povezavi. Učinek zdravljenja izboljša zmanjšanje vnosa maščob s hrano, zaviralci sproščanja želodčne kisine in blažilci peristaltičnih valov.
Descriptors		STOMACH NEOPLASMS GASTRECTOMY