Interrelation of fibrosis and pancreatic hypoxia in pathogenesis of chronic pancreatitis

A.V. Vorobei, A.Ch. Shuleiko, T.E. Vladimirskaya, I.A. Shved, Y.I. Vizhinis, Y.N. Orlovski, M.Y. Makki

Abstract


Background. The pathogenesis of chronic pancreatitis and pain syndrome had not been fully studied. The aim of the study was to evaluate the interrelation of fibrotic and ischemic changes in the pancreatic parenchyma, and pancreatic duct pressure in the pathogenesis of chronic pancreatitis. Materials and methods. In a prospective study, a morphological, immunohistochemical study of pancreatic preparations was performed, and indicators of tissue oxi­metry and pancreatic duct pressure were studied intraoperatively in 40 patients operated for chronic pancreatitis. Results. The patients with chronic pancreatitis were found to have increased TGF-β1 expression (p < 0.001), increased amount of pancreatic stellate cells (r = 0.32; р < 0.05), decreased glycogen (marker of ischemia) with the progression of fibrotic changes in pancreatic tissue. The intraoperative direct measurement demonstrated high pancreatic duct pressure (34.2 (45.3, 26.6) mmHg), a decrease in oxygenation of pancreatic tissue that correlated with the fibrosis degree. Conclusions. Pancreatic tissue in chronic pancreatitis demonstrated chronic hypoxia associated with fibrosis and increased pancreatic ductal hypertension. So, secondary pancreatic ischemia can be a significant factor in the progression of fibrosis and chronic pain syndrome in chronic pancreatitis.

Keywords


chronic pancreatitis; pancreatic fibrosis; hypoxia of the pancreas; pancreatic ductal hypertension; pancreatic stellate cells

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DOI: https://doi.org/10.22141/1997-2938.2.33.2017.107645

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