Współwystępująca glistnica jako czynnik pogorszenia jakości życia u chorych z przewlekłym zapaleniem trzustki

Liliya S. Babinets, Yuliya V. Dronyak, Nataliia A. Меlnyk

State higher education institution “Ternopil State Medical University by I. Horbachevsky of Ministry of Health of Ukraine”, Ternopil, Ukraine

 

ABSTRACT

Inroduction: The urgency of the problem of chronic pancreatitis is increasing due to the fact that in 70.0% – 90.0% of cases of diseases of the digestive system are accompanied by pathology of other organs and systems, also including helminthiasis, especially ascariasis.

The aim: to study and compare the quality of life of patients with chronic pancreatitis in regarding to patients with comorbidity of chronic pancreatitis and ascariasis.

Materials and methods: the study included 53 patients with chronic pancreatitis with ascariasis and 30 patients with isolated chronic pancreatitis. The quality of life of all patients were evaluated by using a common medical questionnaire – the Medical Outcomes Study 36-Item, and a specialized gastroenterological questionnaire the Gastrointestinal Symptom Rating Scale.

Results: during the study, in patients with comorbidity of chronic pancreatitis with ascariasis a lower quality of life was established. The quality of life in patients with chronic pancreatitis and ascariasis was significantly reduced by both the general questionnaire SF-36 and the specific questionnaire GSRS in comparison with patients with isolated chronic pancreatitis.

Conclusions: patients with chronic pancreatitis concomitant with ascariasis had a significantly lower level of quality of life scores on all scales as by a questionnaire Medical Outcomes Study 36-Item and by gastroenterological questionnaire the Gastrointestinal Symptom Rating Scale in regarding to the group of patients with chronic pancreatitis.

 

Wiad Lek 2018, 71, 7, -1253

 

INTRODUCTION

Chronic pancreatitis (CP) is a fairly common disease of the digestive system, which often leads to permanent or temporary loss of ability to work, indicating its not only medical but also social importance. CP is one of the most complex polyethiological diseases in the clinic of internal diseases [1]. Over the past 10 years, the incidence of CP in the population of young people has increased almost 4 times, and the average age since the diagnosis decreased from 50 to 39 years. It have increased the part of women among the patients with CP for 30 % [2, 3]. The wide spread of CP among the working population and the constantly progressing course with steady increase in functional pancreatic insufficiency and the development of trophological insufficiency, pain syndrome that is difficult to cure, necessity for constant compliance with the diet, often lifelong enzyme therapy, makes the CP one of the most important socio-economic problems of modern medicine [4, 5].

The urgency of the problem of СР is increasing due to the fact that in 70.0% – 90.0% of cases of diseases of the digestive system are accompanied by pathology of other organs and systems, also including helminthiasis. Ascariasis is one of the most common helminthiasis in the world and is second only to parasitic invasions after enterobiasis. Annually, about 65,000 patients are registered ascariasis. The source of the invasion of Ascaris lumbricoides is a sick person [6, 7]. Conditions for the spread of A in the cities are minimal, but the proportion of townspeople among registered patients is 2/3. This situation is associated with massive contamination of urban residents with unwashed products purchased at markets and in stores [8, 9].

In recent years, studying the quality of life (QL) around the world is one of the topical issues in medicine. The concept of «quality of life» is the basis of a new paradigm of understanding the disease and determining the effectiveness of treatment methods. In accordance with the new concept of clinical medicine, the QL of a patient is either a primary or ancillary or sole purpose of treatment. Assessment of QL is especially important in chronic diseases requiring long-term treatment [10]. Increasing attention is paid to the study of the combination of gastroenterological diseases with helminthiasis [11]. The high medical and social significance of both CP and ascariasis is determined by their significant contribution to the pathology of people of social active age, high costs of diagnosis and treatment, decreased QL and disability. That is why the study of QL in patients with comorbid course of CP and ascariasis is relevant [12, 13].

THE AIM

To study and compare the quality of life of patients with сhronic pancreatitis in regarding to patients with comorbidity of сhronic pancreatitis and ascariasis.

MATERIALS AND METHODS

To achieve this goal, 83 patients were screened for СP. The patients were divided into two groups: I group included 53 patients with CP in combination with ascariasis; IІ group included 30 patients with CP. They were comparable to the etiological factor, socio-economic conditions and nutrition. Also, the influence of the alcohol factor was excluded. Among patients, there were 43 (51.8 %) male age (48.9±7.6) years and 40 female (48.2 %) age (51.51±6.4) years. The average duration of CP was (13.4±5.3) years. Patient examination was carried out with their consent. The study did not include patients with moderate to severe diabetes mellitus requiring insulin, severe arterial hypertension, cancer and somatic illness in the stage of decompensation. The studies meet the requirements of the Helsinki Declaration of the World Medical Association «Ethical principles for medical research involving human subjects as the object of study» opinion of the Committee on bioethics SHEI «Ternopil State Medical University by I. Horbachevsky of MPH of Ukraine»  24/2017.

The diagnosis of CP was verified on the basis of the generally accepted classification in Ukraine proposed by the Scientific Research Institute of Medical Sciences of Ukraine, which corresponds to the Marseilles-Roman classification according to the «Unified clinical protocol of primary, secondary (specialized) medical care and medical rehabilitation of patients with chronic pancreatitis» approved by Order of the Ministry of Health of Ukraine № 638 dated 10.09.2014.

To evaluate the QL standardized international general and specific questionnaires were used. General questionnaires are used at any pathological condition and allow to compare the QL in various diseases, but do not evaluate the specific aspects of a particular pathology. Specific questionnaires are quite subjective in assessing the impact of concomitant pathology. Therefore, for the reliability of the results, we used simultaneously both specific and non-specific questionnaires.

Patients were evaluated by using a common medical questionnaire – the Medical Outcomes Study 36-Item (Mos SF-36), in which 36 points were grouped into 8 scales. Indicators for each scale range from 0 to 100 points, where 100 points are full health. All scales form two indicators: mental and physical components. The following indicators were quantified:

1) PF (physical functioning) – the scale that evaluates how physical condition restricts physical activity (walking, climbing stairs);

2) RF (role physical) – the influence of physical condition on everyday activities (work, daily duties);

3) BP (body pain) – the scale of pain intensity;

4) GH (general health) – assessment of the patient’s state of health at the moment and the prospects for treatment;

5) VT (vitality) – viability scale;

6) SF (social functioning) – the scale of social functioning;

7) RE (role emotional) – the scale that shows emotional state; the scale provides an opportunity to assess how emotional state have the interfere with the performance of work or other daily activities;

8) MH (mental health) – a scale that characterizes the mood, the presence of depression, anxiety, a general indicator of positive emotions.

The physical component of health reflects on the scale from 1 to 4, and the psychological component – from 5 to 8.

For assess the severity of gastroenterological symptoms and QL, an adapted version of the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire was used. It contains 15 questions that grouped into 5 scales: abdominal pain, reflux syndrome, constipation, diarrhea, dyspepsia. The scale varies from 1 to 7, higher values correspond to more pronounced symptoms and lower QL.

Statistical processing of the received data was performed on a personal computer using standard software packages of Microsoft Excel and with help of the computer program Statistica for Windows version 6.0 (Stat Soft inc., USA).

RESULTS AND DISCUSSION

The evaluation of the results of the study showed that patients with CP+ascariasis compared with CP were statistically significantly lower than the scales that assessed the psychological and physical components of health (p<0.05). According to table 1, the presence of concomitant ascariasis significantly deteriorated QL the patients with CP on all scales reflecting the physical condition of the patient, namely – physical functioning, role physical, the intensity of pain, general health, life activity. Total QL in patients with CP in combination with ascariasis was (39.3±0.9) points, and patients with isolated CP – (58.0±0.8) points, which is by 32.2 % more compared with the group patients with concomitant ascaridosis. Among patients with CP+ascariasis, low rates on the scale of psychological health were noted, indicating that the daily activities of the patient are not limited to the clinical manifestations of ascariasis, but also accompanied by a negative emotional color, a sharp decline in strength and energy, lack of motivation and sufficient physical the potential for doing adequate day-to-day work, due to the presence of two simultaneously diseases. QL at CP+ascariasis is decreased both due to the frequency and severity of symptoms, and due to the negative emotional background they cause, which is confirmed by a low score on the scale (table I). In particular, QL in patients with CP in combination with ascariasis totaled (36.9±0.7) points, and in patients with isolated CP – (59.3±0.6) points. It is by 38.21 % more compared with a group of patients with the presence of ascariasis.

Analyzing the data of the testing of patients with CP+ascariasis by specialized gastroenterological questionnaire GSRS, the leading place in the clinic of the disease is pain, reflux, and dyspeptic syndromes was found (p>0.05). In particular, the scale of pain in patients with concomitant acaridosis was by 37.8 % statistically significantly higher compared with the group of patients and isolated CP, reflux syndrome – by 35.3 %, and the scale of the dyspeptic syndrome – by 25.0 %. The above syndromes syndromes should be considered as the main factor that reduces QL in patients with combined course CP and ascariasis. The increasing of indicators for diarrhea and constipation was less significant in the CP+ascariasis group. Diarrheal syndrome in the group of patients with CP in combination with ascariasis was by 26.9 % statistically significantly higher in comparison with the group of patients with isolated CP. The total score of the GSRS questionnaire (arithmetic mean of the scores of all scales) were (3.6±0.2) points and (2.5±0.1) points in patients with CP+ascariasis and in patients with CP respectively (figure 1).

CONCLUSIONS

Patients with сhronic pancreatitis with concomitant ascariasis had a significantly lower level of quality of life scores on all scales as by non-specific questionnaire SF-36 and by specific for pathology of the gastrointestinal tract of the GSRS questionnaire (total score – (3.67±0.04) points and (2.57±0.03) points, respectively; p<0.05) in regard to the group of patients with сhronic pancreatitis. It has been shown an objective aggravating role of the accompanying ascariasis in the course of the сhronic pancreatitis.

REFERENCES

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6. Babinets L.S., Dronyak Yu.V., Askarydoz i khronichnyi pankreatyt: spilni etiopatohenetychni aspekty, optymizatsiia likuvannia v praktytsi simeinoho likaria. J. Simeina medytsyna. 2014. Vol. 2. 101-104.

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12. Babinets L.S., Nazaruk N.V., Porivnialnyi analiz yakosti zhyttia khvorykh na khronichnyi biliarnyi pankreatyt pislia kholetsystektomii. J. Нastroenterolohiia. 2015. Vol. 4 (58). 79-82.

13. Meier R., Ockeng J., Pertkiewicz M. [et al], ESPEN guidelines on enteral nutrition: pancreas. Clin. Nutr. 2013. 25 (2). 275-284.

The study is a fragment of the planned research work of the Department of Primary health care and general practice – family medicine of the State Higher Educational Institution «Ternopil State Medical University by I. Horbachevsky of Ministry of Healthcare of Ukraine» – «Comorbid conditions in the clinic of internal diseases and family physician practice: predictors of development, early diagnosis, prevention and treatment» (UDC 616.1/4-036-07/-08 state registration number 0106U003338).

Authors’ contributions:

According to the order of the Authorship

Conflict of interest:

The Authors declare no conflict of interest

CORRESPONDING AUTHOR

Nataliia A. Меlnyk

st. S. Bandery, 92/72, 46013, Ternopil, Ukraine

tel: +38(097)185-82-04

e-mail: medicus.nata@gmail.com

Received: 12.06.2018

Accepted: 01.09.2018

Figure 1. Comparative analysis of quality of life on scales of questionnaire GSRS (in points)

Table I. Comparative analysis of quality of life on scales of questionnaire SF-36 (in points)

Scale of questionnaire SF-36

Comparison group

CP

(n=30)

CP+А,

(n=53)

Physical functioning

71,6±0,9

52,8±0,9*

Role physical

44,1±0,9

26,6±0,7*

Body pain

70,0±0,8

43,3±1,0*

General health

46,4±0,7

34,4±0,7*

Vitality

47,4±0,7

25,5±0,7*

Social functioning

73,1±0,9

45,2±1,0*

Role emotional

63,5±0,8

33,2±0,7*

Mental health

54,3±0,7

44,0±0,8*

Note: *the significance of the difference in CP+A regarding to the groups of CP (р<0.05).