Combination of obesity and malnutrition in a patient with chronic alcoholic pancreatitis (case report)

Eating disorder with its two extreme manifestations — obesity and trophological insufficiency (TI) — is one of the common problems of modern society. TI is often diagnosed in patients with chronic pancreatitis (CP); it occurs due to a limited amount of food intake, malabsorption, diabetes mellitus, and chronic alcoholism. TI severity correlates with severity of malabsorption and depletion of nutrients degree. However, TI verification in patients with CP is difficult due to the lack of uniform diagnostic recommendations. Anthropometric technique, laboratory (determination of the level of lymphocytes, albumin) and instrumental (computed tomography, X-ray absorptiometry, magnetic resonance imaging) diagnostics are usually used. The article presents a case report of combination of such two opposite states as obesity and malnutrition in a patient with CP. The patient was hospitalized with CP exacerbation and alcohol abuse. Examination revealed exocrine pancreatic insufficiency and mild malnutrition. Enzyme replacement therapy and additional oral sip feeding with a positive effect were prescribed. Exocrine pancreatic insufficiency stopped after 10 weeks of treatment, but malnutrition remained and required a longer course of treatment. Relevance of this problem, main difficulties of diagnosis are presented in the article. Anthropometric indices, body mass index, lymphocytes, total protein, albumin need to be measured in all patients. Using only body mass index leads to hypodiagnosis of malnutrition in patients with CP.