DESTRUCTIVE AND ADAPTIVE CHANGES IN THE EXOCRINE PART OF THE PANCREAS UNDER PROLONGED ELEVATION OF PRESSURE IN THE PULMONARY CIRCULATION
DOI:
https://doi.org/10.32782/health-2026.1.8Keywords:
pancreas, exocrine function, pulmonary hypertension, right heart failure, hypoxia, venous congestion, microcirculation, fibrosis, pancreatic stellate cells, exocrine pancreatic insufficiencyAbstract
Long-term elevation of pressure in the pulmonary circulation in pulmonary hypertension and right-sided heart failure is accompanied by systemic venous congestion, hypoperfusion, chronic hypoxia, and metabolic-inflammatory activation that may affect the pancreas as a target organ. This review summarizes English-language peer-reviewed evidence (2021–2026; PubMed/PMC and Scopus-indexed sources) on mechanisms linking chronic cardiopulmonary overload with destructive-adaptive remodeling of the exocrine pancreas. In addition to evidence synthesis, the practical aim was to develop a clinically applicable framework for early identification of patients at risk of exocrine pancreatic insufficiency and to define monitoring priorities in routine follow-up. Direct studies specifically addressing the chain “pulmonary hypertension → exocrine pancreatic remodeling” remain scarce; therefore, selected conclusions are explicitly framed as cautious mechanistic extrapolations from heart failure-related venous congestion and hypoperfusion, microcirculatory dysfunction, hypoxia-driven oxidative stress, mitochondrial and endoplasmic reticulum stress, dysregulated autophagy, NF-κB/MAPK signaling, pancreatic stellate cell activation, and TGF-β1/SMAD3-dependent fibrogenic pathways. The review highlights the rationale for symptom-based screening for malabsorption, nutritional assessment, fecal elastase-1 as a first-line test, and further confirmation/supportive pancreatic enzyme replacement therapy within multidisciplinary follow-up. Additional research priorities include combining congestion imaging markers with exocrine function testing and nutritional indicators to improve risk stratification.
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