Gastro-esophageal diagnostic workup before bariatric surgery or endoscopic treatment for obesity: position statement of the International Society of Diseases of the Esophagus

Obesity is a chronic and multifactorial condition characterized by abnormal weight gain due to excessive adipose tissue accumulation that represents a growing worldwide challenge for public health. In addition, obese patients have an increased risk of hiatal hernia, esophageal, and gastric dysfunction, as well as gastroesophageal reflux disease, which has a prevalence over 40% in those seeking endoscopic or surgical intervention. Surgery has been demonstrated to be the most effective treatment for severe obesity in terms of long-term weight loss, comorbidities, and quality of life improvements and overall mortality decrease. The recent emergence of bariatric endoscopic techniques promises less invasive, more cost-effective, and reproducible approaches to the treatment of obesity. With the endorsement of the International Society for Diseases of the Esophagus, we started a Delphi process to develop consensus statements on the most appropriate diagnostic workup to preoperatively assess gastroesophageal function before bariatric surgical or endoscopic interventions. The Consensus Working Group comprised 11 international experts from five countries. The group consisted of gastroenterologists and surgeons with a large expertise with regard to gastroesophageal reflux disease, bariatric surgery and endoscopy, and physiology. Ten statements were selected, on the basis of the agreement level and clinical relevance, which represent an evidence and experience-based consensus of the International Society for Diseases of the Esophagus.

[Clinical evaluation of the efficacy of innovative spread of a given fatty acid composition enriched by adaptogens]

Adaptogens are a group of substances capable to increase the nonspecific resistance of the organism to a wide range of harmful effects and stress. However, only limited data exist on their use in the composition of foods for special dietary uses. The aim of the study was to evaluate the effect of a diet that included vegetable-fat spread enriched with 5-hydroxytryptophan, L-theanine and γ-aminobutyric acid on memory, general well-being and emotional status of healthy volunteers. Material and methods. The single-center, single-blind randomized prospective trial that enrolled persons without signs of significant organic pathology have been performed. Participants were randomly allocated to receive either 45 g/day standard spread enriched with 5-hydroxytryptophan (0.67%), L-theanine (0.56%) and γ-aminobutyric acid (0.45%) (main group, MG) or 45 g/day standard spread (control group, CG) for 10 days. Beside this, all participants followed a standard diet. Initially, as well as on the 10th day after the start of using the diet, the emotional state was assessed using the HADS anxiety and depression scale and Beck's depression inventory (BDI), general well-being by SAN questionnaire, memory according to the Lurie method; reaction time and attention concentration were assessed using the Krepelin counting test and the Burdon correction test. A 5-point Likert visual-analogue scale was used to assess the palatability (pasting) of the product, the severity of feelings of hunger and satiety at the baseline and on the 10th day of the study. All tests were performed under the supervision of staff. During the study, daily monitoring of the presence of adverse events was performed. Results. There were 70 subjects in MG and 70 in CG. Lurie memory score significantly increased in the MG (59.9±6.7 vs 58.1±7.4 points at the baseline; p=0.001), but not in the CG (58.0±6.9 vs 57.3±7.3 points, p>0.05). According to the SAN questionnaire, significant increase of well-being values (46.9±13.4 vs 44.2±13.5 points; p=0.01) and mood (49.9±12.6 vs 47.4±12.9 points; p=0.01) was found in MG, while in CG there was an increase of the mood category only (54.4±10.8 vs 52.2±12.1, p=0.04). At the end of the study an increase of «Satiety» (60.3±22.8 vs 51.5±24.8, p=0.022) and decrease of «Hunger» score (24.1±19.8 vs 29.1±19.4, p=0.02) were revealed in CG but not in the CG. No significant change was found by the results of other tests, stool form and its frequency in both groups. Conclusion. Newly developed spread enriched with 5-hydroxytryptophan, L-theanine, γ-aminobutyric acid was well-tolerated, did not affect the feeling of hunger and satiety, and improved memory and well-being parameters.

Russian consensus on prevention, diagnosis and treatment of gastric cancer

The Russian consensus on prevention, diagnostic and treatment of gastric cancer was prepared on the initiative of the Moscow clinical scientific center named after A. S. Loginov according to the Delphi method. Its aim was to clarify and consolidate the opinions of specialists on the most relevant issues of prevention, diagnosis and treatment of gastric cancer. An interdisciplinary approach was provided by the participation of leading gastroenterologists, oncologists and surgeons.

Analysis of local expression of inflammatory cytokines genes in patients with gastroesophageal reflux disease and its association with types and number of gastroesophageal refluxes

The aim of the study was to evaluate gene expression of proinflammatory cytokines in esophageal mucosa in patients with erosive esophagitis (EE) and non-erosive form (NERD) of gastroesophageal reflux disease (GERD) and perform correlation analysis between the genes expression and types and number of gastroesophageal refluxes. Methods. This was a single-center prospective study. Esophageal mucosa samples were taken from lower part of the esophagus during endoscopy. Expression of IL-1b, IL-10, IL-18, TNFA, TLR4, GATA3, CD68 and beta-2 macroglobulin genes was assessed with ImmunoQuantex assays. Multichannel intraluminal esophageal pH-impedance studies were performed with Ohmega recorder and 2pH-6impedance catheters. Results. Data of 60 patients (females - 34; mean age (M±SD) 54.6 years, 20 - with erosive esophagitis) were available for the analysis. In those with EE, there was higher expression of IL-18 (5.89±0.4 vs 5.28±1.1, p=0.04), GATA3 (2.92±0.86 vs 2.23±0.96, p=0.03) genes, and inflammatory index (92.12±32.41% vs 70.1±30.8%, p=0.02) compared to NERD. Direct correlation was found between acid exposure time and expression of IL-1b (Spearman rank R = 0.29), IL-18 (R=0.31), TNFA (R=0.35), GATA3 (R=0.34), TLR4 (R=0.29), CD68 (R=0.37) genes and inflammatory index (R=0.3). Indirect correlation was revealed between mean рН and expressions of IL-18 (R= -0.28), TNFA (R= -0.33), GATA3 (R= -0.28), TLR4 (R= -0.28), CD68 (R= -0.39) genes and inflammatory index (R= -0.17). No correlation was found between the genes’ expression and number of gastroesophageal refluxes. Conclusions: Expression of proinflammatory cytokines’ genes differ in patients with EE and NERD. There is a correlation between expression of studied genes and esophageal acidity.

[Questionnaire of the Ryzhikh National Medical Research Centre for Coloproctology is a new tool for assessing chronic pelvic pain and pelvic organ dysfunction]

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

May Previous Hepatitis B Virus Infection Be Involved in Etiology and Pathogenesis of Autoimmune Liver Diseases?

INTRODUCTION

Viral infections, especially with hepatotropic viruses, may trigger autoimmune liver diseases (AILDs) and deteriorate their course. However, association of previous hepatitis B virus (HBV) infection (presence of anti-HBc with or without anti-HBs or HBV DNA in serum) with AILDs is poorly studied so far. The aim of the study was to assess the prevalence of previous hepatitis B virus infection markers and its clinical significance in patients with autoimmune liver diseases.

METHODS

The study was based on the data obtained from 234 consecutive HBsAg-negative patients with AILDs [81 with autoimmune hepatitis (AIH), 122 with primary biliary cholangitis (PBC) and 31 with primary sclerosing cholangitis (PSC)] and 131 subjects of the control group without liver diseases. Blood samples of the enrolled patients were tested for anti-HBc and HBV DNA. Samples of liver tissue were examined by standard morphologic protocol and, in anti-HBc positive subjects, for HBV DNA. We assessed estimated risks of AILDs according to anti-HBc positivity and association of anti-HBc positivity with stage of liver fibrosis.

RESULTS

Anti-HBc was detected in 14.5% participants in the control group vs 26.1% (p = 0.016) in patients with AILDs (including 27.1% subjects with PBC (p = 0.021 vs control group), in 29% of PSC and 23.5% in AIH. HBV DNA was detected in three patients with PBC and in one with AIH. Positive anti-HBc test result was associated with higher risk of AILDs-odds ratio (OR) = 2.078 [95% confidence interval (CI) 1.179-3.665], especially in PBC: OR (95% CI) 2.186 (1.165-4.101). Odds of advanced stage of liver fibrosis (F3-F4 by METAVIR) in anti-HBc-positive subjects with PBC were also higher compared to those who had no previous HBV infection: OR (95% CI) 2.614 (1.153-5.926).

CONCLUSIONS

Significant proportions of patients with AILDs are anti-HBc positive, and some of them have OBI. Among patients with AILDs, anti-HBc-positivity is most widespread in the PBC group and in subjects with advanced stage of liver fibrosis. Our data may support the idea of an important role of previous HBV infection in the etiology and pathogenesis of AILDs (namely PBC).

The role of conservative treatment of functional defecatory disorders and further perspectives in patients with pelvic organ prolapse

Введение. В патогенезе расстройств дефекации у больных с ректоцеле могут участвовать как анатомические, так и функциональные нарушения. Однако до настоящего времени о возможности консервативной терапии, направленной на коррекцию функциональных расстройств дефекации, изучены недостаточно. Цель: изучение эффективности использования методов включающих БОС-терапию (терапия биологической обратной связью, biofeedback терапия) и тибиальной нейромодуляции в лечении больных с функциональными расстройствами дефекации на фоне пролапса тазовых органов. Методика. Материалом исследования служили результаты обследования пациенток в возрасте от 18 до 75 лет с наличием функционального расстройства дефекации (ФРД) в сочетании с ректоцеле без ранее проводившихся попыток хирургической коррекции. Проведены оценка общеклинических данных, опрос при помощи специализированного опросника выраженности расстройств эвакуаторной функции толстой кишки, рентгеновская дефектография, аноректальная манометрия высокого разрешения до и после комплекса консервативной реабилитации при помощи БОС-терапии и тибиальной нейромодуляции. Результаты. Конечному анализу были доступны данные 60 пациенток. Ректоцеле 1-й степени выявлено у 3 человек (5%), 2-й - у 37 (61,7%), 3-й степени - у 20 (33,3%) участниц исследования. Средний балл по симптомному опроснику составил 11,4±3,7. ФРД I типа выявлено у 41 (68,3%), II типа - у 6 (10%), III - у 10 (16,7%) и IV - у 3 (5%) участниц. После проведенной БОС-терапии признаки ФРД полностью устранены у 36,7% (22/60) женщин с ректоцеле. Неэффективной БОС-терапия оказалась у 11/41 (26,8 %) пациенток с I типом манометрического паттерна, 2/6 (33,3 %) со II типом и 4/10 (40,0 %) пациенток с III типом ФРД; (всего у 17/60 (28,3 %). У пациенток с IV типом паттерна неэффективные результаты лечения отсутствовали. Заключение. БОС-терапия и тибиальная нейромодуляция приводят к устранению симптомов в 36,7% случаев и положительной динамике у 35,0% больных. Методы могут быть рекомендованы к использованию в комплексной терапии эвакуаторных расстройств дефекации у больных с ректоцеле

Aim. To assess the efficacy of conservative methods like biofeedback therapy (BFB) and tibial neuromodulation (TNM) for treatment of patients with functional FDD and rectocele. Methods. Information collected during examinations of female patients with FDD and rectocele and with no previous surgery served as source data. Before and after conservative treatment with BFB and TNM, symptoms were assessed, responses to a specialized questionnaire on the severity of rectal evacuatory function impairment were analyzed, and X-ray defecography and high-resolution anorectal manometry were performed. Data before and after treatment were compared with non-parametric statistics (Wilcoxon matched pairs test). Results. The data of 60 women (mean age 48.2±13.4 years) were analyzed. Rectocele grade 1 was detected in 3 (5%), grade 2 in 37 (61.7%), and grade 3 in 20 (33.3%) patients. Mean symptom score on the specialized questionnaire was 11.4±3.7. FDD type 1 manometric pattern was found in 41 (68.3%), type II in 6 (10%), type III in 10 (16.7%), and IV in 3 (5%) participants. Complete resolution of FDD after BFB and TNM therapy was found in 22/60 (36.7%) of women. BFB and TNM therapy was ineffective in 11/41 (26.8%) patients with FDD type I, in 2/6 (33.3%) with type II, and in 4/10 (40.0%) patients with type III FDD. This conservative treatment was effective in 100% patients with type IV pattern of FDD. Based on the results, we suggest further actions to improve the outcomes of conservative treatment. Conclusion. Conservative treatment with combined biofeedback therapy and tibial neuromodulation may help improve symptoms in 35% of patients and lead to complete resolution of functional component in 37% of patients with functional defecatory disorders and rectocele. This treatment was not effective in 28% of patients.

New Specialized Food Product “SPP1” in Combination With Iso-Calorie Diet Shows Better Efficacy Than the Diet Alone in Treatment of Non-alcoholic Steatohepatitis

Objectives

The aim of the study was to assess efficacy and safety of newly developed specialized food product “SPP1” in patients with NASH.

Methods

New specialized food product for clinical use (SPP1) consisted of (% of the RDAs): protein 8%; fat 7% (including ω-3 PUFA 40%); soluble dietary fiber 160%; phospholipids 25%; alpha-lipoic acid 33%; betaine 10%; minerals 13%–44%; vitamins (A, E, D3, K1, C, B1, B2, B6, B12, PP, Folic acid, Pantothenic acid, Biotin) 24%–140%. The study (NCT04308980) was approved by LEC and enrolled patients with diagnosis of NASH. Subjects were randomized to the following groups: those received iso-calorie diet (according to REE, by indirect calorimetry (Quarck RMR, Italy) alone (ICD) and iso-calorie diet + SPP1 (2 portions of SPP1 a day, 14 days)(ICD + SPP1 group). Safety was assessed based on clinical and laboratory data. Repeated measurements (baseline vs those on the 15th day of the study) of body composition (InBody, South Korea), and blood chemistry were compared. Non-parametric statistics (StatSoft, USA) was used for the analysis.

Results

The results of complex examination of 20 subjects (12 in ICD + SPP1 and 8 in ICD group) served as a source for the study. Initially, groups did not differ by age, sex, and BMI. The product was well tolerated. In contrast to ICD group, those in ICD + SPP1 group demonstrated greater decrease of weight: BMI initially (BMI0), Mean ± SD: 38.7 ± 5.4 kg/m2 vs BMI at the end-point (BMIEOT) 37.7 ± 5.1 kg/m2, P = 0.003 in ICD + SPP1 group, whereas in the ICD group BMI0 38.9 ± 7.2 kg/m2 vs BMIEOT 37.9 ± 7.3 kg/m2, P = 0.08. These results were reached predominantly by a decrease of the weight of fat: body fat weight (BFW)0 50.2 ± 10.7 kg vs BFWEOT 48.5 ± 10.8 kg, P = 0.002 in ICD + SPP1 group, whereas BFW0 48.9 ± 11.4 kg vs BFWEOT 46.8 ± 11.6 kg, P = 0.07 in ICD group. ALT and AST levels decreased in both groups, but in neither of them was statistically significant.

Conclusions

The new specialized food product “SPP1” is safe, and well tolerated by patients with NASH. In combination with iso-calorie diet, it may increase efficacy of weight loss, predominantly by fat.

Funding Sources

Ministry of Science and Higher Education, #0529–2019-0055.

[Specialized products for dietary correction of the diet of patients with non-alcoholic steatohepatitis]

Non-alcoholic steatohepatitis (NASH) is a widespread disorder associated with a number of metabolic disorders. Lifestyle modification, including diet and physical activity are currently a first-line treatment for the disease. However, there is lack of specialized products (SP) with modified carbohydrate and fat composition, containing biologically active ingredients with proven physiological effects on the liver for this disorder. The aim of the paper is to summarize present knowledge on the biologically active ingredients with proven hepatoprotective effect and to describe the process of the development of two specialized products for clinical use in patients with NASH. Material and methods. Food ingredients containing soy and milk proteins, soluble dietary fiber, mono- and polyunsaturated fatty acids, vitamins, minerals, soy lecithin, L-carnitine, coenzyme Q10, α-lipoic acid, betaine, flavoring and aromatic additives were used in the development of SP formulations. The mass fraction of moisture in the SP was determined by the thermo-gravimetric method on a humidity analyzer, and the water activity was determined by measuring the dew point. The nutritional and energy value of the SP was calculated using data from chemical composition tables and information from manufacturers of food ingredients. Results and discussion. Taking into account the requirements for dietary therapy, the ingredient composition was scientifically justified and the formulations of two SP with a balanced amino acid composition were developed by using a combination of milk whey proteins, casein and soy protein isolate. The fat component included microencapsulated rapeseed oil, that is a source of mono- and polyunsaturated fatty acids (PUFAs) with the addition of ω-3 PUFAs. The carbohydrate composition was modified by eliminating mono- and disaccharides, traditionally used in sweet drinks, and adding maltodextrin in combination with sweeteners (polyols and natural sweeteners). Polydextrose, citrus pectin, inulin, and hydrolyzed guar gum are used as soluble dietary fibers. The SP included essential micronutrients (vitamins, mineral substances) and bioactive substances that have a proven physiological effect (coenzyme Q10, α-lipoic acid, L-carnitine, betaine hydrochloride, phospholipids). Technical documentation was developed and a pilot batch of SP-1 was developed for inclusion in the complex treatment of patients with NASH. Conclusion. The formulations and technology of SP (SP-1, SP-2) for therapeutic nutrition with a given chemical composition, designed to optimize the diet therapy of patients with NASH, have been developed. SP are sources of animal and vegetable proteins, soluble dietary fiber, mono- and polyunsaturated fatty acids, including ω-3 family, vitamins, minerals and trace elements, as well as bioactive substances with antioxidant, hepatoprotective and hypolipidemic effect. The technical documentation was developed and approved, according to which a pilot batch of SP-1 was produced to assess its effectiveness as a part of complex therapy of patients with NASH.

[Recommendations for the Protocol of functional examination of the anorectal zone and disorders classification: the International Anorectal Physiology Working Group consensus and Russian real-world practice]

This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed. Aim to provide information about methods of diagnosis and new classification of functional anorectal disorders to a wide range of specialists general practitioners, therapists, gastroenterologists, coloproctologists all who face the manifestations of these diseases in everyday practice and determine the diagnostic and therapeutic algorithm. Current paper provides agreed statements of IAPWG Consensus and comments (in italics) of Russian experts on real-world practice, mainly on methodology of examination. These comments in no way intended to detract from the provisions agreed by the international group of experts. We hope that these comments will help to improve the quality of examination based on the systematization of local experience with the use of the methods discussed and the results obtained. Key recommendations: the International Anorectal Physiology Working Group protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.

582 ANALYSIS OF FACTORS ASSOCIATED WITH CHANGE IN UES AND LES RESTING PRESSURE IN THE START AND END OF HRM STUDY

 

Lower and upper esophageal sphincter resting pressures' evaluation is not within Chicago classification, but is a part of a standard esophageal HRM examination. As the results of measurements at the beginning and at the end of examination are often discrepant, national guidelines in Russia recommend to record both. The aim of the study was to analyse possible factors that may affect the change between the results of the recordings of UES and LES resting pressures.

Methods

High-resolution esopophageal manometry examinations were performed in upright position with solid-state 36 channel 10 Fr catheter (Unisensor, USA) and Solar (MMS, the Netherlands) equipment. Resting pressures (RP) were measured at rest for ≥30 seconds at the beginning of the examination and after 10 water swallows. Beck depression inventory (BDI-II) was used to assess psychological status. Correlation analysis by Spearman (StatSoft, USA) was used to reveal factors affecting the change in resting pressures at the beginning and at the end of HRM study. Change of pressure was presented as a quotient of dividing the second P value by the first (ΔP).

Results

Eighty-four patients, age (M ± m) 48.5 ± 13.2 y.o. were enrolled. Hiatal hernia was present in 37 subjects.

UES mean RP differed significantly at the beginning (123.7 ± 76.6 mmHg) and at the end of examination (87.9 ± 64.1), P < 0.0001. LES RP didn’t differ significantly at the start and at the end of examination.

The results of correlation analysis of factors affecting ΔP are shown in the table 1. Those with a decrease of UES resting pressure at the end of examination (n = 63) were younger compared to the group with no change or an increase of it (46.3 ± 12.7 y.o. vs 56.0 ± 13.1 y.o., p = 0.003).

Conclusion

Upper esophageal resting pressure measured at the end of the high resolution esophageal examination is lower compared to the initial values in great proportion of patients. Despite the importance of the finding is unknown, this should be considered when the function of the upper esophageal sphincter is studied.

588 THE INFLUENCE OF CHANGE OF DIET COMPOSITION ON ESOPHAGEAL MOTILITY PATTERNS IN PATIENTS WITH NON-EROSIVE GERD

 

The aim of the study was to evaluate the influence of change in diet composition on high-resolution esophageal manometry (HRM) patterns.

Methods

The data of 43 NERD patients with low (<20 g/day) dietary fibre intake served as a source data. These patients were examined with the use of standard food frequency questionnaire and HRM. Thirty of them received psyllium 5.0 G TID 10 days additionally to their usual diet (NCT01882088). Control group was formed by the database search for patients who had repeated HRM examinations and dietary assessments at the same time point and if no significant change in diet composition was revealed. HRM assessment was in accordance to Chicago-3.0. Non-parametric statistics were used to assess the change in HRM metrics.

Results

Minimal LES resting pressure at rest and after 10 water swallows increased in study group: 5.41 ± 10.1 vs 11.3 ± 9.4 mmHg, P = 0.023 and 14.1 ± 8.0 vs 14.9 ± 6.4 mmHg, P = 0.008. No difference was found in those whose diet composition was stable. Ineffective esophageal motility initially was found in 46.7% patients of the study group and 53.8% in the control group (P = 0.7). IEM resolved in 71.4% of the study group, and in 14.3% of controls (P = 0.0135). IEM not changed in 28.6% of the study group and in 85.7% of controls, P = 0.014. New IEM revealed in 12.5% of the study group and 16.7% among the controls (P = 0.13).

Conclusion

Change of diet composition by additional quantity of dietary fibre (psyllium) to the standard rations may result in the improvement of esophageal motility.

[Interdisciplinary consensus on Russian-language terminology of anorectal sphincterometry and profilometry]

Aim to describe the results of a multidisciplinary discussion on the terminology of anorectal sphincterometry (AS) and profilometry (AP). We performed online survey with the use of public platform Google forms to harmonize Russian terms to be used to describe the results of AP and AS and their abbreviations. The invitation to participate in the survey was sent to the authors who use the results of AP and AS in clinical practice and perform the diagnostic procedures. The obtained answers were analyzed with the use of the aggregator and Statistica 10 (StatSoft Inc, USA) software. The level of consensus was analyzed with the use of modified Delphi criteria (C1 agreement of 90% of participants, C2 agreement of 75 to 90%, C3 less than 75%). Invitations sent 76, responses obtained 63 (response rate 82.9%). Consensus level 1 was reached for all the terms of AP and for 4out of 7 terms to describe the results of AS (3 out of 7 terms were of moderate agreement, C2). The need for the use of predefined abbreviations of terms for AS and AP was of a low rate of consensus (71.4%). The agreed terms of AS and AP should be used to prepare a conclusion for the diagnostic procedures and to publish scientific reports.

[Food patterns in Russian patients with gastroesophageal reflux disease: the results of pilot comparative study]

AIM

To evaluate nutritional patterns in patients with gastroesophageal reflux disease (GERD) compared to the control group without GERD.

MATERIALS AND METHODS

The data of complex examination of patients referred to perform esophageal pH-impedance recording and who gave written informed consent to participate in the study served as a source data. All the participants underwent complex examination, including clinical data (presence of heartburn and acid regurgitation), symptom evaluation (GERD-Q questionnaire), esophagogastroscopy, esophageal pH-impedance recordings and food frequency questionnaire. Diagnosis of GERD was based on GERD-Q score 8, acid exposure time 6%, number of gastroesophageal refluxes 80/day by 24-hrs esophageal pH-impedance recordings. Nutritional patterns were assessed with the use of healthy eating pyramid principles.

RESULTS

Overall 165 patients were enrolled and the data of 150 of them (34 with confirmed GERD and 116 of the control group) were available for the final analysis. The patients of the both groups consumed lower compared to the recommended amounts of dairy and higher amounts of meat. Those with GERD consumed larger amounts of fruits (0.910.68 compared to the values of healthy eating pyramid vs 0.520.57 in the control group, p=0.001), and fats (0.690.55 vs 0.490.55, p=0.001). Compared to the controls, patients with GERD consumed lower amounts of vegetables (0.860.46 of the healthy eating pyramid vs 0.940.63 in the control group, р=0.004) and sugars confectionaries (0.380.39 vs 1.930.98, p=0.0001).

CONCLUSION

Nutritional patterns of patients with gastroesophageal reflux disease significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.

[Association of nutritional patterns and arterial hypertension in Russia: does it exist?]

AIM

To evaluate nutritional patterns in patient with arterial hypertension (AH) compared to the control group without elevated blood pressure.

MATERIALS AND METHODS

Retrospective search for unique records of the patients aged 1875 y.o. with complete data on usual nutrition with food frequency methods who had no mentions of diabetes mellitus, food intolerance or allergies, and history of major abdominal surgery, as well as signs of secondary reasons of AH. Nutritional patterns were assessed with the use of healthy eating pyramid principles. Ststistical analysis was performed with the use of SPSS 13.0 for Windows software (SPSS Inc., USA).

RESULTS

The data of 711 patients were available for the final analysis (595 of them in AH group). Both groups consumed lower compared to the recommended amounts of fruits, dairy and higher amounts of meat. Those with AH consumed larger amounts of vegetables (1.130.74 compared to the values of healthy eating pyramid vs 0.940.63 in the control group; p=0.004), fruits (0.800.66 vs 0.520.57; p=0.001), meat (1.851.05 vs 1.620.91; p=0.002) and fats (0.770.60 vs 0.490.55; p=0.001). On the other hand, there were lower rates of consumption of sugars, and confectionaries in the structure of nutritional patterns in patients with AH compared to the control group: (0.350.44 of the healthy eating pyramid in AH vs 1.930.98, in the control group; p=0.0001).

CONCLUSION

Nutritional patterns of patients with arterial hypertension significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.

Recommendations of the Russian Gastroenterological Association on Clinical Use of High-Resolution Manometry in Diagnosis of Esophageal Disorders

Aim. Current recommendations of the Russian Gastroenterological Association on clinical use of high-resolution manometry in diagnosis of esophageal disorders are intended to assist in clinical decision making, terminology standardisation and interpretation of clinical data.

Key points. In 2018, a joint meeting of the Russian Gastroenterological Association and Russian Neurogastroenterology and Motility Group approved unified terminology and classification of esophageal motor function disorders for high-resolution manometry diagnosis.

Gastrointestinal patient complaints typically concern esophageal disorders such as dysphagia, regurgitation, heart-burn, chest pain or belching. To exclude erosive and ulcerative lesions, eosinophilic esophagitis and organic changes, esophagogastroduodenoscopy and biopsy are recommended in pre-treatment. Upon excluding mucosal lesions and esophageal lumen obstruction as causal for symptoms, use of high-resolution manometry is recommended. This method of esophageal examination has become the “gold standard” in diagnosis of motor disorders.

High-resolution manometry enables detailed investigation of integral quantitative and qualitative characteristics of esophagus motor function and specific related disorders, analysis of esophageal contractile propagation and strictly coordinated synchronous peristalsis of upper esophageal sphincter, esophagus and lower esophageal sphincter, which malfunction may provoke development of achalasia, esophagospasm, hiatal hernia, ineffective eso pha geal motility and other motor disorders.

Conclusion. High-resolution manometry is a relatively new method for study of esophagus motor function gaining increasingly wide application in clinical practice. It enables a medical professional to obtain evidence that may critically affect the choice of optimal patient care strategy and effective treatment. Current recommendations are based on an extensive review of up-to-date information and will be updated with new corpus of clinical data and assessment emerging in evidential medicine to provide gastroenterologists country-wide with latest scientific and practical guidelines.

Children With Gastroesophageal Reflux Disease Consume More Calories and Fat Compared to Controls of Same Weight and Age

OBJECTIVE

The aim of the study was to compare the rates of nutrients consumption in children and adolescents with gastroesophageal reflux disease (GERD) compared to the control group without the disease.

METHODS

Based on symptom evaluation and esophageal pH-impedance recordings patients were allocated on to GERD and control groups. All patients underwent esophagogastroscopy. Levels of nutrients consumption were assessed with the use of food frequency questionnaire in the regard to the presence of the disease, esophagitis, and z score body mass index (BMI).

RESULTS

Data of 219 children and adolescents were available for the final analysis. Risks to have GERD were higher in groups with obesity (risk ratio 1.2 [95% confidence interval 0.8-1.7]) and excessive weight (1.1 [0.9-1.4]). Energy values of the rations and amount of fat consumption were higher in the GERD group compared to the control when rations were compared according to z score BMI. In contrast to nonerosive form of GERD, patients with erosive esophagitis consumed more protein (percentage deviation from the recommended daily allowance Me [25%;75%]): 14.3 (11.07; 19.1) % versus 8.5 (6.71; 14.1) %, total fat 36.8 (12.5; 75.5) % versus 16.9 (10.1; 17.9) %, and less polyunsaturated fats -54.3 (-73.4; -47.7) % versus -45.6 (-56.2; -33.1) %, P < 0.05.

CONCLUSIONS

The rations of children with GERD are characterized by higher calorie values and larger amounts of fat intake compared to the control group in the regard to z score BMI. Low dietary fiber consumption is additional factor associated with GERD in children with excessive weight and obesity. Compared to nonerosive GERD, higher intake of energy, protein, and total fat and lower of polyunsaturated fats revealed in patients with GERD with erosive esophagitis.

High resolution anorectal manometry. Recommendations on russian-language terminology based on interdisciplinary consensus

The aim of the paper — is to present the results of the consensus on the terminology used to describe data of high-resolution anorectal manometry.

Methods: Online survey was conducted with the help of the public platform “Google forms” with the aim to harmonize the terms, which are used to conduct high-resolution anorectal manometry (HRAM), to agree the conformity of the proposed Russian-language terms to those used in English-language literature, and their abbreviations.

Results: According to the aim, 56 specialists of different medical specialties who perform and use the results of HRAM in clinical practice and research were invited to participate in the survey. We received 45 answers from the respondents (42.2% coloproctologists, 22.2% gastroenterologists, 15.6% surgeons, 20% — representatives of other specialties). The response rate was 80.3%. According to the survey, 95.6% of respondents supported the need for harmonization of terms. Ten out of the 11 terms reached consensus level C1 (excellent), 1 term level of consistency was C2 (moderate). 90.9% of respondents (consensus level C1) were in favor of the appropriateness of using common abbreviations. However, the proposed abbreviations of the terms used in the conduct and description of the results of the HRAM can be accepted with reservations (in 10 cases out of 11 consensus level was C2).

Conclusions: The agreed in interdisciplinary consensus terms can be approved and recommended for the use in clinical practice and when research data are published in Russian-language scientific literature.