[Lanzoptol efficacy at gastroesophageal reflux disease: results of multicenter study leader]

Results of multicenter study "Efficacy of Lansoptol (lansoprazole, KRKA) and its influence on the Dynamics of GERD symptoms" (LIEDER) are presented. The impact of 56-days treatment with lansoprazole 30 mg once daily on symptoms relief, a quality of life of 121 patients with gastroesophageal reflux disease (GERD) and healing of esophageal lesions of 30 patients with reflux esophagitis were investigated. Rapid acid inhibition effect of first dose of lansoptol was shown by 48-hr pH-monitoring. At the first day of the treatment 43.1% of patients reported decreasing of intensity of heartburn and 36.5%--of regurgitation. It were shown that the treatment with lansoptol provided symptoms relief in 25% patients at day 3, in 50% of patients at day 5 and in 75% at day 8 for heartburn, and at days 2, 6 and 9--for regurgitation. It was conducted improvement of quality of life. Healing rate of esophagitis at 28 day was 83.3%.

[Restoration of the quality of life by eliminating and prevention of heartburn by alginate: results of multicenter study "VIA APIA"]

Was conducted a muIticenter study VIA APIA, in which the impact of gaviscon forte (suspension) on symptoms, general state and quality of life of 148 patients (male 53, female 95, age 42.9 +/- 15.6) with gastroesophageal reflux disease (GERD) were investigated. The patients had undergone clinical evaluation of dynamics of GERD symptoms (Likert scale), general state (Visual Analogue Scale, questionnaire SAN) and quality of life (SF-36). It was shown that 14-days treatment with gaviscon forte provided symptoms relief in 84.5% patients and conducted improvement of general state and quality of life. Gaviscon forte recommended as drug of choice in initial treatment for the first time visited patient with heartburn before endoscopy and for pathogenetic treatment of typical reflux syndrome.

[How to choose correct proton pump inhibitors to patients with GERD?]

Proton pump inhibitors (PPI) are most effective for the gastroesophageal reflux disease (GERD) treatment. The effectiveness of PPI in the long-term treatment of GERD is similar. However, the PPI are different according to fast onset and duration of antisecretory action, pH-selectivity, metabolism, interactions with other medicines and dosage forms. In some clinical situations, these differences can be significant. In this article was described features of the pharmacokinetics of PPI. It was shown that the early stages of treatment of certain advantages in speed of onset of effect is lansoprazole, which potentially increases the patient's adherence to treatment. Metabolism in the cytochrome P450 system provides the lowest profile of pantoprazole drug interactions, making it the most secure in the presence of GERD in a patient comorbidities and need for drugs used to treat it.

[Gastroesophageal reflux disease in the elderly patients: epidemiology, clinical features, therapy]

AIM

Was made a multicenter study of the GERD prevalence in Russia--MEGRE--that revealed quantitative criteria for GERD in 13.3% of respondents but in Moscow it was 23.6%. Also was detected an increasing prevalence with age, and respondents noted a higher prevalence of GERD in groups of older age (over 60) compared with persons younger than 60 years--accordingly 26.5% and 20.2%. We studied the course and treatment of elderly patients with GERD and assessed the results of surgical treatment of patients with short esophagus syndrome.

METHODS

Was made a prospective study of 500 patients with GERD (241--age 60 years) that were treated with PPI and 95 patients were operated with an axial HH (42 of them with shortening of the esophagus 1-2-th power), mean age 65.7 +/- 17.4 years. We used endoscopic techniques (endoscopy), daily pH monitoring, esophageal manometry.

RESULTS

Results of a prospective clinical study in elderly patients allocated two clinical variants of the flow of GERD, predicting a more severe course of disease in patients with a short history (up to 5 years) (the second "adult type") and suggests a differentiated approach to diagnosis and treatment. The expediency of extension to 12 weeks in elderly patients with GERD, the duration of the basic course of PPI therapy in full doses, which increased the effectiveness of therapy in 14.1%. after ending of this protocole, elderly patients with a second type of disease showed maintenance treatment in continuous operation since the regime "on demands from them ineffective. A reasonable approach to therapy in elderly patients, including STIs, can benefit and make a minimal risk of treatment. 24 months after performed fundoplication were observed excellent and good results in 96% of cases. In this case, patients with ineffective esophageal motility observed improvement in esophageal manometry, indicating that nature reflux of these disorders at baseline.

CONCLUSIONS

Course and treatment of GERD in the elderly has its own characteristics, which dictate the need for an integrated approach to diagnosis and treatment of these patients. Older patients with esophageal shortening, 1 st degree possible to perform laparoscopic surgery, and shortening of the esophagus, 2 nd degree is the most secure laparotomic access.

[Pharmacokinetics of the proton pump inhibitors and psychological status in patients as factors that influence the efficiency of treatment of GERD with pantoprazole]

Was made an investigation of the effectiveness of pantoprazole (sanpraz, "SanFarma", India) at gastroesophageal reflux disease (GERD). 53 patients with GERD, including 20--with reflux esophagitis, received a daily dose of pantoprazole 40 mg to 28 days. To the 7 day of treatment heartburn was broke in 63.3%, regurgitation--in 65% of patients initially experiencing these symptoms. The 14-th day of treatment heartburn was broke in 83.7%, regurgitation--in 90%. Endoscopic remission in 28-th day of treatment was obtained in 85% of patients with reflux esophagitis. Broking of symptoms was accompanied by significant improvement in well-being and quality of life of patients. Treatment of a standard dose of pantoprazole was ineffective in 16.3% of patients. The reasons for the conservation of heartburn in 4.1% of the cases was an individual characteristics of the pharmacokinetics drug, in 12.2%--non-reflux mechanisms of symptoms in the face of mental status.

[Functional methods of the esophagus examination]

Manometry of the esophagus is the "gold standard" in diagnosing diseases of the esophagus associated with motor disorders. The combination of manometry with impedance gives an indication of violation of bolus transport along the esophagus. High resolution manometry is new method that provides the most accurate information about the functional anatomy of the esophagus and its sphincters, as well as accurately characterizes the esophageal-gastric junction. We can increase the diagnostic value of daily pH-monitoring by analyzing communication with reflux symptoms. The combination of pH and impedance can identify different types of reflux (acid, sour, gas, liquid and mixed) in patients with symptoms of GERD and related Ahil, after gastric resection in children and infants, to evaluate the effectiveness of antireflux therapy.

[Multicentre study "Epidemiology of gastroesophageal reflux disease in Russia"(MEGRE): first results]

We aimed to determine the prevalence and clinical spectrum of GERD in the urban population of 6 cities in different parts of Russia (St. Petersburg, Ryazan, Kazan, Kemerovo, Krasnoyarsk and Saransk). A previously validated reflux questionnaire developed at the Mayo Clinic was translated into Russian, culturally adapted and administered. Data was collected from 7812 randomly selected subjects greater than 18 years old with the assistance of the yellow pages. 'Frequent symptoms' were defined as a major symptom (heartburn and/or regurgitation) occurring at least once a week or more. "Occasional symptoms" were defined as an episode of one of the major symptoms occurring less than once a week within the past 12 months. Patients were defined as having GERD if they reported frequent heartburn and/or regurgitation. The average prevalence of frequent and occasional GERD symptoms in Russia was 9% and 38.5% for heartburn and 7.6% and 35.3% for regurgitation respectively within the last 12 months. The average prevalence of GERD in Russia was 13.3% (11.3-14.3%). The prevalence of frequent heartburn decreased with age (r = -0.3); however, frequent regurgitation increased (r = 0.7) with age. As a result, we found that prevalence of GERD increased with age. The average prevalence of GERD was statistically the same in men (12.5%) and in women (13.9%). This prevalence didn't change with age in men but did increase with age in elderly women to 24%. Frequent heartburn and regurgitation (GERD) were significantly associated with frequent belching (24.3%), chronic cough (22.9%), dyspepsia (19.8%), non-cardiac chest pain (15.1%), nausea (14.9%), hoarseness (11.4%), dysphagia (8.1%), odynophagia (7.3%) and constipation (37.8%). Alcohol consumption (prevalence of 60.4% among respondents) and smoking (prevalence of 25.4% among respondents) didn't yield any significant difference in subjects with frequent symptoms. Importantly, we also found that only 52.8% of subjects with frequent chest pain and 29.3% of respondents with frequent heartburn had seen a physician for these symptoms.

[Evaluation of action, efficacy, and onset dynamics of a single dose of alginates in patients with heartburn and GERD]

We conducted a crossover study, in which the efficacy and the onset of action of a single dose of Gaviscon (suspension) and Gaviscon forte (suspension) in 52 patients with heartburn of moderate intensity and gastroesophageal reflux disease (GERD) have been investigated. The average age of the patients was 44.0 +/- 17.3-years-old. The patients have undergone clinical evaluation of intensity of GERD symptoms and psychological assessment (questionnaires SF-36, SMOL, LOBI). Alginates' effects and qualities were evaluated using stopwatch technique, clinical examination, and organoleptic assessment. Primary sensation of a cooling (soothing) effect after use of a single dose of Gaviscon has been reported in 65.7 seconds (on average), and Gaviscon forte--in 66.1 seconds. Fourty three (82.7%) patients with heartburn have described the effects of both medications as "instant" cooling effects. Heartburn was relieved in 3.3 minutes in all patients after a single dose of Gaviscon, and in 3.6 minutes in 51 (98.1%) patients who have received a single dose of Gaviscon forte. Organoleptic qualities averaged at 3.6 points (on a scale of 1-5) for Gaviscon, and at 3.5 points for Gaviscon forte. Assessment of mental status of the patients suggested that a "delayed" effect of the medications in relieving heartburn in some patients may have occurred due to possible physical disadaptation.