Multicenter study of gastroesophageal reflux disease symptoms prevalence in outpatients in Russia

Background. Recently, there has been an increase in the prevalence of gastroesophageal reflux disease (GERD) in Northern Europe, North America and East Asia. However data on GERD prevalence in Russian population are very limited. Aim. To determine the prevalence of GERD among the population of Russia, the clinical spectrum of GERD symptoms, the main drugs used for GERD treatment, and the rate of their administration. Materials and methods. The study was conducted from November 2015 to January 2017 in 8 cities of Russia. A survey of patients over the age of 18 years old visiting outpatient medical institutions for any reason, including patients without gastrointestinal complaints was carried out using a short version of the Mayo Clinic questionnaire. Results. In total, 6132 questionnaires of patients aged 1890 years were analyzed [2456 men (40.1%) and 3676 women (59.9%), mean age 46.615.4 years]. The GERD prevalence among the interviewed patients was 34.2%. The incidence of GERD increased depending on body mass index and the age of the patients. Medications used by the patients for heartburn relief included proton pump inhibitors 59.96%, antacids 67.92%, H2-histamine receptor blockers 11.42%, alginates 18.41% of patients. Conclusion. The results of this study indicate a high prevalence of GERD among residents of Russian cities applying for primary health care (34.2%). In comparison with previous studies, an increase in the proportion of GERD patients taking proton pump inhibitors was noted; in most cases the regimen of their intake was in accordance with the recommendations.

[European Registry on the management of Helicobacter pylori infection: features of diagnosis and treatment in Kazan]

BACKGROUND

As part of an observational multicenter prospective study European Registry on the management of Helicobacter pylori infection, conducted on the initiative of the European H. pylori and Microbiota Study Group, the compliance of clinical practice in the management of patients with Helicobacter pylori infection in Kazan with clinical guidelines was assessed.

MATERIALS AND METHODS

The data of 437 patients included into the register by clinical sites in Kazan in 20132019 were analyzed. The methods used for the initial diagnosis of H. pylori infection and eradication control were evaluated. The frequency of various eradication therapy regimens prescription was analyzed in 379 cases. Data regarding the effectiveness of eradication therapy was analyzed in 173 patients.

RESULTS

The rapid urease test (44.2% of cases) and cytology/histology (60% of cases) were most often used for the initial diagnosis of H. pylori infection; however non-invasive methods such as 13C-urea breath (9.2%), serology (6.2%), H. pylori stool antigen test (2.3%) were less common. In 21.7% of patients two methods of H. pylori detection were used for primary diagnosis. The control test to evaluate the effectiveness of eradication therapy at the recommended timepoint was performed in 46.2% of patients. 13C-urea breath test (31.7%), stool PCR/stool antigen test (28.7%), rapid urease test (22.3%), cytology/histology (26.2% of cases) prevailed in the assessment of eradication rate. Standard triple therapy, including proton pump inhibitor, clarithromycin and amoxicillin was most commonly prescribed as first-line therapy (64.6% of cases). The duration of eradication therapy was 14 days in the majority of cases with pantoprazole as the most common proton pump inhibitor in standard triple therapy regimens (84.8%). The efficacy of 14-day standard triple therapy (mITT) was 87.0%.

CONCLUSION

The results indicate a high frequency of non-invasive methods use for assessing the effectiveness of eradication therapy; however, the overall rate of eradication efficacy assessment is low, limiting the possibility of analyzing the eradication results. The effectiveness of the most common 14-day standard triple first-line therapy in Kazan doesnt reach the recommended 90% eradication level. This could be explained by high rate of pantoprazole use, which is not an optimal proton pump inhibitor in eradication therapy regimens.

Shifts in the Human Gut Microbiota Structure Caused by Quadruple Helicobacter pylori Eradication Therapy

The human gut microbiome plays an important role both in health and disease. Use of antibiotics can alter gut microbiota composition, which can lead to various deleterious events. Here we report a whole genome sequencing metagenomic/genomic study of the intestinal microbiota changes caused by Helicobacter pylori (HP) eradication therapy. Using approaches for metagenomic data analysis we revealed a statistically significant decrease in alpha-diversity and relative abundance of Bifidobacterium adolescentis due to HP eradication therapy, while the relative abundance of Enterococcus faecium increased. We have detected changes in general metagenome resistome profiles as well: after HP eradication therapy, the ermB, CFX group, and tetQ genes were overrepresented, while tetO and tetW genes were underrepresented. We have confirmed these results with genome-resolved metagenomic approaches. MAG (metagenome-assembled genomes) abundance profiles have changed dramatically after HP eradication therapy. Focusing on ermB gene conferring resistance to macrolides, which were included in the HP eradication therapy scheme, we have shown a connection between antibiotic resistance genes (ARGs) and some overrepresented MAGs. Moreover, some E. faecium strains isolated from stool samples obtained after HP eradication have manifested greater antibiotic resistance in vitro in comparison to other isolates, as well as the higher number of ARGs conferring resistance to macrolides and tetracyclines.

ERADICATION THERAPY OF HELICOBACTER PYLORI: PRESENT AND FUTURE

Recently the rate of successful H. pylod eradication while using existing treatment regimens continues to decline, primarily due to the appearance of antibiotic-resistant strains of the microorganism. Recent studies confirm the fact that the standard triple therapy becomes ineffective method of H. pylori eradication, due to the increase of drug-resistant strains of.H. pylon. H. pylori resistance level to antibacterial agents is not the same in different countries, as well as in certain regions within the same country. Thus, studing the regional features of H. pylori resistance to certain antibiotics with subsequent development of eradication regimens that are effective in particular region becomes extremely actual. Still bismuth containing quadruple therapy remains an effective method of H. pylori eradication, allowing to achieve good results. In recent years, several alternative schemes of H. pylori eradication were proposed, such as sequential, concomitant, hybrid therapy including three antimicrobial agents. Currently; these regimens allow to achieve quite high H. pyloneradication level.

[Clinical case of a combination of ulcerative colitis and alopecia areata]

Extraintestinal manifestations of inflammatory bowel diseases (IBD) are common in both ulcerative colitis and Crohn's disease. Dermatological manifestations have been reported in one-third of all extraintestinal manifestations of IBD. Erythema nodosum and pyoderma gangrenosum are the most frequently described in the literature. There is no data on the development of alopecia as a cutaneous manifestation of IBD in most of studies. A clinical case of combination of ulcerative colitis and alopecia in young woman is presented in the article. There are several possible causes of alopecia in patients with IBD, such as nutritional deficiencies, side effects of medications or autoimmune alopecia. Most often there is no correlation between the severity of clinical bowel manifestations and other organs involvement, and response to therapy. So the combination of alopecia with IBD, in particular ulcerative colitis, confirms the importance of autoimmune mechanisms in genesis of these diseases.