[Long-term consequences of COVID-19 in patients with functional bowel disorders, rehabilitation prospective of microbiocenosis-oriented therapy]

AIM

To analyze long-term consequences of the new coronavirus infection and rehabilitation prospective of microbiocenosis-oriented therapy in patients with functional bowel disorders.

MATERIALS AND METHODS

The study enrolled 100 consecutive patients with various types of functional bowel disorders with recurrence of symptoms after the new coronavirus infection. The severity of abdominal pain was evaluated in points, and bowel movement disorders were assessed using the Bristol stool scale. A questionnaire was used as part of an in-depth clinical examination for COVID-19 survivors to identify the clinical symptoms typical for the post-COVID syndrome. The Hospital Anxiety and Depression Scale was used to identify and assess the severity of depression and anxiety, and the Asthenic State Scale was used to diagnose the asthenia.

RESULTS

All patients in the study subjectively linked the recurrence of bowel disorders with the new coronavirus infection. The most common bowel disorder was irritable bowel syndrome with diarrhea. A distinctive feature of exacerbations of intestinal symptoms in the post-COVID period is their association with depression/anxiety and asthenic states. The addition of Zakofalk® metaprebiotic to the treatment regimen was associated with significant regression of abdominal pain and normalization of bowel movement, an improvement of asthenia, anxiety, and depression.

CONCLUSION

The addition of Zakofalk® to treatment regimens for exacerbations of functional bowel disorders after the new coronavirus infection significantly improves the effectiveness of therapy.

[Gastroenterological symptoms in COVID-19 patients with mild severity of the disease: opportunities to optimize antidiarrheal therapy]

BACKGROUND

The novel coronavirus infection COVID-19 can be manifested by damage to the organs of the gastrointestinal tract (GIT). Damage to the gastrointestinal tract by the SARS-CoV-2 virus leads to a violation of the microbial-tissue complex of the mucous membrane of the digestive tract. A common gastroenterological manifestation of COVID-19 is diarrhea.

AIM

Study of the clinical features of gastroenterological disorders and the possibility of optimizing the treatment of diarrheal syndrome in patients with COVID-19 with a mild form of viral infection.

MATERIALS AND METHODS

The observation group consisted of 230 patients with mild COVID-19: K-group (n=115) with respiratory symptoms, I group (n=115) with gastrointestinal manifestations in combination and without signs of respiratory damage. In order to compare the effectiveness of treatment of diarrheal syndrome, patients of group I are randomized into 2 subgroups: Ia (n=58) prebiotic treatment (Zacofalk) and Ib (n=57) enterosorbents.

RESULTS

The development of gastrointestinal symptoms with SARS-CoV-2 infection is significantly more often noted in comorbid patients (67%). Gastrointestinal symptoms were dominated by diarrhea (93.9%) and flatulence (76.5%), in 1/3 of patients they were the first manifestos of infection. It was established that in 98.4% of patients of group I (against 42.6% of the K-group) signs of infectious intoxication were detected. In patients with gastrointestinal lesions, an elongation of the febrile period by 91.5 days was noted, a later (6 days) verification of the viral etiology of the disease. It was found that in patients of group I, the regression of clinical symptoms, the duration of viral disease, the dynamics of antibody formation, the prognosis for the development of IBS-like disorders in the post-infectious period depended on the treatment. In patients taking (Zacofalk), these indicators were significantly better.

CONCLUSION

In mild cases, to reduce the severity of viral intestinal damage, for effective relief of intestinal symptoms, to reduce the risk of IBS-like symptoms, it is advisable to prescribe (Zacofalk) in an initial dose of 3 tablets per day.

Non-alcoholic fatty liver disease in adults: clinic, diagnostics, treatment. Guidelines for therapists, third version

.

[Comparative effectiveness of ursodeoxycholic acid preparations in the treatment of biliary sludge]

In the clinical classification of cholelithiasis, biliary sludge (BS) is distinguished as the pre-stone stage. Ursodeoxycholic acid (UDCA) is a drug with an evidence base for effective and safe effects on BS. The therapeutic equivalence of various UDCA drugs remains an important issue for clinical practice.

AIM

To conduct a comparative analysis of the effectiveness of the use of UDCA: Ursofalk with other UDCA drugs for the treatment of BS in a fixed dose of 10 mg/kg of body weight.

MATERIAL AND METHODS

The observation group consisted of 225 patients with various types of BS. In randomized groups, the comparison of the effectiveness of UDCA drugs in the dissolution of BS was determined by the data of ultrasound of the gallbladder. Dynamic ultrasound cholecystography using a standardized technique was performed to study the effect of the compared drugs on the contractile function of the liver. When analyzing the impact of ursotherapy on the clinical manifestations of BS, the dynamics of biliary pain syndrome and dyspeptic disorders were evaluated.

RESULTS

A comparative analysis of the effectiveness of UDCA drugs for BS lysis with a high degree of confidence established the advantage of Ursofalk: after 3 months in 80%, and after 6 months of therapy in 95.65% of patients, a regression of BS was detected. In the group of patients who took other UDCA, the corresponding indicators were 46.36% and 67.27%. The greatest effectiveness of ursotherapy was demonstrated in the BS variant by the type of suspension of hyperechogenic particles, the lowest in the variant by the type of putty-like bile in the form of mobile or fixed clots. In the last variant of BS, the relationship between the success of lysis with the extension of the UDCA intake period to 6 months and the preferred choice of Ursofalk was traced. Normalization of the contractile function of the gallbladder was noted in patients who took Ursofalk.

CONCLUSION

From the standpoint of therapeutic effectiveness, the drug of choice for the treatment of BS, regardless of its type, is Ursofalk, which has proven the best dynamics of BS litolysis, recovery of the contractile function of the gastrointestinal tract, and relief of clinical symptoms.

Constipation in adults

.

[Comparison of clinical-metabolic efficacy of pre- and probiotics in the conducted optimized protocols of eradication therapy of Helicobacter pylori infection]

Low patient compliance due to the development of adverse events in the form of antibiotic-associated diarrhea (AAD) is considered as the main reason for the failure of the eradication of optimized anti-Helicobacter therapy regimens. A key mechanism for the development of AAD is to reduce the number and species diversity of bacteria that form butyric acid.

AIM

The purpose of this study was to study the comparative effect on the clinical effectiveness of eradication therapy (ET) of Helicobacter pylori infection and metabolic changes in the colon microbiota of additional inclusion in the optimized treatment regimen of the combined prebiotic Zakofalk (inulin + butyrate) with probiotics (lacto- and bifidobacteria in an amount of at least 1017 СFU).

MATERIALS AND METHODS

120 patients with chronic gastroduodenal diseases and infected H. pylori were еxamined. A comparative analysis of the effect of a combined prebiotic and lacto-bifid-containing probiotics on improving the effectiveness of the optimized ET scheme and improving its tolerability, as well as on the quantitative and qualitative content of short-chain fatty acids (SFA) in feces. The success of eradication was controlled by a 13C urease breath test.

RESULTS

According to the results of the study in randomized groups of patients, an excellent percentage of eradication (95%) was achieved in patients who performed ET with the addition of the prebiotic Zakofalk. In the same group of patients, there was an increase in the absolute content of SFA and a significant increase in the concentration of butyric acid. In the group of patients who received ET with the addition of probiotics, an acceptable level of eradication was achieved (85.7%), but no changes in SFA were found indicating an increase in the number or activity of the butyrate-producing flora. Patients who performed ET without the addition of pre-probiotics did not achieve the target percentage of successful eradication (83.3%), and a significant quantitative decrease in SFA was found with a significant decrease in the proportion of butyric acid.

CONCLUSION

The inclusion of Zakofalk in the ET scheme, in comparison with probiotics, significantly increases the probability of successful eradication, more effectively restores the metabolic potential of the microbiota, and prevents the development of AAD.

Markers of dysbiosis in patients with ulcerative colitis and Crohn's disease

AIM

The aim of the study was to study the taxonomic and functional composition of the gut microbiota in ulcerative colitis (UC) and Crohn's disease (CD) patients to identify key markers of dysbiosis in IBD.

MATERIALS AND METHODS

Fecal samples obtained from 95 IBD patients (78 UC and 17 CD) as well as 96 healthy volunteers were used for whole-genome sequencing carried out on the SOLiD 5500 W platform. Taxonomic profiling was performed by aligning the reeds, not maped on hg19, on MetaPhlAn2 reference database. Reeds were mapped using the HUNAnN2 algorithm to the ChocoPhlAn database to assess the representation of microbial metabolic pathways. Short-chain fatty acids (SCFA) level were measured in fecal samples by gas-liquid chromatographic analysis.

RESULTS

Changes in IBD patients gut microbiota were characterized by an increase in the representation of Proteobacteria and Bacteroidetes phyla bacteria and decrease in the number of Firmicutes phylum bacteria and Euryarchaeota phylum archaea; a decrease in the alpha-diversity index, relative representation of butyrate-producing, hydrogen-utilizing bacteria, and Methanobrevibacter smithii; increase in the relative representation of Ruminococcus gnavus in UC and CD patients and Akkermansia muciniphila in CD patients. Reduction of Butyryl-CoA: acetate CoA transferase gene relative representation in CD patients, decrease of absolute content of SCFA total number as well as particular SCFAs and main SCFAs ratio in IBD patients may indicate inhibition of functional activity and number of anaerobic microflora and/or an change in SCFA utilization by colonocytes.

CONCLUSION

the revealed changes can be considered as typical signs of dysbiosis in IBD patients and can be used as potential targets for IBD patients personalized treatment development.

DIAGNOSTIC AND TACTICAL IMPORTANCE OF STUDYING SHORT CHAIN FATTY ACIDS IN DIFFERENT BIOLOGICAL SUBSTRATES TOOK PLACE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE, LUNG CANCER AND COMMUNITY-ACQUIRED PNEUMONIA DEVELOPED AFTER ANTICANCER THERAPY

The main aim of the study is to examine microbiocenosis of lower respiratory tract and intestine in patients with chronic obstructive pulmonary disease (COPD), lung cancer (LC), lung cancer with community-acquired pneumonia (CAP) and to determine their role in the etiological diagnosis of lower respiratory tract infections (LRTi), including those that develop during cancer chemotherapy (CC), to discuss the possibility of optimizing the treatment tactics.

MATERIALS AND METHODS

To solve this task were examined 147 patients and 30 healthy individuals were divided into 4 groups, according to nosology. The number of patients in the COPD group was 38 people, m / f-35/3, median age 63 (57; 69) years, in the LC group -60 people, m / f - 56/4, with a median age of 65 (58; 71) year; LC groupwith CAP -21 persons m / f - 17/4, with a median age of 73(69; 75) years, in the LC group with CAP developed in the period up to 30 days after the end of chemotherapy (LC with CAP / CC) -28 persons m / f - 22/6, with a median age of 70 (67; 73) years, the norm group -30 healthy persons m / f- 26/4, median age 48(40,691 years. The spectrum of short-chain fatty acids (SCFA) sputum (in bronchoalveolar lavage standards group) and test groups of feces were studied by gas-liquid chromatographic analysis (GLC analysis). Results of the study. In the norm group: total absolute content of SCFA (X) in sputum was 0.032 mg / g, the relative content of acetic acid (pC2) 0906 u, propionic acid (pC3) 0.085 u, butyric acid (pC4) 0.009 u, anaerobic index (Al) -0.104 units. According to the analysis the total absolute content of SCFA in the sputum may be expressed as follows: ∑ SCPA (C2-C4) norm (0,032) <∑ SCFA (C2-C4) COPD (0,201) <∑ SCFA (C2-C4) RL (0,463) < ∑ SCFA (C2-C4) LC with CAP (0.510) < RCMP ∑ (C2-C4) LC with CAP / CC (0.612) (mg / g), the differences are statistically significant when compared with the norm. The findings of the relative content of C2-C4 show a statistically significant increase of the relative content of propionic and butyric acids: PC3 (0,085) pC4 (0.009) norm <pC3 (0.127), pC4 (0,027) COPD <pC3 (0.174), pC4 (0,03 1) LC <pC3 (0.1 981, pC4 (0,037) LC with CAP <pC3 (0.232) pC4 (0,049) LC with CAP/CC (units). While reducing the content of acetic acid: pC2 (0.906) norm> pC2 (0.846) COPD> pC2 (0.792) LC> pC2 (0.765) LC with CAP> pC2 (0.719) LC with CAP / CC (u) in patients of all study groups compared to the norm, and between groups. And the more pronounced changes in the content of SCFA in the sputum are ascertained in lung cancer with CAP during chemotherapy. *The values of Al in the studied groups are displaced to more negative values: Al (- 0.104) rate> Al (- 0.190) COPD> Al (- 0.257) RL> Al (- 0.307) LC with CAP> Al (- 0.391) LC with CAP / CC (sing.) compared with the norm and between groups. The findings of SCPA in feces in the group norm: ~1 SCFA 10.51 mg / g, 0.634 units pC2, pC3 0,189 units, 0,176 units pC4, -0.576 Al units. The total absolute content of SCFA in feces can be expressed as follows: ∑ SCFA (C2-C4) LC (4,11) <∑ SCFA (C2-C4) COPD (4,81) <∑ SCFA (C2-C4) norm (10 51) (mg / g), the differences were statistically significant when compared with the norm; depending on the chemotherapy, preceding the development of the CAP: ∑ SCFA (C2-C4) norm (10,51)> ∑ SCFA (C2-C4) LC with CAP / che- motherapy (5,54)> ∑ SCFA (C2-C4) LC CAP (4,96)> ∑ SCFA (C2-C4) LC (4.11) (mg / g). Results of the study of the relative content of C4-C2 also demonstrate a statistically significant increase of the relative content of propionic and butyric acids: pC3 (0.189), pC4 (0.176) norm <pC3 (0.219), pC4 (0.191) COPO <pC3 (0.239), pC4 (0,201) LC <pC3 (0,250) pC4 (0,221) LC with CAP <pC3 (0,264), pC4 (0.233) LC with CAP / chemotherapy (u), while reducing the content of acetic acid: pC2 (0.634) norm> pC2 (0.590) COPD> pC2 (0,560) LC> pC2 (0.529) LC with CAP> pC2 (0.503) LC with CAP! chemotherapy (u) in patients of all study groups in comparison with the norm. And the more pronounced changes in the content of SCFA in feces are ascertained at LC with CAP during chemotherapy. The values of Al intestinal ecological community of all groups are displaced to more negative values when compared with the norm: Al (- 0.576) norm> Al (- 0.695) COPD> Al (- 0.786) LC> Al ('0.890) LC with CAP> Al (- 0.988) LC with CAP / chemotherapy (u), with the most significant changes were observedin the group of LC with CAP during chemotherapy. Conclusion, Increased absolute SCFA concentration in patients with CQPD, lung cancer, lung cancer with CAP, LC with CAP! CC in comparison with the norm indicates increased number and activity of anaerobic flora, the most significant changes observed in patients with lung cancer with CAP, developed in the period up to 30 days after the end of chemotherapy. The unidirectional changes in SCFA parameters in the sputum and stool demonstrate the dependence of microorganism biocenosis. The resulting information can be used in the etiological diagnosis of LRTI, as well as the development of therapeutic and preventive measures flAw Af infprtiniis rnmnlications and treatment of these patients.