[Effectiveness of empirical Helicobacter pylori eradication therapy with furazolidone in Russia: results from the European Registry on Helicobacter pylori Management (Hp-EuReg)]

BACKGROUND

First-line therapy does not always provide a high level of Helicobacter pylori eradication due to the increase of H. pylori resistance to antibiotics; therefore, it remains necessary to identify the most effective rescue treatments. The purpose of this study was to evaluate the efficacy and safety of empirical H. pylori furazolidone-containing regimens.

MATERIALS AND METHODS

Adult H. pylori infected patients empirically treated with furazolidone-containing eradication regimens were registered in an international, prospective, multicenter non-intervention European registry on H. pylori management (Hp-EuReg). Data were collected at AEG-REDCap e-CRF from 2013 to 2021 and the quality was reviewed. Modified intention-to-treat (mITT) effectiveness analyses were performed.

RESULTS

Overall 106 patients received empirical furazolidone-containing therapy in Russia. Furazolidone was prescribed in a sequential scheme along with amoxicillin, clarithromycin and a proton pump inhibitor in 68 (64%) cases, triple regimens were prescribed in 28 (26%) patients and quadruple regimens in 10 (9.4%). Treatment duration of 7 days was assigned to 2 (1.9%) patients, 10-day eradication therapy in case of 80 (75%) and 14 days - in 24 (23%) patients. Furazolidone was mainly used in first- (79%) and second-line (21%) regimens. The methods used to diagnose H. pylori infection were: histology (81%), stool antigen test (64%), ¹³C-urea breath test (6.6%), and rapid urease test (1.9%). The mITT effectiveness of sequential therapy was 100%; 93% with the triple therapy and 75.5% with quadruple therapy. Compliance was reported in 98% of cases. Adverse events were revealed in 5.7% of patients, mostly nausea (3.8%). No serious adverse events were reported.

CONCLUSION

Furazolidone containing eradication regimens appear to be an effective and safe empirical therapy in Russia.

Role of silymarin as antioxidant in clinical management of chronic liver diseases: a narrative review

Chronic liver disease (CLD), manifested as hepatic injury, is a major cause of global morbidity and mortality. CLD progresses to fibrosis, cirrhosis, and-ultimately-hepatocellular carcinoma (HCC) if left untreated. The different phenotypes of CLD based on their respective clinical features and causative agents include alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), metabolic-associated fatty liver disease (MAFLD), and drug-induced liver injury (DILI). The preferred treatment modality for CLD includes lifestyle modification and diet, along with limited pharmacological agents for symptomatic treatment. Moreover, oxidative stress (OS) is an important pathological mechanism underlying all CLD phenotypes; hence, the use of antioxidants to manage the disease is justified. Based on available clinical evidence, silymarin can be utilized as a hepatoprotective agent, given its potent antioxidant, antifibrotic, and anti-inflammatory properties. The role of silymarin in suppressing OS has been well established, and therefore silymarin is recommended for use in ALD and NAFLD in the guidelines approved by the Russian Medical Scientific Society of Therapists and the Gastroenterology Scientific Society of Russia. However, to discuss the positioning of the original silymarin in clinical guidelines and treatment protocols as a hepatoprotective agent for managing CLD concomitantly with other therapies, an expert panel of international and Russian medical professionals was convened on 11 November 2020. The panel reviewed approaches for the prevention and treatment of OS, existing guidelines for patient management for CLD, and available evidence on the effectiveness of silymarin in reducing OS, fibrosis, and hepatic inflammation and presented in the form of a narrative review. Key messagesAn expert panel of international and Russian medical professionals reviewed existing guidelines for ALD, NAFLD, MAFLD, and DILI to establish consensus recommendations that oxidative stress is the common pathophysiological mechanism underlying these conditions.The panel also discussed the positioning of original silymarin in clinical guidelines and treatment protocols as a hepatoprotective agent for managing CLD concomitantly with other therapies.The panel reviewed the effectiveness of 140 mg original silymarin three times a day in reducing oxidative stress in chronic liver diseases such as ALD, NAFLD, MAFLD, and DILI.

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.

Russian Consensus on Exo- and Endocrine Pancreatic Insufficiency After Surgical Treatment

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian Pancreatic Club using the Delphi method. Its goal was to consolidate the opinions of national experts on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is ensured by the participation of leading gastroenterologists and surgeons.

European Registry on the management of Helicobacter pylori infection (Hp-EuReg): analysis of 2360 patients receiving first-line therapy in Russia

AIM

European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations.

MATERIALS AND METHODS

The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy.

RESULTS

The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effec- tiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clar- ithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Eradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment.

CONCLUSION

Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

[European registry Helicobacter pylori (Hp-EuReg): how has clinical practice changed in Russia from 2013 to 2018 years]

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: "Hp-EuReg") allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations.

MATERIALS AND METHODS

A comparative analysis of the data entered in the register by the Russian research centers "Hp-EuReg", in the period from 2013 to 2018, was conducted.

RESULTS AND DISCUSSION

Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period.

CONCLUSION

In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.

Effectiveness of mebeverine in patients with post-cholecystectomy gastrointestinal spasm: results of prospective observational program "odyssey"

AIM

To assess the effectiveness of mebeverine 200 mg BID in patients with post-cholecystectomy gastrointestinal spasm not requiring surgical treatment.

MATERIALS AND METHODS

218 patients were included in 16 clinical centers in 14 cities in Russia. All patients had post-cholecystectomy gastrointestinal spasms, not requiring surgical treatment and received mebeverine (Duspatalin®) 200 mg BID. The observational assessment period lasted from the moment of their inclusion into the study up to 6 weeks post inlusion. The therapy results were evaluated using visual analog scales (GPA and 11-point numeric rating scale) by patient self-assessment of the dynamics of spasm/discomfort and other post-cholecystectomic gastrointestinal symptoms after 2 and 6 weeks of treatment. Gastrointestinal Quality of Life Index (GIQLI) was used to assess patient quality of life.

RESULTS

All 218 patients completed the 2-week mebeverine treatment course, 101 of them finished the 6-week course ("prolonged population"). Significant positive changes in the relief of abdominal pain and dyspepsia were noted as well as normalization of stool frequency and consistency. A more marked change in values was observed during prolonged (up to 6 weeks) therapy. Both 2-week and 6-week mebeverine courses led to a normalization of patient quality of life. After 6 week therapy, an effect of mebeverine on the quality of life 91% of patients was observed comparable to cholecystectomy itself, speficially related to the quality of life subscore 'symptoms'.

CONCLUSION

The results of our study demonstrate that mebeverine (Duspatalin®) therapy leads to an effective elimination of clinical symptoms associated with post-cholecystectomy GI-spasm disorders, like abdominal pain, symptoms of dyspepsia and stooldisorders. A more marked change in values was observed during prolonged (up to 6 weeks) therapy.

Hemochromatosis - modern condition of the problem

The iron overload syndrome can be associated with various acquired states and hereditary factors. Hereditary hemochromatosis is the most common genetic disorder. Without therapeutic intervention the disease can lead to the development of life-threatening complications such as cirrhosis, hepatocellular carcinoma. The article presents data on pathogenesis, diagnosis and treatment of hereditary hemochromatosis. Own clinical observation is given.

The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children’s Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

[Abdominal pain syndrome and quality of life in patients with cholelithiasis after cholecystectomy during a 10-year follow-up]

AIM

To estimate the incidence of abdominal pain syndrome (APS) and to assess quality of life (QOL) in patients within 10 years after cholecystectomy (CE).

SUBJECTS AND METHODS

This investigation is part of a long-term prospective follow-up study of patients after CE for cholelithiasis (CL). It enrolled 145 people: 30 (21.5%) patients with baseline asymptomatic CL and 115 (80.7%) with its clinical manifestations. The time course of changes in APS and QOL were analyzed.

RESULTS

Over 10 years, all the patients showed a decrease in the incidence of APS from 84.1% (n=95) to 66.4% (n=75; p=0.004). In Group 1 (n=89), APS was at baseline detected in all the patients; 10 years later, its incidence declined to 67.4% (n=60; p < 0.001). Biliary pains were predominant; these had been identified significantly less frequently over the 10-year period in 47 (52.8%) patients; p<0.001). In Group 2 (n=24), pre-CE APS was generally detected in 6 (25%) patients; following 10 years, the incidence rates of pain significantly increased to 62.5% (n=15; p=0.035), among which there were predominant biliary pains (in 54.2%; p<0.001) and dyspepsia from 33.3% (n=8) up to 66.7% (n=16; p=0.039). QOL in the physical and mental health domains was found to decrease in both groups.

CONCLUSION

Ten years after CE, the group with the baseline clinical manifestations of CL and poorer QOL showed a lower incidence of APS mainly due to the reduced incidence of biliary pains and the baseline asymptomatic group exhibited a rise in the incidence of APS due to the appearance of biliary pains and dyspepsia.

The prevalence of bacterial overgrowth syndrome and its associated factors in patients with inflammatory bowel diseases (according to the data of the Novosibirsk registry)

Aim. To assess the prevalence of bacterial overgrowth syndrome (BOS) and its risk factors in patients with inflammatory bowel diseases (IBD). Subjects and methods. The patients from the Novosibirsk IBD registry, who had undergone a hydrogen breath test (HBT) using a Gastro+ device, were examined. Results. In 93 IBD patients who had undergone a HBD, the prevalence of BOS was 48% (46.2% for ulcerative colitis and 51.2% for Crohn’s disease). There was a strong correlation between abdominal bloating, abdominal rumbling, and positive HBT results in both patient groups. During the HBT, the patients with BOS frequently complained of diarrhea, borborygmi, belching, and anxiety. Conclusion. The findings suggest that BOS is highly prevalent among patients with IBD. BOS is associated with clinical symptoms, such as abdominal bloating, abdominal rumbling, tearfulness, and irritability.

The Russian consensus on the diagnosis and treatment of chronic pancreatitis

1Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children’s Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky Saratov State Medical University, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Ministry of Emergency Situations of Russia, Saint Petersburg; 27Federal Research Center, Krasnoyarsk Research Center, Siberian Branch, Russian Academy of Sciences, Research Institute of Medical Problems of the North, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus (a consensus document) on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian «Pancreatic Club» under the Delphi system. Its aim was to identify and consolidate the opinions of Russian experts on the most topical issues of the diagnosis and treatment of chronic pancreatitis. The interdisciplinary approach involved the participation of leading gastroenterologists, surgeons, and pediatricians.

[All-Russian Consensus on Diagnosis and Treatment of Celiac Disease in Children and Adults]

The paper presents the All-Russian consensus on the diagnosis and treatment of celiac disease in children and adults, which has been elaborated by leading experts, such as gastroenterologists and pediatricians of Russia on the basis of the existing Russian and international guidelines. The consensus approved at the 42nd Annual Scientific Session of the Central Research Institute of Gastroenterology on Principles of Evidence-Based Medicine into Clinical Practice (March 2-3, 2016). The consensus is intended for practitioners engaged in the management and treatment of patients with celiac disease. Evidence for the main provisions of the consensus was sought in electronic databases. In making recommendations, the main source was the publications included in the Cochrane Library, EMBASE, MEDLINE, and PubMed. The search depth was 10 years. Recommendations in the preliminary version were reviewed by independent experts. Voting was done by the Delphic polling system.

[Successes and unsolved problems in the study of celiac disease]

The review gives current views on the problem of celiac disease (gluten enteropathy). It presents the pathogenetic components of pathology development, associations with the specific features of the microflora in different parts of the gastrointestinal tract, as well as groups at risk for this pathology. The idea on other types of gluten intolerance is briefly given. Current elaborated approaches to gluten enteropathy therapy are provided.

HEPATIC SARCOIDOSIS

Sarcoidosis is a multisystemic disease of unknown origin characterized by the formation of non caseating granulomas. Thoracic involvement is the most common presentation; however, sarcoidosis can involve almost any other organ. Liver is one of the most frequently affected organs after lungs and lymph nodes. Microscopic hepatic involvement is common in these patients but is mostly clinically silent. specific symptoms include jaundice and pruritus, mostly from chronic cholestasis. In a significant portion of these patients, macroscopic findings can be detected by ultrasound examination ,abdominal CT or magnetic resonance imaging and these findings may easily be confused with other benign and malignant conditions of the liver. Liver biopsy is usually required to confirm the diagnosis. Not all cases of hepatic sarcoidosis require treatment. For symptomatic patients, the first line treatment includes corticosteroids or ursodeoxycholic acid.

PRINCIPLES OF DIAGNOSIS OF GLUTEN-ASSOCIATED DISEASES

According the background of increasing consumption of gluten-containing products by the population increase in the prevalence and expanding the range of gluten-related diseases was marked. Gluten proteins and other cereals have been recognized as a possible cause of allergies to wheat, and non-celiac gluten sensitivity has been described as a new syndrome (NCGS). The article presents a modern view on the problem of gluten-related diseases, deiThition of NCGS, approaches to the diagnosis and recommendations for management of patients with this pathology.

THE VALUE OF THE REGISTER WITH INFLAMMATORY BOWEL DISEASE TO ASSESS THE EFFECTIVENESS OF DIAGNOSTIC AND TREATMENT ACTIVITIES

Inflammatory bowel diseases (IBD) are chronic recurrent immune-mediated inflammation of the gastrointestinal tract. Now it is not unified system of monitoring patients with IBD in Russia, but there is information from different regions about the prevalence of disease. There are the registers in few big cities. From 2003 the registers of IBO have been done in Novosibirsk. The register data can give us the possibility to estimate the various real-time data of the disease, to analyze the effect of the treatment, to evaluate risk factors for the disease in real clinical practice. Among the patients with ulcerative colitis decreased the number ofpatients with recurrent and continuous increase in the number of patients with distal forms, which is probably due to the more skillful conduct of patients. in general, it decreased the number of patients with Crohns disease with continuously relapsing course option, reflecting, perhaps, improved treatment. Decline in the proportion of persons with the localization process, only in the colon, which is associated with greater availability of diagnostic methods for destruction of the small intestine. The registry was created in April 2012 and includes patients registered up to October 2015.

FULMINANT PARACETAMOL HEPATITIS

This article describes a clinical case of fulminant paracetamoly hepatitis a young woman of 33 years. Fulminant hepatitis has developed as a consequence of uncontrolled reception paracetamol-containing medicines for acute viral infection. Paracetamol poisoning conlirmed at autopsy.

THE FREQUENCY OF DYSPEPTIC DISORDERS FOLLOWING CHOLECYSTECTOMY PATIENTS ACCORDING TO THE 10-YEAR STUDY

AIM

To evaluate gastrointestinal symptoms during 10 years after cholecystectomy in patients with symptomatic and asymptomatic gallstone disease and to identify predictors of them.

MATERIALS AND METHODS

The work is the part of a prospective long-term monitoring of patients with symptomatic (1) and asymptomatic (2) gallstone disease after cholecystectomy (CE). The study included 145 patients: 115 (80.7%) with initially symptomatic disease (1) and 30(21.5%) asymptomatic (2) disease.

RESULTS

The frequency of heartburn increased from 15.9% to 63.7% during 10 years (p = 0.015) after CE especially in the group (1) (from 2.24% to 68.53% (p 0.037). The frequency of "bitter taste in the mouth" raised from 46.9% before the CE to 69.02% after CE (p < 0.001). The frequency of diarrhea increased from 0.88% to 38.2% in both groups. (p = 0.046).

CONCLUSION

The frequency of heartburn, "bitter taste in the mouth", diarrhea increased in patients after 10 years in patients with symptomatic and asymptomatic gallstone disease after CE. A common risk factors are presence symptomps at baseline and the presence of these symptoms at the 6rst years after CE.

[FECAL NONINVASIVE TESTS (CALPROTECTIN, TRANSFERRIN, HEMOGLOBIN) IN COMPLEX DIAGNOSIS OF DISEASES OF INTESTINES]

A research objective was the assessment of informational content of fecal noninvasive tests (calprotectin, transferrin, hemoglobin) in complex diagnosis of diseases of intestines. Open kogortny research by method of a cross cut included 52 patients (middle age - 38,6 years) with IBS-like symptoms (abdominal pain or discomfort, change of frequency and/or character of a chair). Sensitivity of dough on calprotectin for diagnosis of organic pathology of intestines made (89%), for dough on calprotectin and hemoglobin - also 89%. At patients at incomplete compliance of clinical signs to diagnostic criteria of IBS and lack of endoscopic signs of damage of a large intestine research on fecal biomarkers allows to increase efficiency of diagnostics.

[CLINICAL CASE OF CROHN'S DISEASE: A DIFFICULT PATH TO DIAGNOSIS]

This article presents a case of Crohn's disease in a man who was veracity of 30 years from the onset of the disease. This case demonstrating complexity of diagnostic search, even with the classic version of the disease. And it demonstrates the need for a thorough medical history, differential diagnosis.

[GASTROENTEROLOGICAL SYMPTOM IN DIABETES MELLITUS TYPE 2]

The data of the literature and own data on the frequency and mechanisms of gastrointestinal symptoms in patients with diabetes mellitus type 2 are discussed. Changes in the gastrointestinal tract with diabetes mellitus type 2 are detected over its entire length and occur more frequently than in the general population. Among the reasons of it the presence of autonomic neuropathy, factor of hyperglycemia, increased anxiety and depression in patients are discussed.

Human gut microbiota community structures in urban and rural populations in Russia

The microbial community of the human gut has a crucial role in sustaining host homeostasis. High-throughput DNA sequencing has delineated the structural and functional configurations of gut metagenomes in world populations. The microbiota of the Russian population is of particular interest to researchers, because Russia encompasses a uniquely wide range of environmental conditions and ethnogeographical cohorts. Here we conduct a shotgun metagenomic analysis of gut microbiota samples from 96 healthy Russian adult subjects, which reveals novel microbial community structures. The communities from several rural regions display similarities within each region and are dominated by the bacterial taxa associated with the healthy gut. Functional analysis shows that the metabolic pathways exhibiting differential abundance in the novel types are primarily associated with the trade-off between the Bacteroidetes and Firmicutes phyla. The specific signatures of the Russian gut microbiota are likely linked to the host diet, cultural habits and socioeconomic status.

[Patient compliance as one of the factors determining the efficiency of eradication therapy]

AIM

To improve the quality of eradication therapy (ET), by increasing patient compliance.

SUBJECTS AND METHODS

An open-label cohort multicenter randomized study was conducted. A total of 350 patients with Helicobacter pylori infection-associated diseases and indications for ET were examined. Work was done to improve compliance in a study patient group before treatment.

RESULTS

In the study group of patients motivated for treatment, the efficiency of ET was significantly higher than in the control group. The factors influencing treatment adherence were identified and methods to optimize compliance during H. pylori eradication were developed.

CONCLUSION

Awareness of the essence of the disease in a patient and his higher motivation for compliance are one of the components of successful H. pylori eradication.

[Long-term dynamics of gastrointestinal symptoms after cholecystectomy for the treatment of cholelithiasis]

The aim of the work was to analyse dynamics of gastrointestinal symptoms and risk factors at different periods after cholecystectomy (CCE) in patients with cholelithiasis (CL). It was a prospective open cohort observational study with interviewing the patients before, 6 and 36 months after cholecystectomy for the treatment of CL. The pain symptom of CL persisted in 65.9% of the patients till the 6th month after CCE and in 57.3% of the patients till the 36th month. The logistic univariant analysis showed high probability of persistence and/or appearance of biliary pain within 6 months after surgery in patients suffering biliary colic before it (OR = 5.3, p = 0.01) and having hereditary aggravation of CL (OR = 2.7, p = 0.38). The relationship between biliary pain and planned surgical intervention for the treatment of CL was documented 3 years after the operation (OR = 2.6, p = 0.018). Similar relationship was revealed after 6 and 36 months (OR = 3.8, p = 0.002). Biliary pain within 6 months after CL was an independent prognostic factor of its development within the next 3 years. Other increasingly severe gastrointestinal symptoms were heartburn, intolerance of greasy food, and disturbed intestinal passage as a result of biliary insufficiency or disordered intestinal motility. The above relationships between gastrointestinal symptoms may be used to predict their appearance within 6 months after CL.

[Clinical characteristics of dyspepsia in patients with diabetes mellitus type 2]

AIM

To estimate the prevalence of dyspepsia and to study its clinical manifestations and risk factors in patients with type 2 diabetes mellitus.

SUBJECTS AND METHODS

One hundred and seven patients with type 2 DM and 33 with functional dyspepsia were examined. A clinical and laboratory study and testing were made to identify the symptoms of dyspepsia; dyspepsia-associated factors were studied.

RESULTS

Dyspepsia was observed in 71.0% of the examined patients with type 2 DM. It may be attributed to organic gastrointestinal tract (GIT) diseases only in 42.3% of cases. In the type 2 DM patients, dyspepsia that could not be explained by organic GIT diseases was mainly manifested by a dyskinetic type while an ulcer-like type was prevalent in those with organic GIT diseases. In the patients with type 2 DM, dyspepsia that could not be accounted for GIT diseases was associated with the duration of carbohydrate metabolism disturbance, the presence of diabetic complications, Helicobacter pylori infection, and patient age. Some symptoms of dyspepsia (repletion and epigastric discomfort), which could not be explained by organic GIT diseases in patients with type 2 DM were associated with diabetic complications and carbohydrate metabolic parameters.

CONCLUSION

Dyspepsia in type 2 DM was observed in 71% of cases; it can be due to organic GIT diseases in 42.3% and its association with digestive organ pathology was not revealed in 57.7%.

[Evaluation of the efficacy of prucalopride (resolor) in the treatment of patients with chronic constipation]

AIM

To evaluate the efficacy of the enterokinetic prucalopride (resolor) in patients with chronic constipation.

SUBJECTS

The effect of treatment with prucalopride (resolor) in 109 patients with chronic constipation was analyzed.

RESULTS

The effect was noted in 82% of the patients; 61 patients were fully satisfied with treatment results. Among the adverse reactions, headache that was particularly significant on the first days of use, diarrhea, and cramping abdominal pain were reported by 35, 17, and 13% of the included patients, respectively. The authors' experience with prucalopride demonstrated that the patients with chronic constipation displayed the good efficacy of the drug in both the frequency of stool and the elimination of all other constipation symptoms (straining effort, incomplete bowel emptying sensation, solid stool, bloating), and its good tolerability.

CONCLUSION

Prucalopride (resolor) exerts a predictable effect, can extend a physician's capacity to arrest chronic constipation, and, when the drug is used, requires no long-term dose adjustment.

[Different characteristics of quality of life in celiac disease patients]

AIM

To study quality of life (QoL) in patients with celiac disease (CD) in the course of treatment with aglutenic diet (AD).

MATERIAL AND METHODS

Modern algorithm of glutenic enteropathy diagnosis (enzyme immunoassay, histological examination of the biopsy of distal duodenum mucosa) was used in 650 patients with different gastrointestinal symptoms. QoL was assessed in the course of AD treatment of CD with application of universal standard questionnaire MOS SF-36.

RESULTS

CD was diagnosed in 56 (8.6%) patients. Classic CD was diagnosed in 44 (78.6%) patients, atypical CD--in 12 (21.4%). Significant lowering of QoL characteristic psychological health" was observed in CD patients under 30 and over 50 and "physical health" in 30-50-year-old CD patients. Women had low points on "mental health" scale. After 3 AD months QoL worsened by all the scales, but after 12 months QoL significantly improved.

CONCLUSION

QoL in patients with classic CD is associated with gender and age. First, AD deteriorates QoL, but 1-year diet therapy improves QoL.

[Drug UDCA (Ursosan) in therapeutic management of patients Barrett's esophagus]

OBJECTIVE

to evaluate the five-year prospective study the possibility of using the drug UDCA (Ursosan) for the therapeutic management of patients with BE older.

MATERIALS AND METHODS

A prospective open randomized, parallel-group 62 patients of BE with a length of metaplasia less than 3 cm in average age 72.8 +/- 2.8 years. Method of "sealed envelopes" were divided into two equal groups. Patients first--received omeprazole at a daily dose of 40 mg, the second--to combine the same dose of omeprazole drug-Ursosan a daily dose of 10 mg/kg. At baseline and after 4.8+1.2 years assessed the frequency of esophageal, extraesophageal and dyspeptic complaints, endoscopic and morphological pattern of esophageal-gastric junction and lower third of the esophagus. Confirm or exclude the diagnosis of BE during follow-up study was performed after a two-fold endoscopy upper GIT using subdivision techniques for sampling biopsy material and subsequent analysis of biopsy samples pathomorphology of various medical institutions.

RESULTS

The combination therapy with omeprazole and drug UDCA contributed to the positive dynamics is the lack of intestinal metaplasia in 32.3% of patients with Barrett's esophagus, whereas monotherapy with omeprazole in a daily dose of 40 mg possible to achieve a similar result in 6.5% of patients (p = 0,01). The frequency of diagnosis of erosive esophagitis decreased after 5 years of therapy with 80.6% to 51.6% (p = 0.016) in the omeprazole group and 86.7% to 16.7% (p < 0.001) in the group receiving omeprazole and the preparation of UDCA.

CONCLUSION

This study suggests the possibility of combined therapy with omeprazole and the preparation of UDCA (Ursosan) as a promising means for hemopreventciya Barrett's esophagus in the elderly.

[Clinical features of different variants of excretory pancreatic insufficiency]

AIM

To analyse course of excretory pancreatic insufficiency (EPI) of pancreatic and not origin as well as factors associated with its development.

MATERIAL AND METHODS

A total of 139 patients with chronic pancreatitis or malabsorption were examined. The pancreatic function was assessed by the results of elastase test - concentration of pancreatic elastase 1 in the feces. EPI was detected in 57 patients (fecal pancreatic elastase 1 under 200 mcg/g); 38 patients had chronic pancreatitis and absolute EPI, 19 patients had relative EPI (the elastase was low, pancreatic pathology was absent, but other gastroenterological diseases were present--enteropathy, Crohn's disease, previous surgery).

RESULTS

Pancreatic insufficiency in patients with pancreatitis was 36.5%. It was associated with the disease duration. Diarrheal and asthenic syndromes, normal or low lipase levels in the serum were found. Patients with relative insufficiency were significantly younger, had shorter disease duration, more frequent diarrhea, were thinner. Correction of diarrheal syndrome was more successful in patients with absolute insufficiency. Pancreatic elastase concentration in the feces persisted for a year in patients with absolute EPI and normalized in patients with enteropathies after etiotropic and pathogenetic therapy.

[Lanzoptol efficiency for heartburn alleviation in patients with NERD]

Now you can find a growing interest in modern proton pump inhibitors. This article presents results of Lanzoptol (lansoprazol company "Krka", Slovenia) drug study. This study involved 30 people including 13 women and 17 men. Study included patients with NERD aged from 18 to 65 years with clinical manifestations like pyrosis, regurgitation, epigastrium pain and in with absence of esophageal ulcers and erosions at endoscopic study. Duration of disease ranged from 2 months to 20 years. Results of the therapy: completely stopped heartburn for 4 weeks of treatment at 26 people (87%), partly--at 4. 9 patients got acute pharmacological test with 48-hour pH meter. The average time percentage at pH <4 decreased in 2 times, amount of acid esophageal reflux at pH <4--decreased in 4,5 times, the number of long-Esophageal Reflux decreased in 1,5 times. De Meester combined ratio decreased in 2 times. According to the daily pH meter speed of antisecretory effect on the average was 135 minutes. Lanzopotol portability is good, side effects hasn't been identified. So, Lanzoptol demonstrated a high rate of antisecretory effect and high clinical efficacy with an excellent portability.

[Splenic flexure and irritable colon syndromes: conjugate conditions]

AIM

To investigate phenotypical and clinical characteristics in individuals with high fixation of the splenic angle (HFSA).

MATERIAL AND METHODS

The study group included 82 patients with HFSA, the comparison group--76 patients with irritable colon syndrome (ICS), control group--19 patients without colon pathology. the results of the following examinations were analysed: the disease history, detailed intestinal investigation, rectal sensitivity, constitution, connective tissue weakness, vegetative dysfunction and regulation.

RESULTS

HFSA is encountered mainly in persons with hyperstenic constitution. Some HFSA patients have pain on the left side--splenic flexure syndrome (SFS). The pain corresponds most to clinical criteria of irritable colon syndrome diagnosis and is accompanied with reduced threshold of pain sensitivity to balloon extension. Provoking factors of the symptoms are stress situations in childhood.

CONCLUSION

SFS can be considered as a variant of ICS arising in HFSA. The treatment should be based on the principles of ICS treatment.

[Diabetes mellitus and dyspepsia syndrome]

The frequency of dyspeptic symptoms in patients with diabetes mellitus is higher than in non-diabetic subjects. The origin of dyspepsia in diabetics is debatable. The development of this condition appears to depend on sex, duration of the disease, diabetic complications, correction of hyperglycemia, and infection by different strains of Helicobacterpylori. In patients without organic gastrointestinal diseases, dyspeptic symptoms may be regarded as manifestations of autonomous diabetic neuropathy or of functional dyspepsia syndrome in the absence of neuropathy.

[Cirrhotic cardiomyopathy]

Modern studies have shown that hepatic cirrhosis (HC) is accompanied by moderate cardiac dysfunction. The character and degree of these changes do not depend on the etiology of HC and manifest by an increased ventricular wall thickness and diastolic dysfunction, which deteriorate with ascite and physical labor, as well as basal hyperdynamic systolic dysfunction with pathologic response to physical stress. The latter decreases physical tolerance, which contributes to the development of chronic fatigue syndrome and lowered working ability in HC patients. Cardiovascular changes get reversed in 6 to 12 months after hepatic transplantation.

[The efficacy of antifungal therapy in treatment of gastric ulcer]

Certain general and local factors can increase the probability of complications of gastric ulcer (GU) and addition of conditionally pathogenic fungi (CPF), which requires direct examination of GU patients for fungous infections. Considering that addition of active CPF forms to ulcerous defects lead to enlargement and deepening of ulcers and postpones their healing, all patients with GU complicated by addition of CPF were administered antifungal drugs. A comparative study found no significant differences in the efficacy of eradication of fungal infection between system (resorbable) and luminal (non-resorbable) antimycotics.

[Colon diverticula: origin, prevalence, clinical manifestations]

AIM

To study prevalence of colon diverticula (CD) and phenotypical features of patients with this anomaly.

MATERIAL AND METHODS

At the first stage of the study we analysed colon x-ray evidence for 3 years to assess prevalence of CD. At the second stage we examined 59 patients with CD. Sixty patients with idiopathic constipation and 48 patients with irritable colon syndrome served control.

RESULTS

We discovered the following independent factors associated with a high CD risk: history of CD in the relatives of the patients (OR 24.6; 95% CI 5.23-116.23; p = 0.0001) and age of the patient (OR 2.5; 95% CI 1.03-1.13; p = 0.0010). Age-dependent CD occurrence, similar anomalies in the relatives, other structural gastrointestinal anomalies in them, hyperaminociduria suggest that CD represent a metabolic involutionary process with hereditary predisposition. CD manifested clinically with abdominal pain and problems with colon passage. Abdominal pain related to defecation occurred with low pain threshold to extension. Abdominal pain risk in CD patients is significantly associated with intestinal infections (OR 4.56; 95% CI 1.09-18.97; chi-square = 4.34; p = 0.0372) and connective tissue dysplasia syndrome (OR 2.21; 95% CI 1.23-3.95; chi-square = 7.08; p = 0.0078). Independent risk factors of constipation in CD are non-morning defecation (OR 8.68; 95% CI 1.55-48.51; chi-square = 6.06; p = 0.0138), connective tissue dysplasia syndrome (OR 1.77; 95% CI 1.0-3.20; chisquare = 3.65; p = 0.0501), sedentary life style (OR 7.42; 94% CI 1.24 - 44.57; chi-square = 4.81; p = 0.0284).

CONCLUSION

Incomplete CD reflect colon involution. Abdominal pain associated with defecation has much in common with irritable colon syndrome.

[Clinical manifestations of vegetative dysfunction in patients with irritated bowel syndrome]

The purpose of the study was to evaluate interrelations between clinical manifestations of irritated bowel syndrome (IBS) and vegetative dysfunction (VD). The subjects were 153 patients with gastroduodenal pathology: 120--with IBS, and 23--with inflammatory bowel diseases (IBD). The study found that vegetative dysfunction was associated with IBS more often than with IBD. Clinical manifestations of IBS were associated with VD syndrome (VDS), including high intensivity and frequency of abdominal pain, feeling of abdominal swelling, elevated anxiety level, and low rectal sensitivity threshold. VDS is probably one of the links of its pathogenesis. VDS is not associated with a type of intestinal passage disorder. VDS in IBS patients is often of constitutional character and is associated with lower life quality.

[Biliary tract in patients with chronic viral hepatitides]

AIM

To characterize motor-kinetic and inflammatory changes in extrahepatic biliary tracts and gallbladder in patients with chronic viral hepatitis (CVH). To ascertain whether there is a pathogenetic correlation between affection of the biliary system and viral infection.

MATERIAL AND METHODS

The condition of the biliary tract was examined in 183 patients with CVH using fractionated duodenal tubing with biochemical tests and bacteriological investigation of bile, dynamic ultrasonic investigation.

RESULTS

69.9% patients were diagnosed to have dysfunction of the Oddi's sphyncter caused by its hypertonicity, 4.4% patients had hypotonic sphyncter. Hyper- and hypotonicity of the gallbladder were observed in 45.8 and 20.8% patients, respectively. Biliary dysfunction was associated with the process activity but not with a nosological form of the disease. Chronic acalculous cholecystitis was verified in 21.2% patients.

CONCLUSION

Chronic HBV and HCV infections are accompanied with biliary dysfunctions associated with activity of inflammation in the liver. Oddi's sphincter dysfunction in CVH is a risk factor of gallbladder inflammation.

[Mycotic infection in gastric peptic ulcer]

To assess the risk factors of mycotic infection on the gastric mucosa (GM) in patients with gastric peptic ulcer, 34 patients who had much mycelium on the bottom of the defect and 122 patients without fungal infection were examined in detail. The occurrence of mycotic infection in patients with ulcerative defects was associated with a variety of both local (the depth, number, large sizes of defects, diminished gastric acid-producing ability) and total (age, trophological insufficiency, iron-deficiency anemia, oral mycotic disease, autonomic dysfunction) factors. Mycotic involvement of ulcerative defects is secondary and regarded as a focal manifestation of mycotic infection. The likely impact of mycotic infection on the quality of ulcerative defect scarring makes us consider whether antimycotic agents should be added to antiulcerative therapy.

[Medico-economic efficacy of eradication schemes in helicobacter infections in patients with duodenal ulcers]

The purpose of the study was to make a comparative medical and economic analysis of the application of Rabeprazole (Pariet) and Omeprazole generic in a seven-day eradication therapy.

[Role of grandaxin in the treatment of functional gastrointestinal diseases]

AIM

To assess efficacy of grandaxine in correction of anxiety syndrome and vegetative dysfunction in patients with gastrointestinal diseases.

MATERIAL AND METHODS

The trial included 59 patients with functional gastrointestinal, emotional and vegetative disorders who failed standard therapy. 43 patients of the test group received standard therapy in combination with grandaxine.

RESULTS

Anxiety (Spilberg-Khanin scale), vegetative dysfunction (Vein scale) reduced in 90% of the patients of the test group more significantly than in the control group. Intestinal passage in patients with irritable colon syndrome improved also.

CONCLUSION

A pronounced role of psychovegetative disorders was confirmed in development of functional gastrointestinal disorders. Grandaxine proved efficient in correction of such disorders irrespective of location of the pathology and prevalent tonicity of the autonomic nervous system.