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.

Effect of Prebiotic Complex on Gut Microbiota and Endotoxemia in Female Rats with Modeled Heart Failure

We studied the levels endotoxin and microbial markers in the blood of female rats with experimental heart failure and the effects of preliminary treatment with a prebiotic complex based on fermented wheat bran and inactivated Saccharomyces cerevisiae culture on these parameters. The concentrations of endotoxin, markers of lactobacilli, and opportunistic microorganisms were found to increase in rats with experimental heart failure and significantly decreased against the background of treatment with prebiotic complex. The dynamics of markers of bifidobacteria, eubacteria, and propionibacteria were reciprocal. The observed effect of the prebiotic complex effect on gut microbiota in rats with experimental heart failure suggests that this complex can be used for the correction of intestinal dysbiosis and endotoxemia in this clinical condition.

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.

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.

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.

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.

Randomised clinical trial: the efficacy and safety of propionyl-L-carnitine therapy in patients with ulcerative colitis receiving stable oral treatment

BACKGROUND

Ulcerative colitis (UC) is characterised by impaired fatty-acid oxidation; l-carnitine has a key role in fatty-acid metabolism and short-chain fatty acids such as butyrate and propionate are important energy source for intestinal epithelial cells.

AIM

To evaluate efficacy and safety of colon-release propionyl-L-carnitine (PLC) in patients with mild-to-moderate UC receiving stable oral aminosalicylate or thiopurine therapy.

METHODS

In a multicentre, phase II, double-blind, parallel-group trial, patients were randomised to receive PLC 1 g/day, PLC 2 g/day or placebo. Main inclusion criteria were as follows: age 18-75; disease activity index (DAI) score 3-10 inclusive, be under oral stable treatment with aminosalicylate or thiopurine. The primary endpoint was clinical/endoscopic response, defined as a decrease in DAI score ≥ 3 points or remission, defined as a DAI score ≤ 2 with no individual sub-score > 1.

RESULTS

Of 121 patients who were randomised, 57 of 79 (72%) patients receiving PLC (combined 1 g and 2 g cohort) had a clinical/endoscopic response vs. 20 of 40 (50%) receiving placebo (P = 0.02). Specifically, in PLC 1 g/day group, 30 of 40 (75%) patients had clinical/endoscopic response (P = 0.02 vs. placebo) and 27 of 39 (69%) in the PLC 2 g/day group (P = 0.08 vs. placebo). Rates of remission were 22/40 (55%), 19/39 (49%), 14/40 (35%) in the PLC 1 g, PLC 2 g, and placebo groups, respectively. PLC had a similar safety profile to placebo; the most common adverse events were gastrointestinal.

CONCLUSION

Propionyl-L-carnitine 1 g/day should be investigated further as a co-treatment for mild-to-moderate ulcerative colitis (NCT-01026857).

[Chronic pancreatitis: microbe-intestinal tissue complex and systemic inflammatory response]

Today in Russian Federation, we observe significant growth of the chronic pancreatitis incidence with the depression of its therapy efficiency (more than 20% of the patients) and complications rate growth. In many respects given tendency is associated with the inefficiency of traditional medications combination in the context of inflammation process reduction, gut dysbiosis correction and chronic inflammation reaction depression. Present-day studies indicates, that the grade and character of inflammation in the pancreas depends on the pro- and anti-inflammatory cytokines balance, which is associated with the elevation of the pathogenic microbiota concentration and permeability of the gut. We estimate clinical efficacy of complex treatment regimen (PPI, spasmolytic, multienzyme and prebiotic therapy) in the patients with chronic pancreatitis and its effect on chronic system inflammation. We established that efficacy of modern complex treatment regimen depends on its influence on chronic system inflammation and that prebiotics addition potentiates correction of dysbiotic changes in the gut microbial-tissular complex and reduces grade of system inflammation.

[Device laboratory and postmortem parallels in alcoholic hepatitis during combined therapy using thioctic (alpha-lipoic) acid]

The absence of clinical, biochemical, and instrumental signs that characterize the morphological pattern of the liver presents an urgent problem in the diagnosis of alcoholic hepatitis (AH). Sixty-one patients (mean age 41.7 +/- 8.7 years) were examined to study relationships between the histomorphological parameters and laboratory and instrumental findings in patients with AH on combined treatment including alpha-lipoic acid (Berlition). Indirect assessment of the histological activity of the disease may use the parameters of the serum activity of aspartate aminotransferase and gamma-glutamine aminotransferase, the stages of hepatic fibrosis-ultrasound symptoms: the splenic index at the early stages of the disease, the diameter of the splenic vein in moderate and severe fibrosis. The supplementation of Berlition in the combined therapy for AH decreases the severity of fatty hepatocytic dystrophy, hepatic inflammatory and necrotic changes, no increase or a decrease in the stage of fibrotic changes in the liver tissue.

[Acid-base blood balance in patients with ulcer under treatment by the gastric secretion inhibitors and antacids]

There was an analysis of the results of the study of intragastric acidity and acid-base balance (ABB) of the blood in 25 patients with duodenal ulcer. The patients were examined before and against the background of the 14-day monotherapy with one of the following preparations: Losec, 40 mg (omeprazole), famotidine, 80 mg (Quamatel), Phosphalugel, or placebo.

[Pharmacotherapy of non-associated with Helicobacter pylori ulcer]

Examination and pharmacotherapy were performed in 77 patients with ulcer disease (48 patients with duodenal ulcer, 29 patients had gastric ulcer). The disease was not associated with Helicobacter pylori. Ulcer disease free of Helicobacter pylori was treated with famotidine within 5 days since the recurrence onset (in acute phase of ulcer defect) followed by intake of phosphalugel (in duodenal ulcer) or de-nol (in gastric ulcer). Such treatment appeared more effective than ranitidine therapy as it consolidates stable remission and produced minimal side effects.

[New prospects in treating chronic pancreatitis (clinico-pharmacoeconomic study)]

The argument about advantages of certain herniotomy methods has not been settled up to now. Some authors believe that it is reasonable to perform a Shouldice's operation for all inguinal hernias, while others think that it is optimum to use synthetic materials. Certain surgeons prefer endoscopic techniques for recurrent inguinal hernias, etc. In all fairness, it should be acknowledged that none of the currently available hernioplasty methods can ultimately secure against a recurrence of hernia one hundred per cent. Only a differentiated approach to the selection of surgery methods, sufficient surgeon's experience in this field, thorough analysis of remote results of his own operations as well as the use of up-to-date plastic materials, all taken in the aggregate, can considerable improve the results of herniotomy.

[Characteristics of non-Helicobacter pylori ulcer disease]

AIM

To characterize clinicomorphological and psychosomatic manifestations of ulcer disease (UD) with reference to Helicobacter pylori (HP) contamination of gastric mucosa.

MATERIAL AND METHODS

Out of 411 UD patients HP invasion was diagnosed in 338.

RESULTS

Patients with UD having no HP in gastric mucosa showed clinical peculiarities related to changes in psychological and vegetative status.

CONCLUSION

The addition of psychopharmacological drugs to conventional antiulcer therapy promoted induction of clinicoendoscopic remission of UD within optimal time and improved quality of life in patients without HP infection in the stomach.

[Dyspepsia of a nonulcerous nature in servicemen under conditions of ecological-occupational stress]

In the result of complex examination of servicemen with non-ulcer dyspepsia in the conditions of ecological-professional tension it was found out that clinical manifestations of this pathology were the following: existence of morphological substrate as erosive--acute or chronic--and follicular changes of gastroduodenal mucosa. As a rule the non-ulcer dyspepsia in patients with intact mucosa is accompanied by isolated motor-evacuative disorders of stomach and duodenum.

[Acute and chronic gastroduodenal erosions: characteristics of etiology, pathogenesis, clinical aspects and diagnosis]

Comprehensive investigation of 2620 patients with general somatic diseases revealed acute gastroduodenal erosions in 252 of them and chronic gastroduodenal erosions in 178 patients. Principal differences between clinical, endoscopic and morphological features of those two types of erosion due to etiological and pathogenetic character of their formation were established as the changes in the immune response, disorders in the protein and lipid metabolism. Almost 75% of chronic erosions correlated with circulation disorders, the diseases of hepatobiliary system and were their local morphological equivalents.

[The course of the reparative process in patients with gastric and duodenal peptic ulcers (a clinico-statistical study)]

Clinico-statistical evaluation of reparative process in 332 gastric ulcer and 294 duodenal ulcer patients revealed factors of objective value to its course. In order of significance the factors rank as follows: area of ulcer, localization, combination with certain mucosal erosions, total fasting acidity, free fasting hydrochloric acid, basal gastric secretion, cardial function, duodenogastric reflux, sex, age, number of cigarettes smoked daily. When studying treatment effects on regeneration in ulcer patients in is necessary to take into consideration basal clinico-endoscopic parameters.

[The dynamic functional-morphological changes in the small intestine of obese patients undergoing weight-reducing diet therapy]

Two groups of pathogenetic mucosal changes peculiar to fasting period were revealed in 28 obese patients: a structural rearrangement of mucosa with inhibition of mitotic activity of epithelial crypts, and the inflammatory responses manifested by increased cellular infiltration of stroma and compensatory-adaptive changes of capillary bed structures. The adequate dietotherapy provided full recovery of the mucosa tissue parameters on the 26th day.

[Erosive changes of the gastroduodenal mucosa--is it a pre-ulcer state?]

The evidence obtained on 280 ulcer patients, 107 of whom have preulcer erosive gastritis, duodenitis or gastroduodenitis, suggest the conclusion on ulcerogenesis dependence on the type and site of erosions, response of blood germs, characteristics of protein, carbohydrate and electrolyte metabolism. Erosive processes in the gastroduodenal mucosa seem a facultative preulcer state.

[The specificity of the peripheral blood changes in patients with gastric peptic ulcer]

Leucocytes were studied in 112 patients with ulcer disease of the stomach in comparison with periods of existence of an ulcer defect of the gastric mucosa. Methods of statistical analysis allowed to establish that the peripheral blood shows phasic changes in the absolute content of the leucocytes and their forms, pathogenetically related to the course of the reparative process.

[Functional and morphological status of the gastric mucosa mast cells on the administration of dimedrol and suprastin]

Histochemical and morphometric analysis of mast cells of the gastric and duodenal mucosa of rats given dyphenhydramine and suprastin for a long period of time (up to 45 days) revealed an increase in their functional activity that manifested in the enhancement of the processes of neoformation and maturation of juvenile mast cells and in the increased break down of mature cellular forms.