Vol 84, No 2 (2012)

Aim. To determine a population level and significance of Helicobacter pylori in normal microbiocenosis and dysbiosis of mucosal microflora in the esophagogastroduodenal zone. Material and methods. Qualitative and quantitative composition of mucosal microflora was defined in biopsy specimens from different parts of the esophagus, stomach and duodenum and clinical and histological examinations were made in 50 healthy volunteers, 130 duodenal ulcer patients, 24 patients with gastric ulcer, 36 with chronic gastritis and 24 with chronic esophagitis. Results. H. pylori is a component of normal mucosal microbiota of the oesophagus, stomach and duodenum. These bacteria protect normal gastrointestinal microflora. Exacerbations of peptic ulcer, chronic gastritis and oesophagitis are accompanied with overgrowth of dysbiotic mucosal microflora and reduction of H. pylori content in most cases. Healing and scar formation occur both in the presence and absence of H. pylori. Conclusion. The presence of H. pylori in mucosal microbiocenosis in the oesophagogastroduodenal zone has no independent significance in exacerbation of ulcer disease, gastritis and oesophagitis and does not require eradication.

Aim. To characterize cell adhesion molecules (CAM), components of intercellular matrix (ICM) in gluten-sensitive celiac disease (GSCD). Material and methods. A histological examination was made of biopsies of small intestinal mucosa (SIM) obtained from 890 patients with clinical and laboratory symptoms of GSCD. Of them, 124(14%) patients had signs of chronic atrophic duodenitis of different severity corresponding to GSCD. Newly diagnosed GSCD was in 63(7.1%) patients, 61 (6,9 %) patients kept aglutenic diet. Biopsy specimens from unaffected mucosa of distal parts of the duodenum from 10 patients served control. Immunohistochemical examination of CAM and ICM was made using antibodies to E-cadgerin, beta-catenin, CD44, type IV collagen, matrix metalloproteinase of type 9 (MMP-9). Results. Interrupted weak reaction in epithelial basal membrane and enhanced expression of this antigen in stroma were observed in SIM in GSCD of stage IIIC by Marsh. Subnormal irregular expression of E-cadgerin and beta-catenin were seen in membrane of surface epithelium and cryptal epithelium. Moreover, high CD44 expression was detected in membrane of SIM stroma cells and high expression of MMP-9 in the cytoplasm of stromal cells and intercellular matrix. Conclusion. The detected disorders of intercellular and cellular-matrix interaction in GSCD promote tissue lesion, increased permeability of epithelial barrier and changes in histogenesis processes. Further study of minimal disorders in SIM in GSCD on the molecular level will facilitate diagnosis of early stages of the disease and prognosis of its course.

Aim. To determine prevalence of gluten-sensitive celiac disease (GSCD) in women with reproductive dysfunction (RD). Material and methods. Tests for blood serum antibodies to tissue transglutaminase (ABtTG) of IgA class were made in 217 women with RD. Tests for antibodies to gliadin (ABG) were performed in 180 of them. Esophagogastroduodenoscopy (EGDS) with biopsy to verify GSCD was conducted in patients with elevated ABtTG. The control group consisted of 15 healthy females of a reproductive age. Results. The examinees exhibited IgA ABtTG in the range 1 to 280 IU/ml, while 16 of them had elevated level - 50.2 ± 194 IU/ml, on the average. The controls had 0-10 IU/ml level of ABtTG, mean level 4.3±1.5 IU/ml. EGDS with duodenobiopsy was performed in 14 women. The examination of biopsies from small intestinal mucosa has detected pathohistological signs of celiac disease in 7 of 14 women. At the moment of the study two women with a history of spontaneous abortion were pregnant. Their ABtTG was 21.7 and 15.9 IU/mg, respectively, EGDS was not performed because of potential pregnancy complication but in view of possible celiac disease they received recommendations on aglutenic diet. Conclusion. Incidence rate of GSCD in women with RD is 4,1%. Aglutenic diet in GSCD women with RD contributes to reproductive function recovery and normal outcome of pregnancy. Elevation of ABtTG titers in women with RD is an indication to histological examination of small intestinal mucosa to detect GSCD.

Aim. To investigate the role of intestinal microflora impairment in development of clinical manifestations of intestinal dyspepsia in patients with hepatic cirrhosis (HC). Material and methods. Endoscopic and morphological examinations of duodenal and colon mucosa were performed in 160 patients with viral HC and portal hypertension (PH) taking consideration of the presence of portal chypertensive duodeno- and colonopathy. Intestinal microflora was studied with lactulose respiration hydrogen test, bacteriological examination of the feces was also made. Clinical manifestations of intestinal dyspepcia were analysed as in irritable colon syndrome (ICS). The following disturbances were recognized: diarrhea, constipation, mixed, syndrome of duodenal hypertension. Results. Most of HC patients suffered from disturbed intestinal microflora composition, 46,3 % had bacterial overgrowth in the small intestine, 38 (23,8 %) - isolated impairment of colon microflora. Structural changes of intestinal mucosa associated with HC were found in 80% patients. Abnormal intestinal biocenosis occurred more often in patients with portal hypertensive duodeno- and colonopathy. ICS-like disorders were detected in 80,4 % patients with abnormal intestinal biocenosis, 33,1 % - had symptoms characteristic of duodenal hypertension. Conclusion. In HC patients intestinal dysbiosis is an essential pathogenetic factor of formation of intestinal dyspeptic syndrome. Detection of portal hypertensive dyodenopathy and/or colonopathy in HC patients is a definite risk factor of impairment of normal composition of intestinal microflora.

Aim. To study hormone component of food specific dynamic action (FSDA) in chronic pancreatitis (CP) accompanied with metabolic syndrome (MS). Material and methods. A total of 60 patients were examined: 30 patients with CP and 30 patients with CP accompanied with MS. The study of fasting levels of thyrotrophic hormone, thyroxin, cortisol, insulin, C-peptide was conducted as well as one and two hours after carbohydrate breakfast to assess development of FSDA. Results. The study revealed that development of FSDA is characterized by systemic reaction, including changes in multiple hormonal parameters. However, patients with CP accompanied with MS demonstrated abnormal basal secretion and postprandial secretory responses of the above hormones. The absence of hormonal responses to food intake impairs FSDA and thus is involved in pathogenesis of metabolic disorders in patients with CP accompanied with MS. Conclusion. The study of the development of FSDA brings valuable information that can be used in clinical practice for studying mechanisms of metabolic disorders in various pathological conditions.

Diagnosis of autoimmune pancreatitis (AIP) is rather complicated because of low incidence of the disease, insufficient research, scare knowledge about AIP in medical profession, polymorphism of clinical characteristics. Administration of corticosteroid drugs is effective for relief of pancreatic inflammation though its long-term effects on the disease course is not studied well.

This communication describes reformative activity of L. Paster and J.Lister underlying present-day antiseptics and its impact on development of practical medicine.