No 2 (2009)

The article discusses the controversial issues concerning the notion of "dysbacteriosis" and elaborates the term "small bowel bacterial overgrowth syndrome (SBBOS). In light of the actual contradictions, the author provides its own perspective on the problem and tries to determine the place of SBBOS in the general concept of microbial intestinal disorders. The author considers the composition of normal microflora of the gastrointestinal tract (GIT) and the functions of microbiota. The legality of "intestinal dysbacteriosis notion is fully discussed. The article presents a definition of SBBOS as proximal small bowel colonization more than 104 CFU/ml of intestinal contents through the pathogenic microflora entering from the upper GIT (or upper respiratory tract) or due to retrograde translocation of the representatives of the colon microbiota; SBBOS place in the classification of dysbacteriosis is discussed. Data for the contemporary approaches to the treatment of SBBOS are presented.

Neuroendocrine tumors (NETs) of the abdominal space and retroperitoneal space, as well as carcinoid tumors of different localization are not very common diseases, but their frequency of detection in the last 10-15 years has increased by 2-3 times. According to the secreted peptides, NETs are subdivided into the following main types: gastrinoma, somatostatinoma, glyukagonoma, VIPoma, insulinoma, and carcinoid tumors. There are also tumors not accompanied by clinical symptoms, which are called afunctional, and their frequency is 15-40% of the NETs. Modern approaches to the diagnosis of NETs using a wide arsenal of various methods are presented. The possibilities of surgical and medication treatment of NETs, including the use of somatostatin analogues (octreotide) are discussed. Octreotide drugs administration is effectually in the case of impossibility of performance of surgery or unresectable malignant NETs and their distant metastases. This therapy can stabilize the growth of tumors in 50%, and lead to partial or complete tumor regression in 10%. It is emphasized that the results of treatment of NETs is much better than treatment of other tumors of the abdominal space.

The problems of gastroesophageal reflux disease (GERD) and the tactics of treatment with the main pathogenetic mechanisms are discussed. Currently leading trend in the treatment of GERD is acid supression therapy, in particular the proton pump inhibitors (PPI) use. However, given that even the most effective PPI does not affect the underlying cause of illness - motor function disorder of the digestive tract, the use of drugs with prokinetic effect on upper gastrointestinal tract in the treatment of patients with GERD is approved. Itopride hydrochloride (Ganaton) - antagonist of dopamine receptors and blocker of acetylcholinesterase is prokinetic of new generation. Pharmacodynamic and pharmacokinetic characteristics of Ganaton allow using it in patients with GERD in the mode of long-lasting anti-relapse treatment both in combination with PPI and monotherapy.

We consider the causes and the main clinical manifestations of postcholecystectomical syndrome (PHES). The modern approaches to the treatment of various forms of PHES are presented. We discuss the principles of PHES prevention and patients rehabilitation after cholecystectomy due to cholelithiasis.

We discuss the clinical aspects of pain syndrome and its correction with antipyretic analgesics by the example of inhibitor of cyclooxygenase-2 - drug nimesulide. The characteristic of nimesulide, its therapeutic efficacy, tolerability and safety examination are presented. We discuss the problem of drug hepatotoxicity and analyze the main mechanisms resulting to the development of hepatopathy. The nimesulide administration require taking into account the presence of liver disease in patients, manifestations of drug hepatopathy in history, as well as carefully monitoring even the smallest clinical laboratory deviations associated with drug therapy. Hepatotoxicity of nimesulide is not a real threat to patients safety.

We discuss the significance of nausea and vomiting and consider the major causes and mechanisms of these phenomena. It is emphasized that the act of vomiting is highly organized process involving both somatic and autonomic nervous system under the control of two functionally different structures located in the medulla oblongata: the vomiting center and chemoreceptor trigger zone. Principles of differential diagnosis of different variants of vomiting are presented. The basic approaches to the treatment of nausea and vomiting are discussed, and we describe the main types of antiemetics (neuroleptics, serotonin receptor antagonists, dopamine receptor antagonists, cholinolytics, local anesthetics, spasmolytics, hydrocorticosteroids).

The results of a multicenter descriptive study aiming to assess the effect of fermented milk product Activia containing probiotic Bifidobacterium ActiRegularis strain (not less than 108 CFU/ml) on the severity of dyspeptic symptoms in patients with mild digestive disorders are presented. The results indicate that daily consumption of 1 cup of fermented milk probiotic product Activia for 14 days has a positive effect on the function of the gastrointestinal tract in patients with mild digestive disturbances, provides a reduction of the frequency of gastrointestinal symptoms (feeling of weight and stomach ache after eating, bloating, constipation, a need for strong straining effort and a feeling of incomplete evacuation after defecation, hard stool consistency) by more than 2 times, as well as their intensity.