No 15 (2010)

The article is dedicated to the features of idiopathic slow-transit constipation (ISTC) of unknown etiology (Russian equivalent - chronic colonic stasis), sporadic disease, which differs from irritable bowel syndrome, symptomatic, proctogenic and other forms of constipation. ISTC occurs mainly in women (70-80%), this pathology develops in early childhood or adolescence, long life persist, and is very refractory to medical treatment. The article discusses the pathophysiology of ISTC, in which the imbalance of intestinal regulatory peptides and neurotransmitters, including opioids (enkephalines and endorphins) plays important role. It is emphasized that trimebutin (Trimedat) is the only really available drug that stimulates the motor activity of the colon, and this drug is full agonist for all three types of opioid receptors. Available clinical data show positive therapeutic effects of trimebutine on the various functions of the gastrointestinal tract, including stimulation of activity of colon smooth muscles in patients with ISTC .

The article considers the non-alcoholic fatty liver disease (NAFLD), one of the components of metabolic syndrome according to modern concepts. It is emphasized that NAFLD is associated with cardiovascular diseases (CVD) and apparently predicts their development. The article discusses the influence of female sex on the incidence of NAFLD; it is noted that risk of cardiovascular diseases increases dramatically against the background of menopause or gynecological pathology. Essential phospholipids (EFL) are effective means for the treatment of NAFLD. Preparations of EFL (Essentiale forte, Essentiale N) competitively replace endogenous phospholipid phosphatidylcholine of cell membranes and restore damaged membrane structures of cells through the incorporation of EFL molecules in membrane and filling gaps in membrane, stimulate the synthesis of endogenous phospholipids. In the treatment of patients with NAFLD and CVD, the benefits of use of EFL are improvement of receptor function, including insulin receptors, and normalization of lipid metabolism.

The article presents own and literary data for the problem of not cicatrizing stomach and duodenal ulcers. The information regarding risk factors, pathogenesis, diagnostic features, clinical course and treatment of this pathology is presented. The role of antisecretory treatment with new generation proton pump inhibitors - rabeprazole and esomeprasol- is emphasized.

The article is concerned with the role of gastrointestinal microflora in the maintenance of normal function of intestinal tract against the background of digestive diseases. The problems, etiology, clinical presentations, diagnosis, and treatment of small bowel bacterial overgrowth syndrome (SBBOS) are discussed. Based on their own researches, authors in detail reviews current indirect methods of diagnosis, and tests based on examination of metabolites of microflora, in particular the hydrogen breath test with lactulose. Detailed description of the mechanism of action, indications and conditions of practical application of lactulose (Duphalac) for the correction of SBBOS, chronic constipation, hepatic encephalopathy and other pathological conditions are presented.

The problem of modern treatment of chronic pancreatitis is highly relevant. This study was aimed to examination of impact of miotropic spasmolytic Odeston (Hymecromone) on exocrine pancreatic function in patients with chronic pancreatitis. During the study, therapeutic efficacy of Odeston was observed, in particular pain and diarrhea syndromes were decreased, the flatulence phenomenon disappeared. Odeston had a selective spasmolytic effect on the Oddi's sphincter and Lutkens' sphincter, increased the enterohepatic recirculation of bile acids, jugulated maldigestion syndrome and contributed to the regression of duodenum dyskinesia. The drug was well tolerated; complications and side effects were not observed.

The study was aimed to assess the effectiveness of Metadoxile (metadoxine) in the complex treatment of gastropathies against the background of alcoholic liver disease. The study enrolled 137 patients with stage II of alcoholism verified by narcologist, including 72 patients with alcoholic steatohepatitis, 65 patients with alcoholic cirrhosis, and 68 nondrinkers with chronic digestive diseases. All patients with erosive-ulcerous defects received combined treatment with Metadoxile. It was found that Metadoxile as a part of complex treatment of erosive-ulcerous defects contributes to early epithelialization, and has a positive impact on the local endocrine homeostasis in patients with alcoholic liver disease.

Effectiveness of use of taurine (Dibicor) in the treatment of non-alcoholic fatty liver disease (NAFLD) in the stage of steatohepatitis (NASH) was estimated. In the MCH № 7, Novosibirsk, 36 patients of both sexes with NASH with minimal biochemical activity received comprehensive treatment, 20 of them received the drug Dibicor. All patients underwent anthropometric and laboratory physical examination before the study and after 1 month of treatment. Statistical analysis of the results was performed using SPSS 13.0 software package with the definition of levels of statistical significance. Value of P<0.05 was considered statistically significant. Improvement of general condition was observed in patients of both groups. Side effects against the background of the treatment with drug Dibicor were not revealed. In the group treated with Dibicor, improved lipid profile, decreased levels of free bilirubin, fibrinogen, alkaline phosphatase, γ- glutamyltranspeptidase, glycemia, decreased body mass index and diastolic blood pressure were observed. It is concluded that Dibicor (taurine) is a physiological and safety drug with hepatoprotective and hypolipidemic effects in patients with NASH associated with obesity, and may be included in the treatment regimen of NASH.

The article presents the results of evaluation of effect of myotropic spasmolytic (selective blocker of calcium channels in smooth muscle of the gastrointestinal tract) pinaverium bromide (Dicetel) on the intensity of abdominal pain and dyspeptic symptoms in 46 patients with irritable bowel syndrome (IBS). Dicetel can be successfully used for the treatment of abdominal pain in IBS patients. The inclusion of pinaverium bromide in the general complex of therapeutic interventions is most appropriate; in some cases, specifically in moderate pain syndrome, drug is effective as monotherapy.

The article is dedicated to the problems of Helicobacter pylori infection and antibiotics resistance of HP. Based on experience of using the nitrofuran Enterofuril in suspension for the treatment HP- associated diseases in children, the experience of similar use of Enterofuril in adults is presented. In the original study, the authors have shown high efficacy of schemes of eradication therapy using Enterofuril in suspension.

The article presents classification of malignant tumors of the small intestine (MTSI) - rare tumors of the gastrointestinal tract. The approaches to diagnosis of MTSI, especially difficult at early stages of the disease, are discussed. The clinical observation of 55 years old patient with complains of nausea, abdominal pain for a long period, and signs of progressive anemia is described. In-depth examination of the patient has revealed moderately differentiated adenocarcinoma of the small intestine, T4N1M1. The enterectomy was performed. During operation, metastases in the mesenteric lymph nodes and left lobe of the liver, and ascites were detected. The patient was referred to the oncologist to decide the issue of advisability of radiation therapy or chemotherapy. It is emphasized that diagnosis was suspected in routine X-ray examination at hospital stage, and this examination could be performed in outpatient settings. The "unexplained" iron-deficiency anemia requires differential exclusion of any disease of the small intestine, even in absence of malabsorption syndrome.