No 2 (2011)

The article discusses a functional disorder of the gastrointestinal tract - irritable bowel syndrome (IBS). The basic mechanisms of the pathogenesis of IBS, clinical manifestations are discussed; treatment approaches in accordance with the mechanisms of clinical symptoms are described. Much attention is paid to the role of modern selective myotropic spasmolytics with combined effect - calcium channel blocker pinaverium bromide (Dicetel) and sodium channels blocker mebeverine (Duspatalin) in the correction of abdominal pain, dyspeptic symptoms and other manifestations of IBS; current algorithms of diagnosis and therapy of this pathology are presented

Gastrointestinal bleeding is one of the main causes of emergency hospitalization in developed countries. Strict adherence to the algorithm of action and continuity of care for bleeding at different stages of specialized medical care provides significantly better prognosis and survival in patients with this terrible syndrome. Effective treatment of non-variceal bleeding while minimizing the risk of relapse is possible only with combination of modern methods of endoscopic hemostasis and conservative treatment, including the use of high doses of proton pump inhibitors, which halves the risk of recurrent bleeding. Prophylactic eradication of Helicobacter pylori and/or subsequent prolonged parallel use of proton pump inhibitors in patients with suspected long-term use of aspirin and nonsteroidal anti-inflammatory drugs can significantly reduce the risk of ulcers and bleeding.

The article is concerned with possibilities of use of methotrexate in patients with ulcerative colitis (UC) with hormone dependence or hormone resistance. Authors present the experience of use of methotrexate in the treatment of 72 patients with severe UC. Hormone resistance was indication for administration of methotrexate in 59 patients, and hormonal dependence - in 13 patients. The drug was administered at a dose of 25 mg per week for one year against the background of gradual withdrawal of prednisolone. The overall effectiveness of methotrexate in severe UC was 63.8%. During the year, aggravation of UC was registered in 23.3% of patients against the background of maintenance therapy with methotrexate. It is emphasized that the use of methotrexate allows completely discontinuing hormone therapy in hormone-related forms of UC.

The article discusses the role of tissue metabolism disorders arising in patients with gastric ulcer or duodenal ulcer complicated by hemorrhage, especially against the background of cardiovascular and pulmonary pathologies; in these cases, the combined effect of factors of ischemia and hypoxia lead to progressive increase in oxidative stress. Based on data for numerous studies represented in this article, authors have formed the recommendations for early inclusion of antihypoxants in complex of medical interventions, in particular, Actovegin.

The article is concerned with international experience of use of infliximab (Remicade) in patients with ulcerative colitis (UC), indicating that this drug is effective for achieving clinical response and induction of clinical remission; influximab accelerates the repair of the mucous membrane of the colon and reduces the frequency of emergency colectomy. Authors present the results of own study, which included 37 patients with UC not underwent surgery. All patients have received Remicade according the Additional pharmacological support program (DLO) for Moscow region in a dose of 5 mg/kg of body weight per day as induction course (3 infusions at the initial, 2-nd and 6-th week) and then every 8 weeks. The effectiveness of infliximab induction therapy was high, positive clinical and endoscopic dynamics was observed in more than 90% of patients receiving the drug. In most cases (96.3%), supportive therapy with Remicade has provided clinical and endoscopic remission or significant improvement. Corticosteroids were abolished more than in 80% of patients, which have received more than 3 infusions of infliximab.

Prohepar is synergistic hepatoprotective combination based on liver hydrolysate received from bullocks and enriched by cyanocobalamin, choline, myo-inositol and cysteine. The available data for the experimental and clinical pharmacology of Prohepar and its components indicate its undoubted hepatoprotective effect. The authors for the first time have investigated experimental changes in biochemical markers of liver function and histology of liver tissue, as well as other organs in alcohol- and paracetamol-induced liver damage against the background of therapy with Prohepar. Improvement in functional and structural state of the liver against the background of use of Prohepar was shown. Hepatoprotective effect was most noticeable on the model of alcohol-induced liver injury. Histological examination of tissue samples showed a marked morphological differences, which were expressed in radically different degrees of damage of parenchymal cells and circulatory disturbances. Revealed differences in the structure of liver tissue, as well as changes in biochemical markers levels, indicate pronounced protective effect of Prohepar in alcohol- or acetaminophen-induced liver damages.