No 10 (2011)

The review is aimed to revelation of mechanisms of heartburn as the primary symptom of gastroesophageal reflux disease (GERD), and the ways of its effective correction. Furthermore, modern treatment algorithm for GERD taken as a principle of recent recommendations of the Russian Gastroenterological Association for assessment and treatment of patients with GERD is presented. The article describes in detail the mechanism of action of the modern prokinetic itopride hydrochloride (Ganaton ®), which is recommended as a mandatory component of an complex therapy of all forms of GERD at all stages of treatment. Particular attention is paid to high efficiency of this drug for relief of the main clinical manifestations of the disease and its safety, including in long-term administration.

В многочисленных исследованиях показаны плейотропные эффекты и нефропротективное действие блокаторов кальциевых каналов (БРА), в частности ирбесартана, у больных артериальной гипертензией (АГ) и сахарным диабетом 2 типа. В статье представлены литературные данные, на основании которых препараты класса БРА могут рассматриваться в качестве терапии первой линии у пациентов с АГ, особенно относящихся к категории высокого риска осложнений. Данный класс антигипертензивных лекарственных средств перспективен в связи с рядом потенциальных, еще недостаточно изученных свойств - антифибротических, противовоспалительных, а также возможности сохранения почечной функции у пациентов на гемодиализе.

One of the major risk factors for cardiovascular disease (CVD) and atherosclerosis is dyslipidemia. The liver plays an important role in the development of disorders of lipid metabolism; so, treatment of CVD involves the application of hepatoprotectors that reasonable from the viewpoint of the pathogenesis of disease. The article presents an algorithm for correction of dyslipidemia and nonalcoholic fatty liver disease.

The study was aimed to investigation of structural and functional features of esophagogastroduodenal zone and an estimation of efficiency of bismuth dicitrat in patients after cholecystectomy taking into account the results of daily pH-metry. The study enrolled 94 patients in various terms after cholecystectomy, and control group included 62 patients with cholelithiasis. All patients underwent clinical, endoscopic, morphological examination of gullet, stomach, and duodenum, and daily pH-metry was performed in 75 patients. With increase of terms after cholecystectomy, the atrophic gastritis, reflux-gastritis, duodenogastric reflux, and duodenitis, the atrophy, metaplasia and dysplasia of epithelium often occur. Frequency of occurrence of duodenogastric and duodenogastroesophageal refluxes tends to increase; secretion of hydrochloric acid tends to decrease. Use of daily pH-metry in patients after cholecystectomy allow for improve diagnostics and treatment of pathology of esophagogastroduodenal zone. In case of hypoacidity, the drug of choice is bismuth tripotassium dicitrat (De-Nol) which provide regression of clinical presentations and decrease of activity of inflammatory process.

The article presents the results of study on the use of long-acting pentoxifylline (Vasonit-retard 600) in the combination conservative therapy in patients with critical lower limb ischemia (CLLI) and persistent trophic ulcers, who were for a long time treated with narcotic analgesics and sedatives. The study involved 23 patients with CLLI aged 52 to 89 years; 9 patients received conventional therapy (control group) and 14 patients received standard combined therapy with the addition of Vasonit retard 600 in a daily dose of 1200 mg - 600 mg (1 tablet) twice a day, in morning and evening, for two months (experimental group). Against the background of use of drug Vasonit retard 600, the findings suggest the clinical improvement that manifested in the healing of trophic defects (more rapid formation of granulation), increase of pain-free walking distance, reduction of pain intensity during ambulation. It is emphasized that Vasonit-retard 600 should be necessary standard drug in complex treatment of patients with CLLI accompanied with trophic ulcers of soft tissue.

The study including 70 patients aged 45-65 years with postmenopause for at least 2 years and osteopenia at the lumbar spine and/or femoral neck according to WHO criteria (T-test, -1,0 SD to -2,49 SD) was aimed to evaluation of adherence to treatment, the womens preferences to the various schemes of osteoporosis prevention with drug containing calcium and vitamin D. Group 1 received calcium at a dose 1000 mg and vitamin D3 at a dose 800 IU once a day in the evening, Group 2 - 500 mg calcium and 400 IU of vitamin D3 twice a day (Calcium-D3 Nycomed Forte). Regardless of the treatment regimen, very high adherence to therapy (96%) was observed. In 40% of patients, receiving of drug once a day was more convenient, 33% of patients preferred administration of drug twice a day, and 27% reported that treatment regimen was no great shakes.