No 12 (2011)

The review provides information on the main components and the localization of liver interstitial tissue, as well as the modern understanding of the mechanisms of formation, progression and regression of hepatic fibrosis. The role of stellate cells, hepatocytes and endothelial cells in maintaining the normal composition of the extracellular matrix of the liver is presented, as well as the role of these cells in the mechanisms of fibrosis in pathological conditions. Regulatory substances and mediators involved in the activation and transformation of stellate cells in myofibroblasts synthesizing collagen, which may be potential targets for antifibrotic therapy, are presented. Characteristics of repair processes in acute and chronic liver damage are demonstrated. Modern methods and new directions in the treatment of hepatic fibrosis are analyzed in details. The mechanisms of action and efficacy of standardized silymarin (Legalon) in the prevention and treatment of fibrosis in acute and chronic liver diseases are represented.

As exemplified by pantoprazole (Controloc), the article presents data on the characteristics of the acid inhibitory mechanism of action of modern drugs commonly used for treatment and prevention of symptomatic ulcers in the upper gastrointestinal tract in patients receiving drugs with ulcerogenic action. Data from randomized trials on the intensity and duration of reduction of gastric acid production in patients receiving pantoprazole, the nature and extent of drug-drug interactions and metabolic effects on the cytochrome P450 system are discussed. It is concluded that pantoprazole can be used as first-line drug therapy in the treatment of NSAIDs-induced lesions of the upper gastrointestinal tract.

The article considers the indications for antiviral therapy (AVT) of liver cirrhosis against the background of HCV-infection (a combination of pegylated interferon-α and ribavirin). The features of AVT and the difficulties of treatment of such patients, including preparing for a liver transplant operation, are discussed. It is emphasized that patients with compensated liver cirrhosis (Child-Turcotte-Pugh score = 5), particularly with initial signs of portal hypertension - are the only category of this group of patients entitled to AVT in accordance with all the modern guidelines, when AVT is targeted to achieve of sustained virological response.

The article is devoted to the one of relevant interdisciplinary problems of medicine - correction of microecological violations of intestinal tract. Based on the analysis of the composition, evaluation of intestinal microflora functions, and the mechanism for the implementation of microflora-macroorganism relationship, as well as causes of microecological disorders of intestinal tract, the necessity and possibility of their timely correction are shown. The main principles of therapeutic and preventive measures are presented. Given the classification and the requirements for drugs, as well as analysis of the mechanism of action and therapeutic options, major groups - probiotics and prebiotics used to correct the violations microbiocenosis of intestinal tract are presented. Special attention is paid to the place and role of metabolic drug - probiotic Hylak forte. The measures aimed at preventing microecological violations are represented

The article presents the principles of the differential approach to the definition of functional constipation syndrome, the modern classifications, clinical criteria, and standards for diagnosis of chronic constipation. The comparative characteristic of laxatives in the light of recent clinical studies is presented. The advantages of stimulating laxatives - bisacodyl and sodium picosulfate - are discussed.

70% of patients with non-alcoholic steatohepatitis (NASH) experienced insulin-dependent diabetes mellitus, and the remaining 30% of patients experienced glucose intolerance in different periods of the disease. Decrease in the sensitivity of tissue receptors to insulin is a pathogenetic basis of NASH associated with heredity. Thioctic acid prevents the development of fatty liver disease and is a regulator of the number and functionality of membrane receptors, including insulin receptors. Ursodeoxycholic acid, metformin, and thioctic acid (Thiogamma) is well-studied, optimal and safe combination for the integrated pathogenetic treatment of NASH. Participation of thioctic acid in the antioxidant defense allows of conclusion about the advisability of administration of Thiogamma in all patients with elevated body mass index and insulin resistance for the prevention and treatment of hepatic steatosis and NASH.

The issues of evolution of antihelicobacter therapy in recent years are considered. One of the problems in this area is the increasing resistance of Helicobacter pylori to metronidazole - a standard component of eradication therapy. In this regard, the Central Research Institute of Gastroenterology has been developed and tested a scheme of eradication therapy, including proton pump inhibitor, antibiotic clarithromycin, and Enterofuril® (nifuroxazide) as a third component. The article presents the results of study included 120 adult patients with H. pylori infection and various diseases of upper digestive tract treated with 7-day eradication therapy involving pantoprazole 20 mg twice a day, clarithromycin 500 mg 2 times a day, and Enterofuril or metronidazole as a third component. It was shown that the triple therapy of helicobacteriosis including suspension Enterofuril is very effective eradication scheme in adults, with superior to scheme with metronidazole efficacy and tolerability.

The article considers the basic mechanisms of pain in irritable bowel syndrome (IBS), discusses the role of spasmolytics in the treatment of IBS. The results of a clinical study on the efficacy of monotherapy with calcium channel blocker pinaverium bromide (Dicetel) in patients with IBS and abdominal pain are presented.