No 13 (2012)

The article discusses the problem of iron deficiency anemia (IDA), which develops against the background of many diseases, including gastrointestinal diseases. The data on the causes of IDA, pathogenesis, symptoms, diagnosis and treatment of this disease are presented. Particular attention is paid to the drug Ferinject (ferric carboxymaltosate) used for the treatment of IDA in patients with inflammatory bowel diseases.

Alcoholic liver disease (ALD) remains an urgent problem of modern medicine. High rates of mortality and disability in patients with this disease constantly force to seek new ways to prevent or reduce the harmful effects of alcohol on internal organs, primarily on the liver. Only the complete exclusion of alcohol leads to significant positive effect up to the restoration of normal liver structure. The use of membrane-stabilizing drugs (essential phospholipids, S-adenosylmethionine, ursodeoxycholic acid) is most promising treatment. In therapy of ALD, the use of Thiogamma (thioctic acid) provides antioxidant and antitoxic effect. Severe acute alcoholic hepatitis (AAH), especially in the presence of hepatic encephalopathy, is an indication for glucocorticoids. Cumulative data on the role of proinflammatory cytokines in the pathogenesis of the AHH were the rationale for attempts to introduce anticytokine drugs into clinical practice.

In economically developed countries, liver cirrhosis (LC) is one of the six leading causes of death of patients from 35 to 60 years, accounting for 14-30 per 100,000 population. The main etiological factors of the disease are viral hepatitis B, C, D, alcohol, and drugs. The advantages and disadvantages of the morphological and non-invasive methods of diagnosis of LC are evaluated. The clinical manifestations of the disease and the mechanisms of their development are discussed in detail. Pathogenetic variants of cytolytic syndrome, and the basic mechanisms of the LC progression as the point of application of drug therapy are presented. The frequency of detection, mechanisms of development and clinical significance of intestinal dysbiosis in cirrhotic patients are emphasized.

Chronic pancreatitis (CP) is a disease with significant heterogeneity of pathological process and clinical manifestations. Data with class (level) of evidence I for diagnostic and therapeutic treatments are not available. Despite the lack of scientific validity, there are different national standards for the conservative treatment of CP in the world; they form the foundation for this review, with an emphasis on domestic health care and taking into account the opportunities and challenges for medical practitioners in Russia today.

The article considers the current concepts of the etiology and pathogenesis of irritable bowel syndrome (IBS), and the role of visceral hypersensitivity in the development of abdominal pain syndrome. Experience of use of drug Dicetel® of in treatment of IBS and data on its effect on visceral hypersensitivity are presented. It was found that the use of Ditcetel lead to pain relief in in 65 % of patients with IBS with predominance of pain, and to the normalization of visceral sensitivity in 60 % of patients.

The article discusses in detail the etiology, diagnosis, differential diagnosis and treatment of iron deficiency anemia (IDA) and the latent iron deficiency, often encountered in the practice of physicians, particularly among patients with chronic gastrointestinal diseases. The need for comprehensive clinical and laboratory evaluation of patients with hypochromic (microcytic) anemia is emphasized, particularly due to the difficulty of differentiating of IDA, anemia of chronic disease (“anemia of inflammation") and sideroachrestic anemia. The problems of long-term treatment with different iron supplements in patients with IDA, and benefits of use of highly effective complex preparation Ferro-Folgamma in the treatment of iron deficiency are discussed in detail.

Article is dedicated to the evaluation of the therapeutic efficacy of probiotics determined by features of the strains from which the drug is produced, and the final form of its release. It is noted that the therapeutic effect of probiotics is closely associated with the scientific rationale for the choice of Master Seed Bacteria, and phenotypic and molecular properties that determine the safety, immune-modu-lating effect of the drug, adhesion and survival of the microorganism in introduced organism. Dosage form contributes to the realization of probiotic properties of the drug, which are evaluated in double-blind, placebo-controlled clinical trials. Special attention is paid to the characteristics of different forms of probiotic complexes Bifiform, which are designed for different age groups, and are effective in the treatment and prevention of dysbiotic states.

Hepatic encephalopathy (HE) is a consequence of liver cell failure; this pathology develops against the background of liver cirrhosis (LC) in almost all known liver diseases (viral and toxic hepatitis, autoimmune liver disease, Wilson's disease, etc.) and is associated with a decrease in volume of functioning liver parenchyma and inability of hepatocytes to maintain homeostasis and implement detoxifying function. Apart etiotropic treatment aimed to elimination the cause of the underlying disease, early detection and correction of HE have a great significance in the management of patients with LC of any cause, because this pathology directly affect the quality of life of patients. The use of L-ornithine-L-aspartate and lactulose not only significantly improves the course and prognosis of HE, but also effectively prevents its development. This determines advisability of administration of L-ornithine-L-aspartate and lactulose for cirrhotic patients even before the first signs of HE.

Modern data on the etiopathogenesis, clinical presentation and classification of hemorrhoids are presented. The features of the treatment of hemorrhoids, depending on its stage are considered. It is emphasized that conservative treatment of acute hemorrhoids (phle-botropic therapy, etc.) can be administered by a general practitioner, but later the patient should be referred to coloproctologist for a full survey; minimally invasive or surgical treatment of hemorrhoids should be performed by coloproctologist or in a special coloproc-tological hospital. Differentiated approach to the choice of treatment for hemorrhoids depending on its stage, and the use of minimally invasive treatments allow to achieve good results in 98-100 % of patients.

The article presents the results of the study, which evaluated the clinical efficacy of the drug mebeverine (Duspatalin®) in the treatment of diseases of the gallbladder and biliary tract in 68 patients aged 18 to 35 years with a diagnosis of “chronic noncalculous cholecystitis". Both groups of 34 patients received conventional therapy. In addition, first group of patients received drug Duspatalin® 200 mg 2 times a day 20 minutes before meals for 30 days. All patients underwent a complete clinical and laboratory and instrumental evaluation. It was noted that the inclusion of Duspatalin in treatment of patients with biliary tract pathology has a pronounced therapeutic effect in the form of an earlier and full relief of pain and dyspeptic syndromes. Administration of Duspatalin promotes correction of motor-tonic disorders of the gall bladder and sphincter system, and normalization of the physicochemical properties of the cystic and liver bile.

Good purgation of the colon by special preparations is an important condition for providing effectiveness of diagnostic colonoscopy and safety of endoscopic intervention. Currently, a number of these methods are known, and enough special drugs for use in coloprocto-logical practice are produced; therefore, the choice of the most effective options for the preparation of the colon to the examination remains a challenge for the physician. In the SRC of Coloproctology, comparative evaluation of five different options of preparations was performed, including the use the drug Lavacole; another macrogol-containing drug; osmotic laxatives, including sodium hydrogen phosphate dodecahydrate 10.8 g and sodium dihydrogen phosphate dihydrate 24.4 g all-in-one; lactulose; and purgative enema.