No 14 (2013)

In recent times, there is an activation of the epidemic process of hepatitis C in Russia. The article describes modern methods of differential diagnosis of acute and chronic hepatitis C. Diagnostic scales for necro-inflammatory changes and hepatic fibrosis are presented. Clinical forms determining the course of disease, risk factors for chronic HCV infection, and therapeutic regimens in accordance with the modern Russian and European guidelines are discussed.

Chronic pancreatitis (CP) is a common disease with potentially severe course and a high risk of development of serious complications: pancreatogenic diabetes, trophological failure, pancreatic cancer. Only a timely diagnosis and adequate treatment of patients with CP allows to reduce the risk of serious complications and poor outcomes. Abdominal pain syndrome in CP is an early and most significant manifestation. The correct interpretation of complaints of CP patients, purposeful examination and treatment are the basis for the improvement of quality of life and increase in life expectancy. In most cases, for the relief of pancreatic pain in the absence of indications for endoscopic and surgical treatment, it is necessary to use a combined drug therapy, including non-narcotic analgesics, myotropic antispasmodics (hyoscine butylbromide), pancreatin preparations with a high content of proteases, and inhibitors of gastric secretion.

Recommendations for the diagnosis and treatment of Crohn's disease (CD), developed by leading Russian gastroenterologists, are compiled on the basis of the literature data, the European evidence-based consensus on the diagnosis and treatment of CD, represented by the European Society for ulcerative colitis and CD (ECCO). The recommendations provide guidance for clinicians in the management of patients with CD and are subject to regular review in accordance with new research data in this area.

In the past few years, great interest in the neuroendocrine system, particularly in evaluation of neuroendocrine tumors (NETs) has occurred. This is attributable to the increasing incidence of NETs, and development of modern technologies, allowing a new way to their diagnosis and treatment. NETs is definitely oncological problem. However, the first contact with the patient, and, therefore, timely diagnosis are associated with work of general practitioners and gastroenterologists in outpatient settings, which are often insufficiently aware of this disease. The article is aimed to provide general idea of the NETs, and the modern potentials for their diagnosis and treatment, for physicians and gastroenterologists in particular.

Chronic diseases of hepar are extremely widespread and appear to be the great problem for healthcare. The aspects and capabilities of drug correction of chronic hepatic disorders are discussed in this article; etiological factors and pathogenesis specifics are taken into consideration as well. Despite etiotropic treatment directed to the main cause of disease elimination, authors pay their great attention to the pathogenic therapy. They emphasize that the main condition of efficacy for drugs with potential hepatoprotective activity is their ability to influence the hepatic cells membranes lipid peroxidation, to stabilize membranes and to show anti-inflammatory activity.

The article presents data on the epidemiology, pathogenesis, modern classification, and major clinical manifestations of Gaucher disease (GD) in children. The criteria of differential diagnosis with other diseases are discussed. It is shown that pathogenetic enzyme replacement therapy is only effective treatment of GD, which stops the main clinical manifestations of the disease, improving quality of life in patients with GD without causing side effects. The monitoring of condition of patients on therapy is recommended in accordance with the requirements of the Joint International Group on Gaucher disease. The main errors of diagnosis and management of these patients, as well as unwarranted use of drugs for the treatment of G, are discussed.

The article presents the results of a comparative evaluation of the efficacy and safety of cepeginterferon alfa-2b (Algeron) and peginterferon alfa-2b in combination with ribavirin as a part of combination therapy of chronic hepatitis C (CHC), followed by the definition of a therapeutic dose of Algeron. The study included 150 treatment-naive adult patients (all genotypes) with chronic hepatitis C. Patients were randomized into 3 treatment groups. Patients in the two main groups have received Algeron at a dose of 1,5 or 2,0 mg/kg/week in combination with ribavirin (800-1,400 mg/day), in the active control group - peginterferon alfa-2b 1,5 yg/kg/week in combination with ribavirin (800-1,400 mg/day). Comparative analysis of the frequency of achievement of virological response at 4 th and 12 th weeks of therapy, end-of-treatment response, sustained virological response (SVR), and biochemical response in the groups did not show statistically significant differences between the groups. The frequency of SVR in patients treated with Algeron was 75 %, in the comparison group - 68 % (p > 0,05). In patients infected with 2 or 3 HCV genotypes, treated with Algeron, SVR was observed in 83 % of cases, in the comparison group - in 81,8 %. Among patients with genotype 1 HCV, SVR was observed in 67,9 and 57,1 % of cases, respectively (p > 0,05). The safety profile of Algeron was similar to that of peginterferon alfa-2b. Complex assessment of efficacy and safety allowed to make the conclusion about the optimal therapeutic dose of Algeron, equal to 1,5 yg/kg/week. The results of study provide evidence of the high efficacy and safety of Algeron for suppression of HCV replication and make it possible to recommend Algeron 1,5 yg/kg weekly in combination with ribavirin for the treatment of chronic hepatitis C in treatment-naive patients for 24-48 weeks depending on the HCV genotype.

The study was aimed to the evaluation of the efficacy, tolerability and safety of the drug Controloc for the treatment of bleeding associated with erosive and ulcerative lesions of the stomach and duodenum. The drug was administered in 20 patients receiving antiplatelet/ anticoagulation therapy at a dose of 80 mg as intravenous bolus followed by infusion of 8 mg/hr continuously for 72 hours. Thereafter, Controloc was administered at a dose of 40 mg 2 times a day orally for a month. During the study period, no other proton pump inhibitors were administered. The analysis of the dynamics of endoscopic, clinical and laboratory parameters was used for the objective evaluation of the effectiveness. After 1 month, 19 (95 %) patients had a full arrest of bleeding; repair of erosive and ulcerative lesions occurred at the 4th week in the absence of complications/adverse reactions, which allowed to estimate the effectiveness as «excellent». 1 (5 %) patient had partial healing of erosive and ulcerative lesions; the efficiency in this case was rated as «good». The study indicates the efficacy and safety of treatment and prevention of gastrointestinal bleeding using Controloc in patients with pathology of the cardiovascular system, receiving antiplatelet/anticoagulant therapy.