No 2 (2015)

The article reflects the current state of the question about the diagnosis and treatment of such common, but rarely diagnosed functional disorders of gastric motility as gastroparesis. The main etiopathogenic types of the disease and algorithm for the management of patients with clinical signs of this disease are discussed.

The article reflects the current situation of growth of resistance of H. pylori to the main drugs included in the scheme of eradication therapy and, therefore, reduction of the effectiveness of treatment. The authors examine in detail the mechanisms of microbial resistance to antibiotics and provide ways to its overcoming.

Inflammatory bowel diseases (IBD) - Crohn's disease and ulcerative colitis (UC) - are characterized by a violation of the interaction of the immune system of the intestine with external factors, primarily the intestinal microbiota. Modern molecular genetic studies of the composition of the intestinal microbiota confirm that IBD are always associated with dysbiosis. Treatment with correction of intestinal microbiota is pathogenetically justified. Probiotics enhance intestinal barrier and affect the local immune system. Research on the effectiveness of probiotics in IBD show mixed results, due to the different design of studies, variety of strains used, and heterogeneous groups of patients. The efficacy of probiotics in UC is more convincing, so they entered the Russian and international recommendations as a drugs for maintaining and achieving remission in mild to moderate disease activity. Probiotics have proven effectiveness in pouchitis. However, probiotic therapy should take into account the possible risk of bacterial translocation in severe forms of IBD, the different effectiveness of probiotic species and strains, and should be based on the results of previous clinical studies on each drug.

Nonalcoholic fatty liver disease (NAFLD) is an urgent problem of global healthcare service. Despite numerous new methods of diagnostics and drugs, introduced in medicine in recent years, there are still many unresolved issues of etiopathogenesis, diagnosis, treatment and prevention of NAFLD. On the one hand, NAFLD is independent nosological unit; on the other hand, it is a risk factor for cardiovascular diseases. Thus, prevention of progression of liver disease and reduction of risk of cardiovascular complications should be a main goal of therapy. In this context, search for new means of treatment of NAFLD is relevant, and our study was aimed to resolve these problems.

A 5-year prospective randomized trial on the efficacy of treatment of Barrett's esophagus in elderly patients was carried out. 31 patients (mean age 66,8 years) and 30 patients (mean age 66,2 years) were assigned to group A and B, respectively. Patients of group A were treated with omeprazole (20 mg twice a day) and Urosan (10mg/kg/day), while patients of group B received omeprazole (20 mg twice a day) for 5 years. At the end of the follow-up period metaplasia of the lower third of esophagus was not found in 32,3% patients of group A and 6,7% of patients of group B (р=0,03). After 5 years of treatment, esophagitis was diagnosed in 12,9% patients of group A and 53,3% patients of group B (р=0,002). In conclusion, combination of omeprazole and ursodeoxycholic acid (Urosan) as a means of treatment for Barrett's esophagus in elderly patients was superior to omeprazole monotherapy.

Diseases accompanied by inflammatory changes in the broncho-pulmonary system often have a different etiology, but the formation of the inflammation is caused by a common pathogenetic component - an imbalance of cellular and humoral Th1- Th2-mediated immunity response with undoubted integration of macrophages in the process. Understanding of the features of the phenotyping of macrophages in bronchial asthma, gastroesophageal reflux disease and their combination on the M1 and M2 phenotype and the role of surfactant protein D in this process can facilitate the individualization of therapy. The data on the cellular and molecular mechanisms of formation of inflammation in the broncho-pulmonary system in comorbid states will allow to identify the one of the promising new approaches to pathogenetic therapy of diseases at the early stages of the inflammatory response and correct the balance of M1/M2 macrophage phenotypes through their microenvironment factors.

Treatment with pancreatic enzymes should be based on an understanding of normal physiology and pathophysiology of the exocrine function of the pancreas, as well as diseases that are the cause of exocrine pancreatic insufficiency, both structural and functional types. Administration of enzymes is indicated only in case of clinically significant pancreas dysfunction, but sensitive and specific tests for pancreatic function, unfortunately, are not available now. Therefore, it is considered that the treatment with pancreatic enzymes should be started on the basis of actual clinical data, for example, if the patient has diarrhea and weight loss and confirmed presence of the disease, leading to exocrine pancreatic insufficiency. Currently, enteric coated micropellets or mini-tablets with a diameter of 2 mm or less are clinically preferred. The initial dose is 20 000 to 40000 lipase units per meal, with further adjusting the dose as necessary. Dose can be increased and the treatment can be supplemented by taking a proton pump inhibitor. Until now, the application is not possible that drugs enteric coated (micropellets, microspheres and minitablets) one brand have the same or even higher efficiency as compared to other drugs brand. Nevertheless, we have a successful experience of using mini tablet, enteric-coated (trade name Ermital® (Ermytal®) in Russia**).