No 2 (2016)

Purpose: evaluation of pathogenesis and clinical manifestations of H. pylori infection in patients with iron deficiency anemia (IDA) and the assessment of their possible association with variants of the disease, duration of history, gender and age of patients. Material and Methods: The study included 120 patients infected with H. pylori, which subsequently have been divided into two groups. The main group consisted of 70 H. pylori-infected and suffering from iron deficiency anemia patients. Patients of the main groups were randomly divided into two homogeneous groups according to the therapy: 1a subgroup received eradication therapy (ET): amoxicillin (1000 mg twice a day), clarithromycin (500 mg twice a day), esomeprazole 20 mg twice a day for 10 days, then transition to ferrous iron preparations in combination with ascorbic acid after the ET course; 1b subgroup received only a divalent iron preparations in combination with ascorbic acid. The control group (50 persons) consisted of patients infected with H. pylori receiving ET. Infection with H. pylori and control of eradication were confirmed by urea breath test using the Helic test system. Evaluation of the effectiveness of the IDA correction was performed by the monitoring of hemoglobin (Hb) levels, blood color index, total iron binding capacity, ferritin and serum iron. Follow-up assessments of patients were performed on 14th, 28th and 56th day of treatment. Results: Analysis of anemic and sideropenic syndromes on 14th and 28th day of treatment of two subgroups of patients has shown that early response to therapy has been achieved in subgroup 1a. On the 28th day of treatment, the mean Hb level among patient of subgroups 1a was 117.8 g/l (± 29.3 g/l), in patients of subgroup 1b - 104.2 g/l (± 15.6 g/l) (p<0.05). On the 56 th day of treatment, all patients achieved the target values corresponding to the normal Hb level. Dynamics of blood color index on the 28 th and 56th day of the study was also significant in all groups; blood color indices in subgroup 1a were 0.09 and 0.15, respectively, in the subgroup 1b - 0.06 and 0.014, respectively. Moreover, among patients of subgroup 1a target levels were achieved in most patients on the 28th day of treatment (p<0.05). The effectiveness of ET was 80.0% (28 patients) in the subgroup 1a and 82.0% (41 patients) in the control group. Conclusion: ET in patients suffering from chronic iron deficiency anemia allows to achieve a more rapid response to therapy with oral iron preparations, which is confirmed by laboratory parameters.

The article presents the results of the evaluation the incidence of H. pylori infection and the extent of infection in patients with functional dyspepsia based on the 13C-urea breath test urea. A total of 1929 patients were evaluated. High degree of contamination among patients with functional dyspepsia with Helicobacter pylori infection occurrence of 52% is revealed. A technique for bacteriological testing is described. The results of evaluation of H. pylori strains resistance by serial dilutions are presented. Among the analyzed isolates, 42.5% were resistant to metronidazole, 27.1% - to levofloxacin, 25% - to clarithromycin, and 6.3% - to amoxicillin. All tested strains were sensitive to tetracycline.

The article presents the experience of treatment of patients with complicated portal hypertension of various origins. From November 2013 to December 2015, 237 endoscopic ligation of esophageal veins in 211 patients were performed in the Department of Operative Endoscopy of the Moscow Clinical Research Center. The present article describes the methodology, technique of surgery, features of the management of patients in the early postoperative period and the results of treatment.

Patients with type 2 diabetes mellitus (DM2) are at high risk of nonalcoholic fatty liver disease (NAFLD), which includes a range of clinical and morphological characteristics: steatosis, nonalcoholic steatohepatitis (NASH) with development of liver fibrosis (LF) and cirrhosis (LC). Most DM2 patients are unaware of their NAFLD. Because of the high prevalence of DM2, liver biopsy can’t be carried out often for the diagnosis of liver fibrosis (LF). Objective: Assessment of results of screening of LF in DM2 patients using non-invasive tests: liver fibroelastometry (FEM), biomarkers and determination of their comparative diagnostic significance. Methods: A total of 67 patients aged 30 to 82 years, treated at the endocrinology department with a diagnosis of type 2 diabetes mellitus underwent examination. The statistical evaluation of the reliability of both methods using the ROC-analysis, correlation analysis of various factors and the severity of LF according to FibroTest (FT) and liver fibroelastometry (FEM) was performed. The influence of various factors on the prognosis of LF was assessed using multiple logistic regression and ANOVA. Results: According to the FEM and FT, liver fibrosis was detected in 11.9% cases; LF was absent in 33% cases according to the FT(F0) and in 45% - according FEM. According to ROC-analysis, the quality and accuracy of the FT and FEM were regarded as good: AUROC- 0.7 and AUROC-0.8, respectively. Reliability of FT and FEM for F-4 stage is rated as very good (AUROC for F4-0.86). Conclusions: The diagnosis of LF in 67 patients with DM2 has showed that LF was identified in the DM2 in 11.7% at a random sample. These data indicate that the presence of DM2 is a risk factor for progression of LF, which requires screening for such patients. Noninvasive tests have good diagnostic accuracy in determining the LC. Further research is needed to identify predictors of progression of fibrosis and hepatic steatosis.

The main functional disorders of the gastrointestinal tract (GIT) in the practice of internists include functional dyspepsia and irritable bowel syndrome, which often occur in the population. Current pharmacological approaches to the treatment of these diseases are based only on relieving symptoms, resulting in many patients remain unsatisfied and unhappy with their quality of life. In addition, drug treatment approaches are associated with side effects that reduce the benefits of therapy for the patient in terms of treatment outcomes. In addition to diet and lifestyle changes, the most common way to treat functional disorders of the gastrointestinal tract is the use of herbal preparations in the form of individual plants or their combination. Iberogast® is the drug of choice at all stages of the treatment of functional disorders of both upper and lower gastrointestinal tract. Multidirectional therapeutic effects, good tolerability without significant side effects, the possibility of long-term use are the distinctive characteristics of Iberogast®.

To date, non-alcoholic fatty disease is considered to be one of the most common diseases of the liver, which is confirmed by large-scale epidemiological studies. Important mechanisms of this disease are associated with metabolic disorders (insulin resistance, obesity, diabetes). The approaches to the treatment of nonalcoholic fatty liver disease are constantly improving. Particular attention is paid to the comprehensive treatment of patients, which should include optimizing diet and lifestyle, pharmacologic correction of hyperglycemia (metformin, etc.), dyslipidemia (statin), oxidative stress (antioxidants), and the use of various hepatoprotectors.

Early enteral nutrition is the method of choice after the laparoscopic surgery on the pancreas for chronic pancreatitis. The transition to enteral nutrition, however, should be fast (ideally within a week), sequential (a gradual transition from the aqueous electrolyte to oligomeric compounds and only then to balanced sip-feeding and diet), and should meet physiological capabilities of limiting absorption organs (in particular, the secretory activity of the pancreas) in each individual case.