No 15 (2016)

The worldwide high prevalence of hepatic cirrhosis (HC) of various etiologies with unfavorable fatal outcomes dictates the need to search for the modern and available methods for evaluating the effectiveness of the treatment of such patients. The article considers the results of last 5-year study dedicated to this issue. The results of the examination of 194 patients with HC of various etiologies aged age 18 to 75 years are presented: 56 patients with HC of alcoholic etiology, 48 - with HC as outcome of non-alcoholic fatty liver disease, 53 and 23 patients with HC as outcome of chronic hepatitis C and B, respectively, and 14 - with HC as outcome of co-infection of hepatitis B+D. The study analyzed the effect of the therapy on the progression of HC and its complications according to the elastography of the liver. Presence or absence of treatment was taken into account. Close correlation of clinical manifestations of the disease in patients with HC of various etiologies and liver density values according elastography of the liver depending on the presence or absence of the treatment was found.

The article presents the results of evaluation of the malondialdehyde (MDA) levels in 80 patients with non-alcoholic fatty liver disease (NAFLD), the relationship of peroxidation and phospholipase mechanisms of hepatocyte membrane damage with other markers of inflammation. Basic morphological changes in examined patents were characterized by macrovesicular hepatic steatosis. The analysis of biochemical parameters showed 2-3-fold increase of aminotransferase and gamma-glutamyl levels in 40% of cases. Lipid spectrum in examined patients was characterized by an increase in total cholesterol, LDL, triglycerides and decrease in high-density lipoprotein levels. Relationship between inflammatory markers (lipoprotein-associated phospholipase A2 - LpPLA2, nitric oxide - NO, endotoxin - ET, MDA), morphological pattern of the hepatic injury and activity of liver enzymes was revealed. LpPLA2 activity in 40% of NAFLD patients was increased by 3.8 times compared with that of in the control group and in patients with steatosis, and it was accompanied by an increase in liver enzyme activity and severity of morphological changes. NAFLD leads to the development of antioxidant system failure as a result of the activation of lipid peroxidation. In patients with NAFLD, serum MDA levels were 2-fold increased, in patients with steatohepatitis - in 30% of cases. LpPLA2 activity and MDA levels had correlation (r=-578). Increase in ET, NO levels and LpPLA2 activity were observed with the progression of inflammatory liver infiltration.

At the present time the number of overweight people is steadily increasing that in the near future can lead to so-called obesity pandemic, and its consequences will be the one of the most serious problems for the modern health care. For example, there is growing number of overweight patients, who are increasingly diagnosed with metabolic syndrome and, consequently, they have a high risk for the development of nonalcoholic fatty liver disease (NAFLD). Ways to optimal treatment of NAFLD continue to be studied. In the present review, the authors present opportunities for the treatment of NAFLD in modern clinical practice in Russia.

The prevalence of gastroesophageal reflux disease (GERD) varies from 11.6 to 23.67% in different regions of the country. Proton pump inhibitors (PPIs) demonstrate the greatest efficacy in the treatment of GERD; however, the incidence of clinical treatment failure in patients with GERD using different PPIs is 5-40%. Optimization of the therapy traditionally includes the addition of natural mineral water in the schemes of treatment of internal diseases. The article presents the results of the evaluation of the effectiveness of the use of natural Borjomi sodium hydrocarbonate mineral water in 30 patients with GERD without esophagitis. Against the background of treatment, a rapid reduction of the heartburn and other dyspeptic disorders, noncoronary chest pain, sleep disturbances, as well as marked improvement in the quality of life were observed in study group. These positive clinical effects in patients receiving combination therapy have correlated with a significant decrease in acid attack on the oesophageal mucosa in comparison with the control group according to the daily pH-metry Against the background of the additional use of mineral water, a small amount of severe side effects was registered, that indicates its good tolerability and safety of use. The use of natural Borjomi sodium hydrocarbonate mineral water is appropriate for inclusion in the scheme of treatment of GERD without esophagitis.

Portal hypertension - one of the major causes of death and complications of chronic liver disease (CLD). An increase in intrahepatic vascular resistance, which is developed before cirrhosis, is the basis for the portal hypertension. These portohepatic hemodynamic disturbances are caused by mechanical (fibrosis, inflammation) and dynamic components. The dynamic component is controlled by complex relationships between damaged hepatocytes, endothelial cells, and hepatic stellate cells. At the early stages of CLD, these mechanisms are not well understood. The article presents an overview of this issue and the results of studies of the features of portohepatic hemodynamic disturbances, some mechanisms of these disturbances and their correction at the early stages of fibrosis in CLD.

Chronic constipation (CC) is a global medical and social problem. Current approaches to diagnosis and treatment of CC are clearly phasing and sequencing. The inclusion of pharmacological therapy in the treatment of CC is indicated the case of failure of correction of diet and lifestyle. This article discusses the criteria for diagnosis and tactics of modern pharmacotherapy of CC.

The article considers the problem of gastric polyposis in terms of the clinical and morphological diagnosis, endoscopic diagnosis and modern methods of treatment. Particular attention is paid to the role of adenomatous polyps as high risk markers for development of adenocarcinoma in the surrounding gastric mucosa. The relationship between development of adenomatous polyps and H. pylori infection is emphasized; eradication of H. pylori is discussed as an effective direction in cancer prevention. An algorithm for the management of patients with gastric polyps is presented.