No 2 (2017)

The article presents the modern view of the pathogenesis and diagnostic criteria for irritable bowel syndrome - IBS (Rome IV). The modern tactics of medical treatment of patients with different variants of IBS, aimed at pain relief and normalization of motor disorders with motility modulators, such as trimebutine, is presented. In addition, data on the effectiveness of laxative agent lactitol in normalization of defecation in IBS with constipation, and efficacy of dietary supplement containing alpha-galactosidase used for improving cellulose tolerance, are provided.

Last decade is marked by increase in the frequency of liver cirrhosis (LC) in patients with chronic hepatitis C. Patients with compensated and decompensated LC are in high risk of «hepatic» death, cancer hepatocellular, and are difficult to treat cohort of patients, in which the modern antiviral therapy with direct-acting antiviral drugs must be carried out immediately. Modern treatment regimens for viral-induced LC, recommended by the international community of hepatologists and domestic researchers, are presented.

The article provides an analysis of the results of evaluation of 87 patients who underwent resection surgery for various diseases of the pancreas. The severity of functional pancreatic insufficiency was assessed. The study has shown that pancreatoduodenal resection led to predominantly severe exocrine insufficiency, and distal resection - to moderate exocrine insufficiency. Diabetes mellitus after surgery occurred in 13.3% of patients who underwent pancreatoduodenal resection, and 100% of patients required correction of functional pancreatic insufficiency with high doses of enzymes and insulin preparations after pancreatectomy. The results showed that all patients who have undergone resection of the pancreas need constant enzyme replacement therapy and control of glycemia to a greater or lesser extent.

The article presents the results of evaluation of the clinical efficacy of the metabiotic Actoflor-S in correcting the symptoms of altered defecation and intestinal dyspepsia in patients with celiac disease. It is shown that the use of the original composition of bacterial metabolites is effective in complex therapy for the relief of symptoms of dyspepsia and the normalization of stool frequency and consistency.

In developed countries, the prevalence of non-alcoholic fatty liver disease (NAFLD) is 10-40%. Data from epidemiological studies indicate a steady increase in its frequency in the world. In a variety of regional and international recommendations for drug treatment, there is no uniform opinion on the efficacy and safety of the use of certain drugs in the NAFLD. The use of essential phospholipids (EPLs) in liver diseases, in particular NAFLD, is pathogenetically justified and proved in a number of clinical studies. EPLs, however, is an easily decomposable substance, because they can be involved in lipid peroxidation processes with an increase in the level of lipid peroxides, which are an active oxidants, and consequently enhance oxidative stress. The creation of a domestic combined hepatoprotector BAA Hepaguard Active became an effective solution of this problem. One capsule of Hepaguard Active contains 222 mg of EPLs, 93 mg of L-carnitine and 1.25 mg of tocopherol acetate (vitamin E). These biologically active substances act synergistically, providing membrane-protective, lipotropic, lipid-lowering, and hypocholesterolemic effects. The course effect of BAA Hepaguard Active is manifested in a decrease in the severity of steatosis, and in non-alcoholic steatohepatitis - in the reduction of necroinflammatory processes and liver fibrosis, and also contributes to the normalization of body weight, and lipid profile. BAA Hepaguard Active has a prebiotic effect, helps to reduce insulin resistance, and is well tolerated, which allows to recommend it for primary and secondary prevention of NAFLD.

The article presents a clinical case of very severe portopulmonary hypertension in a patient with Child-Pugh class C and MELD 19 liver cirrhosis as the outcome of chronic viral hepatitis B. It has been shown that antiviral therapy and treatment of pulmonary hypertension led to the stabilization of the condition and even a slight decrease in pulmonary hypertension, and improvement of liver functional parameters.