No 13 (2017)

To date, it is known that not only chronic viral hepatitis, but also non-alcoholic fatty liver disease (NAFLD) are a significant risk factors for the development of liver cirrhosis. Since the clinical picture of NAFLD is asymptomatic, its treatment should first of all be directed to factors that contribute to its development and progression, correction of associated metabolic disorders, and a reduction in the risk for developing cardiovascular complications.

Gastric microbiota is much more diverse than previously thought; there are 5 predominant major types of microbes among gastric bacterial community: Proteobacteria, Firmicutes, Bacteroidetes, Actinobacteria, and Fusobacteria. In patients infected with Helicobacter pylori, there was a significant decrease in the number of bacterial types, especially the number of Bacteroidetes, except for the Proteobacteria. H. pylori creates conditions and certain niches, which are filled with other microbes in the process of progressing atrophy. Reducing microbial diversity may predispose to the development of gastric cancer. A gradual shift in the profile of the gastric microbiota from non-atrophic gastritis to intestinal metaplasia, and then to intestinal type of gastric cancer was observed. Taking into account the possibility of safe and comprehensive impact on the composition of the gastric microbiota, and presence of immunomodulatory effects, probiotics may be promising direction of therapy. Monotherapy with Lactobacillus reuteri (Helinorm) had no significant difference in achieving eradication of H. pylori compared with the standard scheme, but led to a significant decrease in inflammatory changes in the gastric mucosa.

The article presents the results of evaluation of modern epidemiological and clinical and laboratory features of campylobacteriosis. The primary transmission of campylobacteriosis with improper thermal and hygienic processing of chicken meat is shown. A comparable frequency of detection of severe forms of the disease in elderly and young patients is established, as well as a reduction in the severity of infection with co-infection with other intestinal pathogens. The high efficacy of macrolide antibiotics in the therapy of campylobacteriosis is discussed.

Combined pathology of the oral cavity and internal organs plays an important role in modern practical medicine of doctors of the stomatological and gastroenterological profiles, because oral cavity has a close anatomical and pathogenetic connection with the organs of the gastrointestinal tract. Recently, acid-related diseases occupy a significant place among diseases of the digestive tract, a classic example of which is gastroesophageal reflux disease (GERD). Coordination dysfunction of the lower esophageal sphincter underlies the pathogenesis of GERD. The constant reflux of aggressive contents from the stomach into the esophagus has a negative effect on the mechanisms of the development of inflammatory processes in the periodontal tissues and oral mucous membrane, leading to the destruction of hard tooth tissues.

The article presents modern aspects of pathogenetic and clinical interrelation of erosive and ulcerative lesions of the gastroduodenal zone, dyspeptic syndrome, periodontitis and Helicobacter pylori infection. It is concluded that the data accumulated to date do not give grounds for considering H. pylori infection as the only etiological factor for the combined pathology of the oral cavity and gastrointestinal tract. The results of the study aimed to the evaluation of the efficacy of eradication schemes involving macrolides and bismuth in the treatment of patients with H. pylori-associated pathology of the gastroduodenal zone are discussed, and treatment regimens for patients with functional dyspepsia syndrome are analyzed.

The article systematizes literature data on the safety of eradication therapy (ET) of Helicobacter pylori infection. Data on the individual safety profile and tolerability of antibacterial drugs included in the ET regimens are presented. It is shown that the risk of development of side effects with the use of ET is 24% on average and varies depending on the specific treatment regimen: triple therapy with clarithromycin (21-24%), triple therapy with metronidazole (30%), bismuth-containing quadrupletherapy (23%), quadrupletherapy therapy without bismuth preparations (24%), sequential therapy (22%), triple therapy with levofloxacin (15-27%), hybrid therapy (26-32.9%). The factors that increase the risk of side effects include the duration of the course of therapy, incorrect dosage of drugs, the presence of concomitant liver pathology, including cirrhosis. A significant reduction in the incidence of side effects associated with ET can be achieved only with the use of adjuvant therapy with the probiotics.