No 5S (2017)

Autoimmune gastritis (AIG) is a disease characterized by progressive atrophy of the mucous membrane of the body of the stomach with the development of iron deficiency or B12-deficiency (pernicious) anemia. In AIG, circulating antibodies to parietal cells and the Castle’s intrinsic factor are detected in the blood. The pathogenesis and symptoms of AIG are considered, the principles of its diagnosis are presented, the relationship of AIG to other autoimmune diseases, diabetes mellitus and Helicobacter pylori infection is discussed. Pathogenetic therapy of AIG has not been developed. Symptomatic treatment depends on the clinical manifestations and results of laboratory tests. It is emphasized that the eradication of H. pylori in patients with AIG is a prerequisite for the therapy of this disease.

Modern views on terminology, classification, etiopathogenetic mechanisms, features of the clinical manifestation and diagnosis of diverticular disease of the colon are presented. Modern approaches to the treatment and prevention of various variants of this pathology are discussed.

Since nonsteroidal anti-inflammatory drugs (NSAIDs) are effective preparations for the pathogenetic therapy of acute or chronic pain resulting from tissue damage and inflammation, the area for intended use of this class of drugs is quite wide. Therefore, practitioners have to face a frequent and serious problem such as NSAID-induced gastropathy, the clinical and pathogenetic features of which are well-understood and known. NSAIDs, however, are not only able to have a damaging effect in the gastroduodenal zone, but also cause damage to the mucous membrane of the esophagus, as well as the intestines. The infrequent compatibility of the clinical and endoscopic picture of NSAID-induced esophagitis, especially in elderly patients, the nonspecific symptomatology, as well as the difficulty of diagnosing small bowel lesions against the background of use of NSAIDs and acetylsalicylic acid (including its enteric-soluble forms), do not always allow the clinician to suspect this pathology. The lack of developed algorithms for the management of such patients also creates certain difficulties in correcting NSAID-induced lesions of the esophagus and intestines.

The article presents the main provisions of the Russian Consensus on the Diagnosis and Treatment of Autoimmune Hepatitis (AIH). The consensus was conducted on the initiative of a group of specialists in the field of hepatology and gastroenterology. Voting was performed according to the Delphic system using the 6-point Likert scale: «1 point» meant «totally agree» (A +), «2» - «agree with small remarks» (A), «3» - «agree with significant comments» (A-), «4» - «disagree, but with significant comments» (D-), «5» - «do not agree, but with small remarks» (D), «6» - «strongly disagree» (D +). The agreement was deemed to have been achieved in agreement with the provision (A+, A, A-) of more than 2/3 experts (i.e. 67% or more). The interdisciplinary approach was provided by participation of leading gastroenterologists, hepatologists, morphologists, and pediatricians. The article is published as part of a series of papers on the main provisions of the Consensus. The purpose of these recommendations is to improve the diagnosis and therapy of AIH in conditions of real clinical practice, to provide timely assistance to this category of patients. Experts of large domestic clinical centers with significant experience in the diagnosis and treatment of AIH participated in the discussion of these recommendations.

Elongation of the colon or one of its departments - dolichocolon - is the most frequent anomaly of development of the colon, which occurs with a frequency of 23.8 to 31.0% in virtually all age groups. The main clinical manifestation of dolichocolon is persistent constipation and abdominal pain, which gives grounds to diagnose irritable bowel syndrome in patients. If the therapy is ineffective, it is necessary to perform an x-ray examination of the intestines, which can reveal the true cause of the pain syndrome and intestinal transit disorders in a number of cases.

In a randomized clinical trial involving 60 patients with irritable bowel syndrome (IBS), a comparison of the efficacy and safety of the use of Neobutine® Retard (film-coated prolonged- release tablets 300 mg, manufactured by AO FP «Obolenskoe»), and Trimedat® tablets 200 mg (manufactured by OAO «Valenta Pharmaceutics», Russia) was performed. The objectives of the study also included an assessment of the quality of life of patients and the compliance with treatment in comparison with the variants of treatment of IBS. Administration of Neobutine® Retard 300 mg and Trimedate® 200 mg lead to significant and comparable positive clinical effects for the relief of IBS symptoms. It is shown that therapy with trmebutine preparations (opioid receptor agonists) significantly improves the quality of life of patients and leads to a reduction in the time of achieving remission of IBS. The recommended regimen of treatment with Neobutine® Retard (300 mg twice a day) is superior to the traditional regimen of treatment with Trimedat® (200 mg 3 times a day).

The etiology of inflammatory bowel diseases (IBDs) is unknown, and pathogenesis is not fully understood. To date, monoclonal antibodies to tumor necrosis factor a and antibodies to α4-β7 are available for patients with IBDs in the Russian Federation. But at present, the direction of targeted therapy is actively developing in the world: the experience of the use of these agents is accumulating; the search for new molecules that are capable of interrupting the inflammatory cascade and simultaneously having a high safety profile is continuing.

The article presents 2 clinical cases of genetically confirmed hereditary hemochromatosis. The main criteria for diagnosis and treatment of this disease are given. In case of presence of cytolytic syndrome, it is necessary to include hemochromatosis in the diagnostic search. It is emphasized that timely and rational treatment of hemochromatosis can prevent the development of liver cirrhosis and significantly increase the life expectancy of patients.