No 2 (2018)

Analysis of current international and domestic recommendations allows to conclude that the leading non-medicinal methods for treating non-alcoholic fatty liver disease include the use of a low-calorie diet with a sufficient content of polyunsaturated fats and graduated exercise to reduce body weight. Among the drugs, leading positions belong to insulin sensitizers, essential phospholipids (Essentiale Forte N) and antioxidants (vitamin E).

Analysis of current data suggests that lifestyle modification and weight reduction are the first line of therapy of non-alcoholic fatty liver disease (NAFLD). For the treatment of NAFLD, it is recommended to reduce the caloric content of the diet (decrease by 500-1000 kcal per day in comparison with the usual regimen), to increase the number of products containing ω-3 polyunsaturated fatty acids (seafood) in the ration, and decrease the proportion of refined carbohydrates; systematic mid-intensity physical exercises and overall increase in physical activity, body weight reduction by 7-10% of the initial values in case of overweight are also recommended. The change in behavioral stereotypes that should contribute to the formation of a healthy lifestyle is of fundamental importance.

The purpose of the work is to highlight the notion of personalized nutritiology, to present an individualized approach to the correction of nutritional disorders and the selection of programs for the treatment of diseases using nutrients, and to give a brief overview - timeline of the main events in nutritional science. The literature data, as well as the results of authors’ own observations on nutritional status assessment, the role of microbiota in the personalization of nutritional support, the principles of creating individualized programs for the correction of metabolic disorders were used in the work. Characterization of nutritional insufficiency was carried out in accordance with known alimentary-volemic parameters. Personalized nutritional science is a new scientific area with two main strategic directions: industrial-technological and medical-technological. At present, there are already some programs of personalized alimentation for correction of metabolic disorders in various diseases, and prospects for creating new medical technologies and technologies for creating corrective food products are designed.

The article deals with the issues of use of fermented milk products as complementary foods in children of the first year of life. Data on new types of complementary dairy products containing probiotic microorganisms and the possibility of their use in children of the first year of life are given. The results of clinical studies of products containing probiotics L. rhamnosus GG, BB12, and acidophilous bacterium in children are presented.

Purpose. Assessment of regional blood flow in the mucous membrane (MM) of the body, antral part of the stomach, and duodenum in patients with a combination of chronic pancreatitis (CP) and gastroesophageal reflux disease (GERD), depending on gastroduodenal motor activity, morphological changes in gastroduodenal MM and patient’s age. Material and Methods. The study included 41 patients (27 males and 14 females) aged 20 to 64 years with CP in combination with GERD, and 25 healthy controls (15 males and 10 females) aged 22 to 46 years. All patients underwent assessment of exocrine and endocrine functions of the pancreas, esophagogastroduodenoscopy with body biopsy of the MM of the body, antral part of the stomach and duodenal bulb. Morphological state of MM was assessed in sections stained with hematoxylin and eosin. The gastroduodenal mucosal blood flow velocity was measured by the polarographic method. Comparative assessment of gastroduodenal mucosal blood flow and gastroduodenal motility was conducted in 23 patients. Results. Analysis of the histological findings of patients with a combination of CP and GERD compared with control group has revealed a significant predominance of lymphoplasmocytic infiltration, gastric metaplasia and glandular atrophy in duodenal MM, as well as a significant decrease in villous height, especially in persons over 50 years of age. Morphological changes in the MM of the duodenal bulb in patients were accompanied by a significant decrease in the blood flow velocity (by 26.2%) compared to persons with unchanged MM. There was also a significant increase in the mucosal blood flow velocity (by 1.5-1.7 times) in the phase of motor activity in comparison with the phase of motor resting in all patients in all parts of gastroduodenal MM. Conclusion. These data indicate that in patients with CP in combination with GERD or NERD histological changes in gastroduodenal MM were accompanied by a decrease in the mucosal blood flow velocity associated with glandular atrophy of the body and antrum of the stomach, more pronounced in patients older than 50 years, in comparison with healthy controls. Also, the possibility of electrochemical registration of gastroduodenal motor activity by the character of polarographic curves of hydrogen clearance reflecting the mucosal blood flow velocity is confirmed. The observed cohe-rent changes in gastroduodenal motor activity and the mucosal blood flow velocity reasonably suggest their associated drug correction.

Purpose of the study. Analysis of modern aspects of the clinical and laboratory course of pseudomembranous colitis (PMC), and the determination of the optimal treatment regimens for this disease. Material and Methods. Using continuous sampling method, 122 patients with PMC aged 18 to 96 years, including 35 (28.7%) men and 87 (71.3%) women, were enrolled in study. Results. During an endoscopic examination, a typical macroscopic picture was revealed in all patients: whitish-yellowish pseudomembranous plaques were found throughout the distal sections of the mucous membrane of the colon. Development of PMC was most often preceded by courses of antibacterial drugs from groups of fluoroquinolones and cephalosporins. As etiotropic drugs in the complex therapy of PMC, metronidazole and vancomycin were used. Conclusions. PMC is a variant of the severe course of antibiotic-associated diarrhea (AAD). For effective treatment of PMC, complex therapy is needed, including etiotropic agents, probiotic drugs and pathogenetic agents. Colonoscopy in patients with AAD can significantly increase the frequency of detection of severe forms of this condition and timely adjust the drug therapy.

Purpose: to evaluate the antihelicobacter action of some probiotics in vitro and in vivo. Material and Methods. 3 probiotics were used: 1st - Enterococcus faecium strain L-3, 2nd - Bacillus subtilis, 3rd - combination of Bifidobacterium longum and Enterococcus faecium. In vitro, the growth of 14 strains of H. pylori against the background of the addition of probiotics was evaluated. Probiotic probes were diluted in distilled water in a ratio of 1:100 and then added to an agar plate, on which the H. pylori strain was plated. Analysis for growth was carried out on the 6-7th day. Fifty-five patients with H. pylori-associated chronic gastritis were divided into 3 groups: 1st group received B. subtilis; 2nd - E. faecium, 3rd - standard triple eradication therapy (omeprazole, amoxicillin, clarithromycin for 7 days). Results. Inhibition of H. pylori growth occurred in 50% of cases on contact with a B. subtilis-based probiotics, in 78.6% of cases on contact with Enterococcus faecium strain L-3, and in 64% of cases on contact with a combination of B. longum and E. faecium. Eradication efficacy (in vivo) was 39%, 41 and 60% in the 1st, 2nd and 3rd groups, respectively. Conclusions. The results obtained can be explained by the direct antagonistic action of probiotics against H. pylori, possibly due to the production of bacteriocins. This hypothesis needs further in-depth study.

The article presents a clinical case of portal vein thrombosis against the background of liver cirrhosis with signs of significant decompensation of liver function and portal hypertension. The feature of the case is that portal vein thrombosis was revealed in patient with alcoholic liver disease (cirrhotic stage), with inefficiency of standard treatment. The cessation of anti-inflammatory therapy and the appointment of anticoagulants allowed to stabilize the patient’s condition. Clinical experience has shown it is necessary to perform dopplerography of the portal vein to exclude its thrombosis against the background hepatic cirrhosis, especially in the case of rapid decompensation of the disease.