编号 9 (2018)

Primary sclerosing cholangitis (PSC) is a chronic autoimmune cholestatic liver disease characterized by a progressive course leading to the development of liver cirrhosis. The feature of this disease includes a close relationship with inflammatory bowel diseases (ulcerative colitis and Crohn’s disease). PSC and inflammatory bowel diseases are complex pathological conditions; their etiopathogenesis is associated with a genetic predisposition, immune mechanisms, altered intestinal microbiota, and probably having a common mechanisms, and is not fully understood. For the combination of PSC and inflammatory bowel diseases, a certain phenotype is characteristic, differing in the isolated course of these nosologies. This research was carried out to review current scientific data on epidemiology, demography, etiopathogenetic mechanisms, clinical features, mutual influence of associated diseases, diagnosis and treatment of patients with PSC combined with inflammatory bowel diseases.

The article presents the results of analysis of modern scientific medical literature on the relationship between microbiota and metabolic syndrome, their impact on the psycho-intellectual status of patients. Given that the nervous system and psycho-intellectual functioning are adversely affected by both the signal molecules produced by the microbiota and the metabolic abnormalities, it is advisable to consider these disorders within the framework of a single pathological process with common clinical and pathogenetic links. An integrated approach to this complex pathology within the framework of current trends in the development of medical science will contribute to more adequate and effective management of such category of patients.

Background. The liver pathology remains a serious problem for the health of the world’s population. The need for non-invasive methods for diagnosing these diseases is increasing every year; and a search for additional methods as an alternative for needle liver biopsy is underway. The 13C-methacetine breathe test (13C-MBT) is of great value in assessing the ability of microsomal liver function and a large potential for effective monitoring of hepatic parenchymal function in patients with diffuse liver diseases (DLDs). Objective: to evaluate the potential of 13C-MBT in patients with DLDs of different etiology and to identify additional opportunities for differential diagnosis between these diseases. Methods. In the North-Western State Medical University n.a. II Mechnikov, 13C-MBT to evaluate the functional reserve of the liver in patients with DLDs of different etiology (n=88) was conducted in 2016-2018. Study design: case series. All patients, in addition to mandatory tests, according to their nosology, additionally underwent 13C-MBT with further comparison of the data obtained, depending on the etiology of the process. Results. The analysis of the data obtained has revealed some deviations in the 13C-MBT indices with different DLDs, which makes it possible not only to obtain information on the functional reserve of the hepatic tissue, but also to be useful in differential diagnostics of the etiology of liver diseases. Conclusion. The analyzed data indicate that 13C-MBT reflects the dynamic processes in the liver; it is non-invasive, safe and easily-reproducible test. As a consequence, this method should be included in the list of additional examinations in the diagnosis of DLDs of different etiologies, and in the monitoring of therapy effectiveness.

Objective. Search for a rational regimen for the treatment of diverticular disease of the colon (DDC) depending on the age of the patient, the duration of the anamnesis of the disease and the presence of concomitant pathology. Methods. Between 2003 and 2016, 396 patients aged 24 to 89 years (mean age 61.4±9.3 years) with an instrumentally confirmed diagnosis of symptomatic uncomplicated diverticular disease (SUDD) of the colon characterized by high comorbidity were under observation. As a therapy, patients were prescribed myotropic antispasmodics (trimebutin or mebeverine), lactulose or psyllium for constipation, non-absorbing intestinal antiseptics (rifaximin or nifuroxazide) in the syndrome of excessive bacterial growth. In addition, some of patients have received protected butyrate (combined preparation of butyric acid and prebiotic inulin with sustained release of active substances in the colon). Results. In patients with SUDD, reduction of the pain syndrome using trimebutin was more pronounced than with mebe-verine. In patients with intractable symptoms of intestinal dyspepsia (stomach bloating, rumbling, unstable stool), rifaximin was superior to nifuroxazide in efficiency. The drugs psyllium and lactulose were prescribed for 2 years. In the psyllium group, the number of recurrences of SUDD was 20% less than in the lactulose group. An additional therapeutic effect in relieving the symptoms of SUDD was achieved with the use of the preparation of butyric acid. Conclusions. Trimetabutine remains the most effective drug for the relief of abdominal pain in patients with DDC in all age groups. It is reasonable to assign intestinal antiseptics (rifaximin, nifuroxazide) for patients younger than 45 years, and to normalize the stool with the predominant use of laxatives with prebiotic actionthose in patients over 75 years of age. Psyllium is the drug of choice in case of combination of DDC and constipation with hyperlipidemia. For senile patients, the use of protected preparation of butyric acid with the purpose of correction of possible ischemia of a wall of a gut at microscopic level is indicated.

Background. Postoperative motor-evacuation disorders play an important role and occupy a significant place in the structure of complications after abdominal surgery. Treatment of acute adhesive intestinal obstruction requires partial or total adhesiolysis in addition to direct restoration of the passage of chyme, which can become a springboard for motor disorders due to edema of the intestinal wall, peritoneal injury, the effect of denudation and the formation of new adhesions. Objective. The evaluation of the effectiveness of resonance electric stimulation in complex correction of motor-evacuation disorders in patients in the postoperative period after elimination of acute non-tumor small intestinal obstruction. Methods. 65 case histories of patients who were on inpatient treatment for the period 2015-2018 were subjected to analysis. The mean age was 53.4±3.7 years, gender distribution with a male predominance of 1.5:1. The groups were divided into the main group (n=33, standard management in the postoperative period with additional application of resonance electric stimulation) and the comparison group (n=32; standard postoperative management of patients). The groups were completely matched by sex, age, extent of operation, severity of the condition (p≤0.05). Patients underwent surgery for non-tumor intestinal obstruction with laparotomy access. Results. Against the background of resonance stimulation, a faster recovery effect of motor-evacuation function of the intestine was noted in the main group. Complete restoration of the digestive tract function in the main group was noted at 5 days of treatment in 33 (100%) patients, which significantly differed from the identical parameters of the comparison group (n=26, 81.25%, p≤0.05). Complications according to the Dindo D. et al. scale: in the comparison group 7 (21.9%, p≤0.05) cases of intestinal paresis, in the main group this complication was not registered. The duration of postoperative hospital treatment was significantly longer in the comparison group (9.3±1.3 days) than in the main group (6.2±0.8 days, p≤0.05). Conclusion. The use of resonance electric stimulation in the complex management of the postoperative period promotes faster normalization of peristalsis, restoration of passage of intestinal contents through the digestive tract, early normalization of intraperitoneal hypertension, and prevention of multiple organ failure.

Breast milk is the best feeding for the child of first 6 months of life. By the end of the early infancy, however, the nutrient content in breast milk is becoming insufficient for normal growth and development of the child. This determines the need to expand child’s diet by introducing complementary foods as an additional source of protein, fats, dietary fiber, minerals (iron, calcium, zinc, etc.) and vitamins. The most important component of the diet of the second half of the first year of life is cottage cheese as a valuable source of animal protein, fat, calcium, and vitamin B2. Modern technologies for the production of cottage cheese for children allow not only to obtain a product that is a source of well-assimilable calcium by enriching it with vitamin D, but also to give to it functional properties by introduction of probiotic strains to ensure the physiological process of the formation of intestinal microbiota and the prevention of infectious gastrointestinal diseases. The article presents modern recommendations defining the timing and sequence of introduction of complementary foods into the child’s diet, the role of cottage cheese as an important component in the prevention of calcium deficiency in children, the literature on the safety and efficacy of the probiotic Bifidobacterium lactis (BB12) strain used to improve clinical efficacy of infant products.

The need for systemic glucocorticosteroids (GCSs) to induce remission in patients with inflammatory bowel diseases (IBDs) is beyond doubt. Thus, this group of patients is at risk of developing adverse events during the therapy, including from the upper gastrointestinal tract (GIT). GCSs have the ability to reduce the protective and reparative functions of the gastric and duodenal mucosa, thereby increasing the possibility of erosive-ulcerative changes in the gastroduodenal zone. Therefore, the use of proton pump inhibitors (PPIs) is certainly capable of reducing the risk of ulcerogenesis and gastrointestinal bleeding. But, like any group of drugs, PPIs are not devoid of side effects, and the risks of some of them are higher in patients with IBDs. In modern reports on the results of large studies, the potential benefit from the application of acid-suppressive therapy has been proved only for people with increased risks of adverse events, for example, concomitant use of GCSs and non-steroidal anti-inflammatory drugs, elderly age, history of erosive and ulcerative diseases of the upper gastrointestinal tract, history of gastrointestinal bleeding. Thus, a clear understanding of the potential benefits of PPI therapy for patients with IBDs who are on GCS therapy is required.