Vol 26, No 2 (2019)

The review presents current information on thromboembolic complications (TECs), which are one of the most characteristic manifestations of inflammatory bowel diseases (IBDs). The etiopathogenetic relationship between IBDs and the development of TECs has not yet been sufficiently studied, but it can be assumed that there are also hereditary factors contributing to the development of TECs in addition to the acquired factors of hypercoagulation. Hypercoagulation, as many researchers believe, is involved in the pathogenesis of IBDs, and a future evaluation of this phenomenon will help identify potential therapeutic targets for the treatment of IBDs. TECs worsen the prognosis of the disease and increase mortality from IBDs. It is necessary to enhance doctors’ awareness of the risks of TECs, measures of primary and secondary prevention, about the methods of their treatment, which is of great practical importance in the treatment of IBDs. In the future, it is necessary to clarify the controversial problems of thromboprophylaxis of patients with active disease in outpatient settings, thromboprophylaxis of patients in the period after discharge from the hospital, and also solve the problem of the duration of thromboprophylaxis. Currently, there is a need to provide clinicians with reliable methods or markers for assessing the prothrombotic risk for patients with IBDs in order to promptly apply preventive measures.

Currently, it is assumed that inflammatory bowel diseases (IBDs) occur when certain environmental factors influence the intestinal microflora in genetically predisposed individuals. In the pathogenesis of IBDs, different mechanisms such as damage to the epithelial barrier of the colon mucosa, changes in metabolism and virulent properties of commensal bacteria, the ratio of normal and pathogenic intestinal bacteria, dysregulation of immunological reactions, as well as genetic factors, play a role. The modern dynamics of life inevitably leads to a violation of the diet, which, according to many researchers, causes a change in the intestinal microflora. The review presents literature data on the effect of food components on the intestinal microflora, discusses the symptoms of micronutrient deficiency in patients with IBDs, and lists recommendations that can eliminate micronutrient deficiency.

The review briefly summarizes all current methods of treating non-alcoholic fatty liver disease. Based on completed randomized clinical trials, the effectiveness of each group of drugs was assessed; the main contraindications and side effects of therapy with the described drugs were identified.

Background. Disaccharidase deficiency and functional bowel disorders (FBDs) are largely similar in clinical manifestations and require differential diagnosis due to different pathogenetic approaches to treatment. Objective. To assess the activity of disaccharidases of the mucous membrane of the small intestine in patients with clinical symptoms of FBDs. Methods. 102 patients aged from 18 to 50 years (41 men and 61 women) with clinical symptoms of irritable bowel syndrome (IBS) with a predominance of diarrhea (35 patients), IBS with a predominance of constipation (16), mixed type IBS of (14), functional diarrhea (33) and functional constipation (4) were examined. Disaccharidase activity was evaluated using Dalquist method modified by Trinder in duodenal biopsy specimens obtained during esophagogastroduodenoscopy. Results. Normal enzyme activity was detected in 11 (10.8%) patients. The activity of all the enzymes studied was reduced in 33 (32.3%) patients. In 58 (56.9%) patients, selective reduction in carbohydrase level was found. The basis for the treatment of patients with disaccharidase deficiency was a low-carb diet, intestinal antiseptics and enteroprotectors, which reduced clinical symptoms and increased the activity of membrane enzymes. Conclusion. In 89.2% of patients, the symptoms characteristic of FBDs were associated with a decrease in the activity of membrane enzymes of the small intestine. The reason for the enzymatic deficiency can include prior acute intestinal infections, the use of nonsteroidal anti-inflammatory drugs or other agents that damage the mucous membrane of the small intestine. Treatment with low-carb diet, intestinal antiseptics and enteroprotectors helps to stop pain, abdominal discomfort, flatulence and stool disorders.

Objective. Comparison of the efficacy and tolerability of the two Helicobacter pylori infection eradication regimens (classical triple and classical with the addition of bismuth tripotassium dicitrate [BTD] preparation - Ulcavis). Methods. The study included 138 patients aged from 19 to 78 years with H. pylori-associated diseases requiring eradication therapy and randomized into two groups. Diagnosis of H. pylori infection was performed using a urease test during video gastroscopy. Group 1 received the classic triple regimen: esomeprazole (Emanera) 40 mg twice a day+amoxicillin (Flemoxin) 1000 mg twice a day+clarithromycin (Fromilid) 500 mg twice a day. The group 2 received similar preparations+BTD (Ulcavis) 240 mg twice a day. The duration of both treatment regimens was 10 days. Patients daily filled out a questionnaire on the tolerability of treatment and medication. The result of eradication therapy was evaluated after 8 weeks. Results. The study protocol was completed in 121 patients, and not completed in 17 patients for various reasons. The treatment efficacy among those who completed the protocol (ITT- intention to treat) was 95% in total (93.7% with classical triple therapy and 96.6% with addition of BTD; p=0.5). When calculated for all patients included in the protocol (PP - per protocol), treatment efficacy was 83.3% in the total group, 80.8% in group 1, and 86.3% in group 2, i.e. advantages of the scheme with the addition of BTD were revealed. This treatment regimen had an advantage in tolerability: bitter taste in the mouth was less common (p<0.04), and the duration of diarrhea was shortened by 2-3 days (p<0.04). Conclusion. The classical triple scheme using a double dose of a generic proton pump inhibitor (Emanera) and enhanced with a generic drug (Ulcavis), in case of high compliance, demonstrates high efficiency with a lower frequency of some side effects and can be recommended for widespread use in practice.

Background. Over the past few years, the approach to the treatment of gastrointestinal stromal tumors (GIST) has undergone significant changes, reflecting a clearer understanding of the nature of the tumor and the possibility of determining the degree of its malignancy at the preoperative stage. To date, sufficient international experience in the removal of small-sized GISTs using various endoscopic technologies has been gained. Objective: a review of modern endoscopic techniques for the removal of gastric GIST and the presentation of authors' own experience. Methods. From March 2014 to September 2018, a single-site prospective study in the Loginov MCRC was conducted; study included 22 patients with GIST. All tumors were removed by an endoscopic method using the submucosal tunneling endoscopic resection (STER) technique. Results. In total, 25 gastric tumors were removed by a tunneled technique. The average size of the tumors was 17 mm, the smallest size of the neoplasms - 13 mm, the largest - 37 mm. The average duration of the operation was 145.9 minutes. All tumors were removed without damaging the integrity of the capsule. According to the results of an immunohistochemical examination, 12 removed tumors were a low-grade malignant GIST. Four removed tumors were assigned to an intermediate group, with the need for imatinib adjuvant chemotherapy in two cases. Seven neoplasms were leiomyomas. Conclusion. Authors’ own experience and literature data suggest that tunneled dissection can be an alternative to surgical resection in the treatment of patients with a GIST of a specific location. Nevertheless, further evaluation of the problem and accumulation of experience with obtaining long-term results are necessary to confirm the data obtained.

Disbalance of vitamins and minerals in the body leads to a deterioration in the health of children. A number of anatomical and physiological features in children of preschool and school age cause increased needs for vitamins and minerals. Calcium is one of the most common trace elements in the human body and performs many functions, and its participation in the formation of bone mineral density is especially important. Calcium metabolism is closely related to the metabolism of vitamin D. Osteocalcin is also involved in bone mineralization, and its activity depends on the presence of vitamin K. Constant and balanced intake of calcium from food is an important condition for skeletal growth, normal physical development and maintaining child health

The article presents a literature review devoted to the prevalence, etiopathogenetic mechanisms, the clinical picture and methods of diagnosis and treatment of functional biliary disorders and biliary sludge. The results of the study convincingly proving the need for combined therapy with ursodeoxycholic acid and gimecromone in the biliary sludge stage are presented. Timely diagnosis and treatment of functional biliary disorder and biliary sludge are essential for the prevention of cholelithiasis.

Alcoholic liver disease remains the main cause of complicated course of liver diseases with high mortality throughout the world. Excessive use of alcohol with harmful health consequences is an extremely urgent problem for Russia. Hepatic cirrhosis makes a significant contribution to the population mortality from diseases of the digestive system. The majority of patients with ALD have a mild alcohol dependency, with rare hangover syndrome, which allows them to drink alcohol for many years. Subclinical course of ALD up to the formation of cirrhosis is very common in such patients. This leads to the inability to provide timely medical care and prevent cirrhosis. The assessment of severity and short-term life prognosis in patients with ALD is based on various prognostic models. The basis of the concepts of ALD pharmacotherapy includes effect on the pathogenetic components of this pathology. L-ornithine L-aspartate is one of the drugs used for pharmacotherapy of ALD of various severity. Treatment with L-ornithine L-aspartate is carried out according to the schemes determined by the course of ALD (alcoholic hepatitis and alcoholic cirrhosis).

Background. Autoimmune gastritis (AIG) is considered as one of the reasons for the formation of progressive atrophy of the gastric mucosa. This publication is presented for the purpose of updating information about AIG in the practice of a clinician and a morphologist. Description of the clinical case. A clinical example of AIG with step-by-step description of the stages of diagnosis is presented. The pathogenetic aspects of the formation of AIG, its endoscopic and morphological features, modern diagnostic and therapeutic approaches are discussed. Conclusion. For the diagnosis of AIG, a competent assessment of morphological changes, their localization, severity and prevalence with the subsequent analytical assessment of these changes in conjunction with serum markers, anamnestic data, and results of physical examination is required.

Background. According to various studies, the cause of bleeding from the gastrointestinal tract in 3-27% of cases are angiodysplasias, abnormally dilated, convoluted blood vessels from 1 to 15 mm localized in the submucosal intestinal layer. There are a number of methods for diagnosing angiodysplasias, among which capsule endoscopy (CE) occupies an important place. Clinical guidelines recommend CE as a first-line procedure for patients with suspected small intestine bleeding the after performing EGDS and colonoscopy. Description of the clinical case. The article presents a rare clinical case of diagnosis and management of a patient with arteriovenous small intestine angiodysplasias. A 58-year-old patient for a long time presented various gastrointestinal complaints. During hospitalization, there were controversial bleeding symptoms. Comprehensive examination with CE revealed vascular injection, varicose veins, arteriovenous malformations without signs of bleeding at the time of the study at the border of the jejunum and ileum and in the ileum. The most likely reason for the decrease in hemoglobin level (up to 120 g/l) was bleeding from small intestine arteriovenous malformations. The patient received therapy with enzyme preparations, proton pump inhibitors, intestinal antiseptics, motility regulators with a positive effect in the form of relief of pain and dyspeptic syndromes, and normalization of stool. Conclusion. CE helps to diagnose acute and chronic bleeding, the sources of which are small intestine angiodysplasia; this allows to start timely treatment, as well as identify asymptomatic angiodysplasia, which makes it possible to prevent life-threatening complications.