Vol 27, No 2 (2020)

An increase in the number of people with comorbid pathology that requires the simultaneous administration of several drugs led to an increase in the frequency of drug-induced lesions of organs and systems, primarily the digestive tract. Due to the low awareness of doctors, as well as the absence of specific symptoms and markers, the diagnosis of drug-induced bowel lesions is very difficult in real clinical practice and often lasts for a long time. The main diagnostic criteria for drug-induced bowel lesions include chronological relationship with the use of a drug and the reduction or disappearance of symptoms after its withdrawal. It should be noted that it is particularly difficult to identify the drug that initiated the development of the pathological process in comorbid patients who need to take several drugs simultaneously. This review is aimed to systematization and updating of information about drug-induced bowel lesions.

Background. Development of a gradation of precancerous lesions is aimed at improving the secondary prevention of neoplasms. This is facilitated by the search for factors that allow stratifying the severity of manifestations of atrophic gastritis (AG). Objective. The evaluation of indicators of the immune status in the blood of patients depending on the stage of AG according to the OLGA system. Methods. The study included 125 patients aged 18 to 80 years: 52 healthy volunteers (26 men and 26 women, mean age 48.2±4.0 years) undergoing annual medical examinations at the Research Institute of Medical Problems of the North, Federal Research Center “Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences", and 73 patients with AG (38 men and 35 women, mean age - 49.9±4.6 years). Healthy patients were determined on the basis of the absence of a gastroenterological medical history and clinical symptoms of digestive diseases, the blood pepsinogen-1 (PG-1) level >50 pg/L, and the PG-1/PG-2 ratio >3. All patients were H. pylori-positive. The diagnosis of AG was established by a gastroenterologist on the basis of a clinical examination, the presence of H. pylori infection and detection of atrophy of the gastric mucosa during histological examination. All patients underwent a standard clinical examination by a gastroenterologist and laboratory and instrumental studies. Fiberoptic esophagogastroduodenos-copy with a sampling of 5 biopsy specimens from the gastric mucosa was performed in 73 AG patients. Evaluation of AG was carried out according to the OLGA system in histological preparations stained with hematoxylin-eosin. H. pylori was determined by histological method in preparations stained by Romanowsky-Giemsa method. The study of the immune status included determining the number of leukocytes and lymphocytes and indicators of cellular immunity by indirect immunofluorescence of lymphocytes using monoclonal antibodies to CD3, CD4, CD8, CD16, CD19 (Sorbent LLP, Moscow). Results. Compared to healthy individuals, patients with stage III - IV chronic atrophic gastritis according to the OLGA system had inhibition of the T-cell immunity, manifested by a decrease in the absolute number of leukocytes and lymphocytes; a decrease in the absolute and relative levels of mature T-lymphocytes, CD4+ cells, immunoregulatory index (CD4+/CD8+) and NK cells. Impaired cellular immunity was associated with an increase in the stage of atrophy according to the OLGA system. Conclusion. The combination of the use of the OLGA morphological system with the determination of immune parameters increases the possibility of stratification of AG to determine the risk of developing gastric cancer.

Background. Complications of hepatic cirrhosis (HC) and the associated mortality are potentially preventable. Timely diagnosis of HC, the development and widespread implementation of algorithms for maintaining this complex population of patients that meet the standards and national clinical guidelines will help reduce the mortality from digestive diseases. Objective. Optimization of medical care for patients with hepatic cirrhosis (HC) based on an analysis of systemic mistakes in the management tactics for this group of patients in real clinical practice. Methods. 523 medical records of HC patients who received medical care in an outpatient and inpatient settings and who died of HC in the areas of the Krasnodar Territory in 2015-2019 were examined. Results. A number of systemic mistakes in the management tactics for this group of patients were identified and analyzed; authors’ own experience and literature data on the elimination of identified defects are presented. Conclusion. Optimization of the quality of medical care for HC patients can be reached by a multidisciplinary approach involving physicians, gastroenterologists, infectious disease specialists, narcologists, nutritionists, surgeons, endoscopists, and physical therapy specialists. The main line of work with this group of patients is the timely detection of HC at the stage of compensation, etiological treatment, prevention and timely treatment of HC complications.

Background. The importance of the problem of opisthorchiasis is dictated by the long-lasting disease duration with possible complications provoking the formation of periportal fibrosis, recurrent pancreatitis, cholecystitis, gallstone disease, and cholangiocarcinoma. Objective. The evaluation of clinical and biochemical manifestations in patients with chronic opisthorchiasis, depending on the severity of liver fibrosis (LF). Methods. 58 patients with chronic opisthorchiasis (33 men and 25 women; mean age - 42.3 years) and 25 healthy patients (14 men and 11 women; mean age - 41.5 years) aged 24 to 60 years were examined. Opisthorchiasis was diagnosed in all 58 patients by determining the eggs or bodies of adult parasites in duodenal contents and/or feces (according to the Kato technique). Clinical symptoms and medical history were studied using a standard questionnaire developed on the basis of current international classifications. To diagnose concomitant changes and complications, all patients underwent ultrasound examination of the liver and pancreas, and fibrogastroscopy. LF was studied in all 58 patients with opisthorchiasis by the elastometry using Aixplorer (France) or Siemens Acuson S2000 (Germany) ultrasound systems according to the METAVIR scale with 4 degrees of fibrosis. The control group was recruited from healthy individuals who did not present gastroenterological problems during the annual medical examination, did not have pronounced chronic diseases of various organs and systems, were characterized by normal clinical and biochemical blood tests, lack of viral hepatitis markers and antibodies to opisthorchis, and had no history of alcohol abuse. Results. The most common clinical manifestations of opisthorchiasis included astheno-vegetative syndrome (60.3%), right subcostal pain (34.5%) and pain in the lower abdomen associated with altered defecation pattern (17.2%). The systemic nature of the clinical manifestations of the studied parasitosis was indicated by a high frequency of articular syndrome (24.1%) and skin itching (25.9%). METAVIR F2 stage LF was registered in 20.7% of the examined individuals, and F3-F4 stage LF was detected in 17.2% of patients with opisthorchiasis. In opisthorchiasis patients, weekly right subcostal pain, bloating, skin itching, articular and asthenovegetative syndromes, hepatomegaly, and an increase in blood transaminase, alkaline phosphatase and total bilirubin levels were associated with severe LF. Conclusion. In patients with opisthorchiasis, clinical symptoms were clearly associated with the severity of LF. A significant proportion of patients with opisthorchiasis had biochemical equivalents of cytolytic and cholestatic syndromes, which indicates the presence of an aggressive inflammatory process in the liver. We found a high incidence of severe LF (METAVIR F2-F4 stage), which verifies the basic concept of our study. The project “Immuno-biochemical model for predicting the severity of precancerous changes in the liver in patients with chronic opisthorchiasis" was carried out with the support of the Krasnoyarsk Regional Fund for the Support of Scientific and Technical Activities (application code: 2019051404996).

This review contains brief information on the current etiopathogenesis of alcoholic liver disease (ALD), collected from relevant sources in the world medical literature over the past 10 years. The direct and indirect effects of ethyl alcohol on the body are described in detail. The fundamental importance of alcohol withdrawal and adequate nutritional support for people with ABP is emphasized. In severe alcoholic steatohepatitis, treatment with glucocorticosteroids is recommended, with a switch to pentoxifylline in case of contraindications and/or pronounced side effects, assessed using the Lille model on the 7th day of hospitalization. The important role of succinic acid in the complex pathogenetic therapy of the effects of chronic ethanol intoxication has been determined. An original infusion polyionic methionine-succinate complex based on succinic acid, under the trade name Remaxol®, has been proposed as a first-line therapy for mild alcoholic steatohepatitis. A detailed description of the components of the complex is given, the feasibility of their use in ALD of various stages is explained. The main conclusions of the available clinical trials of the drug are discussed; its main effects with an indication of the dosage regimen are described.

Post-radiation bowel diseases are a common problem in patients after radiation therapy for cancer. The small intestine, rectum and sigmoid colon are the most commonly affected. Lesions can be both acute and chronic, and occur in a fairly long-term period. There are not only morphological, but also functional changes that are clinically manifested by diarrhea, pain, bacterial overgrowth, bleeding, malabsorption, strictures, and intestinal fistulas. Severe bowel damage can lead to permanent disability. The treatment is mainly symptomatic, but in case of complications can be surgical. A number of studies have shown the protective and therapeutic effects of some drugs, but the evidence base is still insufficient.

Proton pump inhibitors (PPIs) are the “gold" standard for pharmacotherapy of gastroesophageal reflux disease, functional dyspepsia, gastric and duodenal ulcer associated with both Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs. The article systematizes the evidence base for the effectiveness of the use of PPIs in the above pathologies accumulated to date.

Background. Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract (GIT), manifested by periodic abdominal pain associated with a change in the frequency of defecation and/or a change in the consistency of the stool. Currently, one of the most effective and safe drugs for the treatment of IBS is trimebutin, which from the modern point of view is considered not just as an antispasmodic, but as a means of regulating gastrointestinal motility. A series of clinical cases. The article presents clinical observations demonstrating objective difficulties associated with the management of IBS patients, including during pregnancy and in the presence of psycho-emotional stress, as well as the effectiveness of the use of trimebutin in these situations as a drug for the treatment and prevention. Conclusion. Clinical observations reviewed demonstrate objective difficulties associated with pharmacotherapy of patients with IBS. In the above cases, trimebutin is the optimal drug in terms of both effectiveness and safety. Thus, the use of trimebutin, which has a normokinetic effect on the motility of the lower gastrointestinal tract, as well as antispastic and analgesic effects, is considered a priority treatment strategy for patients suffering from IBS.

Background. The article considers the problem of primary hyperparathyroidism (PHPT) as the cause of the development of chronic pancreatitis (CP). The most informative diagnostic methods for PHPT have been determined. The possibilities of examination and treatment of a patient with a rare form of CP are shown. Description of the clinical case. A clinical case of chronic calcifying pancreatitis in a patient with PHPT with symptoms of pancreatogenic diabetes mellitus and pancreatic hypertension is presented. The complexity of diagnosing this pathology and the possibility of collaborative management of the patient by specialists of various profiles: gastroenterologists, endocrinologists, radiologists and surgeons are shown. Conclusion. This clinical example demonstrates the difficulty of diagnosing PHPT in a patient with CP, whose successful treatment was ensured by the integrated coordinated work of gastroenterologists, endocrinologists and surgeons. It is emphasized that detection of hypercalcemia in patients with CP requires additional laboratory and instrumental tests, such as determining the parathyroid hormone level, parathyroid scintigraphy in combination with multispiral computed tomography. The resection of pathological parathyroid gland is the only method of treatment for PHPT, which allows to achieve normalization of biochemical parameters.