Vol 29, No 2 (2022)

Today, almost half of the calories consumed by the human population in the world come from cereals, with wheat being the most popular grain in Europe and America. Its use is so widespread that it is very difficult for people suffering from gluten-associated disorders to avoid eating this element. This article discusses the variants of gluten intolerance. Particular attention is paid to gluten sensitivity without celiac disease. Its possible causes, pathogenesis, diagnostic criteria, issues of differential diagnosis with celiac disease and irritable bowel syndrome, and the possibility of treating these disorders are described.

Inflammatory bowel diseases are chronic diseases of unknown etiology that occur with periods of exacerbations and remissions, leading to negative consequences in the social, physical and emotional spheres, reducing the quality of life and thereby exacerbating the course of the disease, increasing the risk of exacerbations and relapses. An obvious fact is that a significant number of factors influence the state of psychological status and the level of quality of life, including the nosology itself (most often Crohn's disease is more severe, especially with the debut in young patients), the severity of the course of the disease, the extent of the lesion of the digestive tube, extraintestinal manifestations, complications, surgical interventions, as well as the effectiveness of the selected therapy. In this article, we analyzed the available domestic and foreign literature, tried to identify risk factors that contribute to a negative impact on the quality of life, and described possible methods for alleviating psychopathological symptoms. Currently, there is no available and effective drug therapy that directly affects the quality of life of patients. Most likely, a positive impact on the quality of life will be largely associated with the activity and severity of the underlying disease.

Background. Obesity and gastroesophageal reflux disease are comorbid pathologies. A significant proportion of patients with non-erosive gastroesophageal reflux disease (NERD) have failed standard acid-suppressive therapy. The effectiveness of weight loss interventions and the effectiveness of acid suppression therapy has not been compared in patients with NERD and obesity. Objective. Comparison of the effectiveness of lifestyle changes (diet therapy, intensification of physical activity) and traditional therapy with proton pump inhibitors (PPIs) in overweight or obese patients with non-erosive reflux disease (NERD). Methods. The randomized clinical trial involved 30 patients with NERD, 12 (40%) men and 18 (60%) women of middle age, median age 51.5 (45; 62) years. 17(56.66%) patients were overweight, 13 (43.33%) - obese, and 27(90%) - with abdominal obesity. Patients were randomized into two groups: control group - 15 patients who received initial therapy with omeprazole 20 mg 1 time per day for 4 week, then maintenance therapy with omeprazole 10 mg 1 time per day for 5 months; intervention group - 15 patients who participated in the program for the correction of eating behavior for 6 months and received only initial therapy with omeprazole 10 mg 1 time per day for 4 weeks. The follow-up duration was 6 months. The effectiveness of the two treatments was compared by assessing the symptoms of gastroesophageal reflux disease, 24-hour pH-impedancemetry, levels of anxiety, depression, and quality of life. Results. At 1, 3, and 6 months, standard and experimental treatments had similar effects on heartburn and regurgitation symptoms. At the same time, by the sixth month of treatment, in the group of correction of eating behavior, personal anxiety was significantly lower, the quality of life according to the vitality scale of and the role-emotional scale was higher; 24-hour pH-impedancemetry revealed a lower total number of gastroesophageal refluxes (GERs), acid GERs, proximal acid GERs, less % of the time with pH <4. Conclusion. The study demonstrated the benefit of lifestyle modification over traditional PPI therapy in overweight or obese patients with NERD. Eating behavior modification and weight loss are similar to PPI therapy in terms of influencing the main symptoms of gastroesophageal reflux disease (heartburn and regurgitation), while improving upper gastrointestinal motility, reducing the number of distal and proximal acid GERs.

Gastroesophageal reflux disease (GERD) is one of the common diseases with increasing incidence. Diagnosis is based on clinical evaluation of symptoms and response to antireflux therapy; detection of damage to the mucous membrane of the esophagus during endoscopy and pathological changes according to reflux monitoring. In recent years, the criteria for making a diagnosis have been revised and become more stringent. Proton pump inhibitors are recommended as the most effective class of drugs for the treatment of GERD. At the same time, the issue of prescribing drugs that can quickly stop the symptoms of the disease, improve the effectiveness of therapy and the quality of life of patients remains relevant. The accumulated scientific data and long-term experience of use allows to consider alginates, drugs with a physical antireflux mechanism of action, not only as an rescue medications for heartburn and for longterm monotherapy or in combination with PPIs, but also to take into account their effectiveness as a diagnostic criterion for the disease. A review of key consensus documents on the diagnosis and treatment of GERD is presented.

Background. Chronic autoimmune gastritis (CAG) refers to precancerous diseases of the stomach with progressive atrophy of the gastric mucosa. Due to the late diagnosis, it is important to systematize the available data on possible clinical stigmas associated with chronic autoimmune inflammation in the gastric mucosa. Description of the clinical case. In a clinical example of a patient with dyspepsia syndrome and mild anemia, with a concomitant autoimmune thyroid disease, an algorithm for the necessary examination for the diagnosis of CAG is demonstrated. Conclusion. In CAG, it is extremely important to take into account the presence of concomitant autoimmune pathology, signs of vitamin B12 and iron deficiency for additional examination to detect autoimmune inflammation of the gastric mucosa.

Background. Pancreatitis, which develops against the background of hypertriglyceridemia, occurs quite rarely, but is characterized by a severe course. Metabolic and nutritional factors are involved in the development of the disease. The recurrent course of hypertriglyceridemia-induced pancreatitis (HTIP) leads to the formation of fibrosis of the pancreatic parenchyma and a decrease in its exo- and endocrine functions. Description of the clinical case. A clinical case of a recurrent course of pancreatitis against the background of hypertriglyceridemia, combined with the development of comorbid pathology, in a 30-year-old man is presented. The difficulty in diagnosing HTIP in this case was associated with the combination of moderate hypercholesterolemia with high triglyceride levels and unchanged blood and urine amylase levels during the exacerbation period. Conclusion. This clinical case demonstrates the difficulties in diagnosing HTIP due to the features of the clinical course of the disease, due to the combined influence of nutritional factors and dyslipidemia. Achieving positive clinical and laboratory dynamics, regression of exacerbation episodes require complex etiopathogenetic therapy, as well as adherence to dietary recommendations.