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Current Issue. Articles

№4(96) // 2017

 

Обкладинка

 

1. Original researches

 

Gall bladder motility during the stimulated pancreas secretion in patients with chronic biliary pancreatitis and its effect on the pressure in the antral stomach department

M. Yu. Nichitailo, S. P. Kozhara, O. P. Kharlanovska

O. O. Shalimov National Institute of Surgery and Transplantology of NAMS of Ukraine, Kyiv

Objective — to investigate the variants of gall bladder (GB) motility during the stimulated pancreas secretion according to the type of the pressure in the antral stomach department (ASD) in patients with chronic biliary pancreatitis (CBP).
Materials and methods. The ASD pressure was measured during the stimulated pancreas secretion on the intraduodenal infusion of 0.5 % HCl solution in 362 patients with CBP. The availability of GB contraction, the time of its beginning, its character (persistent or intermittent) were registered. The motility was considered as continuous, if the admixture of the bladder bile was noticed in each of the consecutively collected five-minute portions.
Results. The GB contraction during the stimulated pancreas secretion was absent in 15.33 % of patients with ASD pressure of 0 — 5 mm Hg, in 12.03 % of patients with unstable ASD pressure, in 18.96 % of patients with ASD pressure 6 — 9 mm Hg and in 33.33 % of patients with ASD pressure 10 mm Hg and higher. The significant (p < 0.019) differences were observed in groups of unstable ASD pressure and ASD pressure 10 mm Hg and higher. The intermittent GB motility was in 15.75 % of patients with ASD pressure 0 — 5 mm Hg, 29.06 % of patients with unstable ASD pressure, 21.28 % of patients with ASD pressure 6 — 9 mm Hg and in 21.43 % of patients with ASD pressure 10 mm Hg and higher. The significant (p < 0.025) differences were observed in groups of ASD pressure 0 — 5 mm Hg and unstable ASD pressure. The GB contraction began during first 15 minutes of stimulated pancreas secretion in 95 % of patients with CBP. The duration of the persistent GB motility varied from 5 to 35 minutes in 95.77 % of patients with CBP. Both indicators did not depend on the type of ASD pressure.
Conclusions. The GB dyskinesia indirectly affects the ASD pressure, breaking the process of inhibiting pancreatic secretion due to discoordination discoordination of the GB and pancreas functioning. The intermittent GB contractions during the stimulated pancreas secretion increases the probability of the weakening of the process of pancreatic secretion inhibition, and absence of GB contraction increases the probability of the inhibition process failure. The recovery of co-ordination between pancreas and biliary tract that occurs during the interdigestive motor activity decreases the probability of overstrain of the process of inhibiting of pancreatic secretion. The transition from functional to organic insufficiency of the process of pancreatic secretion inhibiting, the sign of this is decreasing of pancreatic polypeptide concentration, is accompanied by loss of the influence of the pancreas on ASD function and development of chronic pancreatitis, that should be taken into consideration when defining the tactics of the chronic biliary pancreatitis treatment.

Keywords: pancreas, secretion, gall bladder, contractions, antral stomach department, pressure.

Original language: Russian

2. CLINICAL CASE

 

Importance of the lifestyle modification in the treatment of gastroesophageal reflux disease and other acid-dependent diseases: evidence-based medicine data and clinical observations

N. B. Gubergrits 1, N. V. Byelyayeva 1, O. V. Shvets 2, A. N. Agibalov 3

1 Donetsk National Medical University, Lyman
2 SE «State Research Center of Nutrition Hygiene of the Ministry of Health of Ukraine», Kyiv
3 VitaCenter, Zaporozhia

The authors described their own clinical observation of a married couple with a similar complex of acid-dependent diseases: gastroesophageal reflux disease with erosive-ulcerative esophagitis combined with diaphragmatic hernia, with erosive-ulcerative lesion of the gastroduodenal zone with cicatrical-ulcerative deformation of the duodenal bulb. Having analyzed the data of evidence-based medicine on lifestyle and nutrition modification upon acid-dependent diseases, the authors substantiated the relevant recommendations for patients, prescribed medicamentous treatment and achieved positive results.

Keywords: gastroesophageal reflux disease, treatment, lifestyle modification, obesity, diaphragmatic hernia

Original language: Russian

3. MEDICINES

 

Morphological aspects of diagnostics of ulcerative colitis: modern view of the problem

А. E. Dorofeyev 1, I. V. Vasilenko 2, Е. А. Dyadik 1, P. P. Snisarevsky 1, Е. А. Kyriyan 3, А. А. Dorofeyeva 4, I. А. Derkach 5

1 P. L. Shupyk National Medical Academy оf Postgraduate Education, Kyiv
2 Donetsk National Medical University, Lyman
3 Ukrainian Medical Stomatological Academy, Poltava
4 SI «D. F. Chebotarev Institute of Gerontology of NAMS of Ukraine», Kyiv
5 Truskavets city hospital

Objective — to evaluate the clinical, endoscopic signs of ulcerative colitis (UC) and to compare them with modern morphological diagnostic criteria using both standard staining and immunohistochemistry methods.
Materials and methods. The examinations involved 438 patients with UC, from them 79 (18.1 %) patients had UC in the remission stage (81.9 %). The UC activity was minimal in 98 (22.4 %) patients, the moderate stage in 179 (40.8 %) patients, and higher UC activity was established in 82 (18.7 %) subjects. The distal UC was diagnosed in 127 (29.0 %) patients, 157 (36.8 %) patients had a left-sided UC, and 154 (35.1 %) patients suffered from pancolitis. The extraintestinal manifestations were diagnosed in 178 (40.6 %) of the examined UC patients, and 83 (18.9 %) patients had extraintestinal lesions of several organs and systems.
Results. The branching, crypt distortion with elements of their atrophy and a wide aperture in crypts have been revealed in UC patients, which is a marker of the chronic UC course. The established decrease in the number of goblet cells and the secretion of mucus in them, in particular PAS-positive mucins, is also a characteristic morphological feature of the UC. The reduction of goblet cells number and decreased mucus secretion occurs in the acute period of the disease and correlates with the UC activity.
Conclusions. The microscopic examination of endoscopic biopsies in UC patients allows not only to verify the diagnosis, but also to determine the degree of severity and activity, to assess the completeness of remission of the disease. Moreover, it gives the possibility to identify certain pathogenetic peculiarities, including changes in the nonspecific resistance, immune mechanisms, which in turn plays an important role in assessing the course and prognosis of the disease.

Keywords: ulcerative colitis, morphological diagnostics.

Original language: Ukrainian

4. Original researches

 

Gastroesophageal reflux disease: the main accents of modern differentiated and controlled pharmacotherapy

V. M. Chernobrovyj 1, S. G. Melashchenko 1, O. I. Chernobrova 2, O. O. Ksenchyn 1

1 National Pirogov Memorial Medical University, Vinnytsya
2 Hormonia Medical Center, Vinnytsya

The article presents recent data and results of own studies of the differentiated and controlled (esophagogastro-gastro-impedance-pH-monitoring) pharmacological treatment of gastroesophageal reflux disease (GERD), in particular with pantoprazole (Zolopent), domperidone (Domrid SR) and ursodeoxycholic acid (UDCA, Ukrliv). The diagnostic value has been shown of the multichannel esophagos-gastro-pH-monitoring, and intraluminal impedance-pH-monitoring based on the original technique and method for the control of acid inhibiting and antireflux effects of pantoprazole and domperidone: acidic, weakly acidic, and weakly alkaline refluxes, including biliary reflux. The UDCA role and place in the modern antireflux pharmacotherapy of GERD has been elucidated.

Keywords: multichannel intraluminal impedance-pH-monitoring, gastroesophageal and duodenogastroesophageal reflux, pantoprazole, domperidone, ursodeoxycholic acid.

Original language: Ukrainian

5. Original researches

 

Engilen: therapeutic capacity and clinical effectiveness

N. B. Gubergrits, N. V. Byelyayeva, O. Ye. Klochkov, P. G. Fomenko

Donetsk National Medical University, Lyman

Composition of the Engilen preparation, medicinal properties of plants, ingredients of the preparation, indications for its administration have been analysed in details. A particular attention was paid to the advantages of Engilen, such as optimal doses and ratio of active ingredients, wide range of indications, effectiveness upon combined diseases of the digestive system and with the concomitant pathology of other organs and systems. The results of own investigation have been presented, showing the Engilen efficacy at the chronic acalculous cholecystitis and non-alcoholic steatohepatitis in patients with excessive body mass or obesity. The effective correction of various types of the gallbladder dysfunction has been obtained.

Keywords: phytohepatoprotectors, silymarin, inulin, curcumin, Engilen, chronic cholecystitis, non-alcoholic steatohepatitis, dysfunction of the gallbladder.

Original language: Russian

6. MEDICINES

 

Current aspects and «underwater rocks» in the treatment of Н. pylori-associated diseases

V. V. Chernyavskyi

O. O. Bogomolets National Medical University, Kyiv

The authors presented current views on the role of Н. pylori-infection in gastroduodenal diseases. The consideration has been given to the practical aspects of the infection treatment in the light of the last Maastricht consensus, as well as to the peculiarities of implementation of its basic provisions in the practical activities. The analysis has been maid for the methods to overcome practical problems in the diagnosis and the treatment of H. pylori-associated diseases.

Keywords: Helicobacter pylori, treatment, Maastricht V.

Original language: Ukrainian

7. MEDICINES

 

Unidentified problems and new opportunities in the therapy of chronic constipation: what should a general practitioner know?

I. G. Paliy, I. V. Chernova

National Pirogov Memorial Medical University, Vinnytsya

Chronic constipation is a complex medical and social problem, which is often faced by practical doctors: therapists, general practitioners (family doctors), gastroenterologists. Causes of constipation can be both functional and organic. A practitioner should be able to differentiate between these conditions and to determine with subsequent tactics of examination and treatment. The problem of the chronic constipation treatment is not fully resolved today, since a comprehensive approach to treatment involves lifestyle correction, a change in the diet nature, and, in case when the effect of the mentioned above measures is absent, the administration of laxatives. The key to successful treatment is to establish confidence between the patient and the doctor. General practitioners (family doctors) should pay attention to the complex laxative drug Microlax®, which causes both chemical and mechanical action, acts gently, not irritating the intestines and without causing systemic side effects. The drug has no special contraindications for use and can be used in adults, children, as well as pregnant women and women during lactation.

Keywords: chronic constipation, diagnostics, treatment, laxatives, Microlax®.

Original language: Ukrainian

8. MEDICINES

 

Modern views on the pathophysiology and strategy of treatment of gastroesophageal reflux disease

S. M. Tkach

Ukrainian Research and Practical Centre of Endocrine Surgery,
Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukrain, Kyiv

The article describes the modern views on pathophysiology of gastroesophageal reflux disease (GERD), including increasing of frequency of transient relaxations of low esophageal sphincter and acid pocket, main reasons for the lack of effectiveness of proton pump inhibitors (PPI) in patients with GERD and basic methods to improve their effectiveness. It was concluded that in order to optimize the GERD treatment, especially due the lack of effectiveness of the standard PPIs doses, it should be more widely used combination of drugs, allowing effective and prolonged control of intragastric pH, such as proton pump inhibitors and alginates, which have also a more rapid symptomatic effect.

Keywords: gastroesophageal reflux disease, treatment, acid pocket, alginates, proton pump inhibitors.

Original language: Ukrainian

9. Original researches

 

The role of proton pump inhibitor in the successful eradication of Helicobacter pylori: the place of pantoprazole

I. G. Paliy, S. V. Zaika, N. M. Kondratiuk

National Pirogov Memorial Medical University, Vinnytsya

Objective — to study the indicators of daily intragastric pH during Helicobacter pylori (H. pylori) eradication according to three-component scheme (pantoprazole + clarithromycin + amoxicillin) in patients with acid-dependent diseases of esophagus, stomach and duodenum with successful H. pylori eradication and to make comparative analysis of the results of express-gastro-pH-monitoring in patients with successful and not successful H. pylori eradication.    
Materials and methods. The examinations involved 15 patients with acid-depended diseases infected with H. pylori, who underwent treatment. The patients were administered pantoprazole (Nolpaza) 0.04 g 2 times a day + clarithromycin 0.5 g 2 times a day + amoxicillin 1.0 g 2 times a day. The express-gastro-pH-monitoring and daily gastro-pH-monitoring was carried out during three-component scheme of H. pylori eradication. Control urea 13C-breath test (IRIS, Wagner, Germany) in all the patients of the group was negative. In addition, we analysed the results of express-gastro-pH-monitoring of 10 H. pylori infected patients with acid-dependent diseases with not successful result of anti-Helicobacter therapy (control group). The treatment scheme of these patients consisted of: proton pump inhibitor (standard dose) 2 times per day + clarithromycin 0.5 g ґ 2 times a day + amoxicillin 1.0 g 2 times a day. Express-gastro-pH-monitoring was carried out during three-component scheme of H. pylori eradication. Control of urea 13C-breath test in this group was positive.
Results. It was found that during the day in the main group intragastric pH ≥ 5 units was 14.9 ± 1.9 h, and diurnal Mo pH Me pH accordingly were 5.8 ± 0.57 and 5.4 ± 0.41 units. Moreover in the control group compared to the main group, the set of indicators of intragastric pH express-gastro-pH-monitoring was significantly (p < 0.01) lower: min pH (3.6 ± 0.45 vs 5.4 ± 0.34); max pH (5.6 ± 0.56 vs 6.9 ± 0.23); X pH (4.2 ± 0.61 vs 5.9 ± 0.24); Mo pH (3.9 ± 0.76 vs 6.1 ± 0.42) and Me pH (4.0 ± 0.55 vs 5.9 ± 0.36).
Conclusions. Successful H. pylori eradication depends on the values of intragastric pH during treatment. Maintaining of intragastric pH ≥ 5.0 during 14.9 ± 1.9 hours per day is sufficient for successful H. pylori eradication in patients with acid-dependent diseases. Express-gastro-pH monitoring can be used as a screening technique for controlling the effectiveness of antisecretory action of PPI and forecasting of antihelicobacter treatment success. Pantoprazole (Nolpaza) at a dose of 0.04 g 2 times a day provides sufficient blocking of hydrochloric acid secretion for successful eradication of H. pylori

Keywords: Helicobacter pylori eradication, urea 13C-breath test, gastro-pH-monitoring, pantoprazole (Nolpaza).

Original language: Ukrainian

10. MEDICINES

 

The effects of Beta-immune on the eradication rates and the state of the immune system in patients with Helicobacter pylori-associated gastritis

M. B. Shcherbinina, T. M. Shevchenko, V. E. Kudryavtseva

Oles Honchar Dnipro National University

Objective — to evaluate the clinical effects of Beta-immun as part of the standard therapy of Helicobacter (H.) pylori-associated gastritis in terms of eradication and immunological status.
Materials and methods. The observations involved 58 patients with chronic antral gastritis associated with H. pylori. All patients underwent anti-Helicobacter therapy (AHT): a proton pump inhibitor in a standard dose + clarithromycin 500 mg + amoxicillin 1000 mg 2 times per day for 10 days. Patients of the main group (n = 29) were additionally administered the natural immunomodulator Beta-immun inside 1 capsule 3 times per day against the AHT background, then 20 days in a regimen of 1 capsule 2 times per day. Clinical data, H. pylori-status, immunological parameters were recorded before the treatment and during the period of 30 — 34 days after the AHT completion. Side effects were taken into account. The subpopulation lymphocytes’ levels were determined with a lymphocytotoxic test with monoclonal antibodies related to markers CD3+, CD4+, CD8+, CD16+, CD19+. The immunoregulatory index (IRI) was calculated. The parameters of healthy people (donors (n = 30)) were used as a control.
Results. As a result AHT tolerability assessment in both groups, side effects were registered in 24 % cases in the main group and 55 % in the comparison group. The H. pylori eradication rate was 89 % and 81 % in the main and comparison group, respectively. At baseline, patients of both groups had an imbalance of the immune status in the T-cell link. Immunocorrection performed in the main group, determined a positive shift in immunity parameters: an increase in the percentage of T-lymphocytes (СD3+), p < 0.05; an increase in T-helpers (CD4+), p < 0.01; reduction of T-cytotoxic cells of suppressors (СD8+), p < 0.05; restoration of IRI to the norm, p < 0.05. There was only a tendency to normalization of these indicators in the comparison group and their values did not change significantly. There was a decrease in the activity of the nonspecific link of immunity (NK cells, СD16+) and activation of B-lymphocytes (СD19+) in both groups.
Conclusions. It has been established that Beta-Immun administration is advisable along with AHT during the treatment of H. pylori-associated gastritis. Beta-immun proved to occur the corrective effects on immune status indicators, which coincides with the positive clinical effect. The use of Beta-immun in such patients provides better tolerability of AHT. Restoration of the immune status of patients promoted the higher degree of successful H. pylori eradication.

Keywords: eradication, immunocorrection, Beta-immun, β-glucans, anti-Helicobacter therapy, immune status.

Original language: Russian

11. Original researches

 

The rifaximine efficacy in the treatment of non-alcoholic fatty liver disease

S. M. Tkach, T. L. Cheverda

Ukrainian Research and Practical Centre of Endocrine Surgery,
Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukrain, Kyiv

Objective — to investigate frequency of the intestinal bacterial overgrowth syndrome (IBOS) at various forms of non-alcoholic fatty liver disease (NAFLD), possibilities of its pathomorphosis as a result of eradication of the small intestine bacterial overgrowth with the use of rifaximine or multicomponent probiotic.
Materials and methods. The investigation involved 125 patients (70 men and 55 women aged 18 to 65 years) with NAFLD, developed against the background of type 2 diabetes mellitus (DM2) and obesity. From them 85 patients with liver steatosis and 40 subjects with non-alcoholic steatohepatitis (NASH). The control group consisted of 20 healthy people (12 men and 8 women aged 18 to 49 years), with excluded NAFKD diagnosis after the complex NAFLD investigation. The IBOS diagnosis was established based on the results of H2-lactulose breath test.
Results. The IBOS was established significantly more frequently in NAFLD patients than in healthy control (58 % vs 10 %, р < 0.005), and in patients with steatohepatitis more frequently than at steatosis (80.0 % vs 47.1 %; р < 0.01). The IBOS eradication after rifaximine course occurred in 30 (83.3 % patients with NAFLD, including 80.0 % patients with steatosis and 87.5 % patients with steatohepatitis. The use of rifaximine was associated with decreasing of severity of steatosis, steatohepatitis and HOMA index in NAFLD patients.
Conclusions. The eradication of the intestinal bacterial overgrowth syndrome in NAFLD patients was accompanied with the reduction of manifestations of liver steatosis and inflammation, as well as insulin resistance attenuation in the most part of patients.

Keywords: non-alcoholic fatty liver disease, intestinal bacterial overgrowth syndrome, prophylaxis, treatment, rifaximine.

Original language: Russian

12. Reviews

 

Современные возможности коррекции дислипидемии у больных с коморбидным течением неалкогольной жировой болезни печени и гипертонической болезнью на фоне висцерального ожирения путем комплексного лечения с назначением поликозанола

Г. Д. Фадеенко, Я. В. Никифорова

SI «L. T. Mala National Therapy Institute of NAMS of Ukraine», Kharkiv

Дислипидемия — важный фактор патогенеза многочисленных хронических неинфекционных заболеваний и неотъемлемый компонент метаболического синдрома. Освещено значение нарушений липидного обмена в развитии процессов атерогенеза, которые также являются основными патогенетическими механизмами для возникновения и прогрессирования неалкогольной жировой болезни печени, гипертонической болезни и висцерального ожирения. Установлено положительное влияние комбинированной терапии с назначением поликозанола на основные этиопатогенетические звенья развития упомянутых нозологий.

Keywords: дислипидемия, атеросклероз, висцеральное ожирение, неалкогольная жировая болезнь печени, гипертоническая болезнь, поликозанол.

Original language: Ukrainian

13. Reviews

 

The possibilities of the use of probiotics for the correction of intestinal microbiota composition at the gastrointestinal pathology

O. V. Shvetz

SI «State Scientific and Research Center with the Problems of Food Hygiene MoH of Ukraine», Kyiv

On the main achievements in medical science of the last decades relate to the clarification of the role of intestinal microbiota in the physiology of different organs and systems of human organism, including digestive, endocrine and immune systems. The multifactorial influence on the microbiota composition starts from the first minutes of life of a newborn child. The huge number of pathologies associated with changes of digestive tract bacterial colonization. Certain probiotic bacteria received evidence of their efficacy in the treatment of some diseases and more perspectives could be discovered in the studies of their usage potential in the future.

Keywords: Microbiota, probiotics, ucerative colitis, Crohn’s disease, pouchitis, diarrhea, Helicobacter pylori infection.

Original language: Russian

14. Reviews

 

The relationship between Helicobacter pylori infection, type 2 diabetes mellitus and obesity: intriguing questions worthy of discussion

V. M. Chernobrovyi 1, O. I. Chernobrova 2

1 National Pirogov Memorial Medical University, Vinnytsya
2 Hormonia Medical Center, Vinnytsya

The results of the study of H. pylori infectivity, its extension, its importance in the diagnosis and treatment of extragastric diseases, namely, type 2 diabetes mellitus (DM 2) with abdominal obesity, metabolic syndrome and insulin resistance in the literature are limited, controversial and need further research. The prevailing opinion is that H.p.- infectivity in the DM 2 patients 2 is more prevalent and correlates with the duration of the disease, the presence of symptoms of dyspepsia, cardiovascular disease, autonomic neuropathy, as well as with age, sex, body mass index, blood pressure, level of glucose onset and glycosylated hemoglobin (HbA1c). The causal-resulting relationship between H. pylori infection and diabetes mellitus is the subject of scientific discussion, and further researches are needed on the impact of H. pylori infection on the DM 2 and on the evaluation of the long-term benefits of H. pylori eradication to prevent the progression of diabetes. A comprehensive analysis of the main components of modern eradication schemes, particularly the analysis of the PPIs’ efficiency, is important in understanding the effectiveness of the H. pylori eradication. According to the latest recommendations (Maastricht V), priority is given to PPI in particular esomeprazole (Ezolong). This is due to the fact that the metabolism of esomeprazole is significantly less dependent on the pharmacogenetics of isoenzymes (CYP2C19 and CYP3A4) by cytochrome P450. Thus, esomeprazole has sufficient acid-inhibiting efficacy (especially in elevated — double standard doses twice a day in accordance with the requirements of Maastricht V) and is an important component of modern eradication schemes of Helicobacter pylori.

Keywords: Helicobacter pylori, diabetes mellitus, H. pylori eradication, esomeprazole.

Original language: Ukrainian

15. Reviews

 

Pathogenetic role of food allergy and food intolerance in irritable bowel syndrome

A. R. Levchenko

O. O. Bogomolets National Medical University, Kyiv

The article presents contemporary views on the role of food allergy and food intolerance in the pathogenesis of the irritable bowel syndrome (IBS). This role is evidenced by both frequent morphological confirmation of the presence of allergic inflammation in the intestinal mucosa in patients with IBS, and frequent combination of IBS, confirmed food allergy and food intolerance. The authors presented data from various studies, confirming the pathogenetic role of food allergy in IBS, as well as the effectiveness of various restrictive diets in this disease.

Keywords: irritable bowel syndrome, food allergy, food intolerance.

Original language: Russian


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