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Current Issue. Articles

6(98) // 2017

 

 

1. Original researches

 

Quality of life in pediatric patients with ulcerative colitis

N. V. Chernega, M. F. Denisova, N. M. Muzyca, N. Yu. Bukulova

SI «Institute of Pediatrics, Obstetrics and Gynecology of the National Academy of Medical Sciences of Ukraine», Kyiv

Objective — to perform assessment of the quality of life (QoL) in pediatric patients with ulcerativecolitis.
Materials and methods. Examinations involved 64 children (36 girls and 28 boys) aged from 5 to 18 years with acute ulcerative colitis (UC). The UC diagnosis was verified by clinical examination, laboratory tests, endoscopyandmorphology. The QoLwas assessed with questioning with the use of a special international Inflammatory Bowel Disease Questionnaire (IBDQ), adopted for children with UC.
Results. The study of the QoL of children with UC allowed establishing the most negative effects on the state of health of the intestine and emotional factors, their dependence on the patients’ age and gender, degree of activity and localization of the process, thus giving the ground for the development of individual treatment schemes for this pathology in pediatric patients.
Conclusions. The QoL assessment in the UC pediatric patients proved to be a sensitive marker of the health-associated well-being of a sick child. In-depth investigation of the quality of life of children with ulcerative colitis, with account the disease clinical course, form, and activity, will allow determining the tactics of treatment for each individual patient.

Keywords: children, ulcerativecolitis, IBDQ, qualityoflife.

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Original language: Ukrainian

2. Original researches

 

Investigation of the role of certain intestinal hormones and pepsinogens in the pathogenesis of gastroesophageal reflux disease

V. B. Boichuk

Ivano-Frankivsk National Medical University

Objective — to study changes of themotor and evacuation functions of stomachand indicators of the 24-hours pH monitoring in the esophageallower third, to establish the role of gastrin-17 (G-17), cholecystokinin-pancreozymin, changes in the level of pepsinogens I and II, and their correlation in the pathogenesis of gastroesophageal reflux disease (GERD).
Materials and methods. Examinations involved 80 patients with GERD. The GERD diagnosis was based on the diseaseanamnesis, patients’ complaints, results of 24-hours pH monitoring in the lower third of the esophagus, results of esophagogastroduodenoscopy, chromoendoscopy, 13C-octanoic breath test, serum levels of G-17, pepsinogens I and II (PI and II) and cholecystokinin-pancreozymin (C-P).
Results. The results of 24-hours pHmonitoring of the lower esophagusshowed the predominance of acid refluxes in 40 GERD patients and of the mixed refluxesin the rest of patients.In patients with predominance of acid refluxes, the mean values of the 13C-octanoic breath test (half-life excretion of solid food from the stomach) was (45.25 ± 1.34) min.In patients with the mixed refluxes, the hypergastrinemia was established, as well as the high C-P and PI II levels ((37.44 ± 3.41) μg/l; < 0.05), as well as a trend towards the hypokinetic stomach motility, evident due to the decreasedhalf-life excretion of solid food from the stomach up to (139.24 ± 11.87) min. In case of the predominance of acid refluxes, the significance reduction of the G-17, C-P and PI II levels was reveled, and increased PI I levels.
Conclusions. The results of 24-hours pH monitoring of the lower esophagus showed virtually equal rate of the acid and mixed refluxes.In case of the predominant acid refluxes, the accelerated stomachmotilitywas established, and the delayed motility was reveled in the patients with mixed refluxes.The acid refluxes prevailed in GERD patients with the low serum G-17 level and mixed reflux was more frequent in subjects with the increased levels. With the predominance of acid refluxes, blood levels of pepsinogen I was 3.5 times higher than in healthy people, and in case of the mixed reflux,it was within normal ranges with the increased levels of pepsinogen II.

Keywords: gastroesophageal reflux disease, daily pH monitoring in the lower third of the esophagus, 13C-octanoic breath test, gastropanel, cholecystokinin- pancreozymin.

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Original language: Ukrainian

3. Original researches

 

Three-channel esophageal and gastric 24-hours pH monitoring: equipment, technique, and clinical application

O. O. Ksenchyn

National Pirogov Memorial Medical University, Vinnytsya

Objective — to investigate the topographic and functional peculiarities of the stomach and esophagus in patients with GERD with the use of esophageal and gastric 24-hours pH monitoring.
Materials and methods. The study involved 28 patients (11 men and 17 women, the mean age 47 ± 2.4 years), from them GERD was diagnosed in 15 subjects, and functional gastric dyspepsia without GERD in 13 patients. The data, obtained with 3-channel esophageal and gastric 24-hours pH monitoring, were analyzed separately in the groups with GERD and without GERD.
Results. Medium and minimum values of intragastric pH as in the cardia and the body were lower in patients with GERD (p < 0.05 for cardia). Undoubtedly, esophageal monitoring of the is decisive in the GERD diagnosing, however the presence of daily intragastric pH high potency was considered as a predictor of GERD development.
Conclusions. The presence of more acidic stomach contents in patients suffering from GERD not only confirmed the major role of hydrochloric acid in a damaging effect on the esophageal mucosa and occurrence of symptoms, and should also be considered as a possible predictor of GERD in patients without severe clinical symptoms during the examination.

Keywords: gastroesophageal reflux disease, 3-channel esophageal and gastric 24-hours pH monitoring, functional gastric dyspepsia, acid-dependent diseases of the stomach.

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Original language: Ukrainian

4. Original researches

 

CT scanin patients with inflammatory bowel diseases: is it advisable to use it in the routine practice?

O. S. Prymak

Medical Center LLC «Health Clinic», Vinnytsya

Objective — to evaluate the advisability of the use of CT scan as a routine diagnostic method for patients with suspected inflammatory bowel disease (IBD).
Materials and methods. A retrospective analysis was performed on 72 outpatient cardsof patients with suspected IBD or with established diagnosesof ulcerative colitis (UC) or Crohn’s disease (CD). All patientswere undergone a CT scan with the Aquilion-64 helix computer tomography scanner with 64-slices and with double-contrast method (oral and intravenous) for the primary diagnosis of IBD or to evaluate the effectiveness of the treatment. The patientswere divided into three groups: subjectswith suspected IBD, patients with established UC and CD diagnoses; and persons to be under regular medical check-up due to IBD, for whom CT was used to assess the efficacy of treatment.
Results. In patients of the 1st group, CT scan confirmed the UC and CD diagnosis (similar to the endoscopyresults) and allowed to reveal the terminal ileitis and the UCinitial stage of without visual changes in the mucosa during endoscopy but with signs of inflammation in the histology. Besides, it allowed disproving the IBD diagnosis and confirmingother diseases (diverticulitis, pseudomembranous colitis). In group 2 patients, CT scan gave the possibility to confirm or disprove the pre-exposed UC and CD diagnoses, and to detect concomitant pathology at an early stage (primary sclerosis cholangitis and hepatocellular carcinoma). For the subjects of group 3 CT scan enabled tracking of the treatment efficacyin patients with UC and CD, correct choice of the treatment tactics,and complications’ identifying.
Conclusions. The use of CT scan is advisable in the routine practice of diagnosis in patients with the suspected IBD, the established UC and CD diagnosis, as well as assessment of the treatmentefficacy.

Keywords: inflammatory bowel disease, ulcerative colitis, Crohns disease, CT scan.

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Original language: Ukrainian

5. MEDICINES

 

Management of patients with functional diarrhea

O. V. Shvetz

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

Functional diarrhea is a type of functional bowel disorder presenting with loose or watery stool as consequence of intestinal transit dysregulation. The peculiarities of patients’ management dependon the presence of alarm symptoms. Clinical and instrumental measurements aim to rule out of diarrhea secondary to organic disease. The dietary interventions, loperamide, cholestyramine, probiotics and synbiotics may have good efficacy in the functional diarrhea management.

Keywords: functional diarrhea, chronic diarrhea, stoolprevalence, diagnostic criteria, diet intervention, μ-opioid agonist, cholestyramine, probiotics, synbiotics.

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Original language: Russian

6. MEDICINES

 

Irritable bowel syndrome: the topicality of the problem and the issues of modern therapy according to Rome IV Criteria

I. G. Paliy, S. V. Zaika

National Pirogov Memorial Medical University, Vinnytsya

It is known that about 15 — 25 % of the adult population in the developed countries have functional disorders of the gastrointestinal tract, regardless of age, race, religion or socio-economic status. Among the functional diseases of the gastrointestinal tract, patients with irritable bowel syndrome occupy a significant proportion at the reception of a general practitioner and a gastroenterologist (30 % to 50 %). The article deals with the main differences between the Rome IV Criteria for the diagnosis and treatment of irritable bowel syndrome. The necessity of the use of spasmolytic therapy, laxative and antidiarrheal drugs, depending on the clinical variants of the irritable bowel syndrome have been discussed.

Keywords: Rome consensus IV, functional disorders of the gastrointestinal tract, irritable bowel syndrome, diarrhea, constipation, laxatives, antidiarrheal drugs, Mikrolaks, Imodium.

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Original language: Ukrainian

7. Reviews

 

Autoimmune hepatitis: a search for new solutions

V. P. Shypulin 1, G. D. Fadieienko 2, L. L. Pavlovskyi 1, V. V. Chernyavskyi 1, A. V. Neverovskyi 1

1 O. O. Bogomolets National Medical University, Kyiv
2 SI «L. T. Mala National Therapy Institute of NAMS of Ukraine», Kharkiv

This paperpresents modern approaches to the treatment of autoimmune hepatitis (AH) according to the latest international recommendations, their positive and negative aspects. Data on alternative therapies for AH, the prospects of introducing immunologically active and targeted drugs into the clinical practice for treatment and management of AHpatients have been elucidated. A clinical case of a patient with AH against the background of nonspecific ulcerative colitis has been presented.

Keywords: autoimmune hepatitis, prednisolone, azathioprine, budesonide, mycophenolatemofetil, tacrolimus.

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Original language: Russian

8. Reviews

 

Non-alcoholic fatty liver disease and metabolic disorders: what is primary?

T. A. Solomentseva

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

Nonalcoholic fatty liver disease (NAFLD) combines a range of diseases, including simple steatosis, non-alcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma. Recent studies have shown the high prevalence of NAFLD and its close pathogenetic relationship with the metabolic syndrome. The relationship between MS and NAFLD allow assuming that both conditions have pathogenetic interconnections and common pathways and mechanisms of the development. Insulin resistance and inflammation are involved in the process of both diseases. The insulin resistance promotes inflammation, which in turn increases lipolysis of adipocytes and aggravates lipotoxicity. Moreover, IR and inflammation form a vicious circle, with each condition contributing to another and accelerating the development of NAFL in the presence of lipotoxicity. Biologically active fat tissue regulates the expression of pro-inflammatory cytokines, such as tumor necrosis factor α, interleukin-6, and anti-inflammatory cytokines such as adiponectin in NAFLD.

Keywords: non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, metabolic syndrome, obesity, diabetes, tumor necrosis factor, interleukin.

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Original language: Russian

9. Reviews

 

Hereditary pancreatitis: a brief review and the first case of diagnosis in Ukraine

N. B. Gubergrits 1, 2, N. V. Byelyayeva 1, 2, A. Ye. Rlochkov 1, P. G. Fomenko 1

1 Donetsk National Medical University, Lyman
2 Multidisciplinary Clinic «Into-Sana», Odesa

The article presents a literature review on the main genetic mutations leading to the development of pancreatitis. The analysis has been performed for the pathogenesis of hereditary pancreatitis and the high risk of pancreatic cancer at this disease. The authors described their own clinical observation of calcificating pancreatitis that developed in a patient with a mutation of the cationic trypsinogen gene and presented discussion of the treatment and follow-up tactics.

Keywords: pancreas, hereditary pancreatitis, mutation of the cationic trypsinogen gene, risk of pancreatic cancer, clinical observation.

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Original language: Russian

10. Reviews

 

Chronic inflammatory bowel disease and viral infections

E. I. Sergienko

Kharkiv Medical Academy of Postgraduate Education

Viral infections is a key safety concern in the treatment of patients with chronic inflammatory bowel disease (IBD).Patients with chronic inflammatory bowel disease do not receive routine preventative care at the same rate as other patientsof general medical.The improvement of the tacticsof D management involves control of the diseaseinflammatory activity with thecontroller medicationsand prevention of viral infections.The author highlights the recommendations for vaccination against influenza and herpetic infection in patients with IBD, especially those receiving treatment with immunosuppressive drugs.

Keywords: inflammatory bowel disease, ulcerative colitis, Crohns disease, viral infections, treatment, preventive care.

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Original language: Russian

11. Reviews

 

Diagnosis of nonalcoholic fatty liver disease: real opportunities and prospects

G. D. Fadeenko, I. E. Kushnir, Y. V. Nikiforova

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

The article presents the main invasive and non-invasive methods for diagnosing nonalcoholic fatty liver disease (NAFLD). Although liver biopsy is the only accurate method for differentiating patients with nonalcoholic fatty steatohepatitis (NASH) and without it, as well as fibrosis, which is important for determining the tactics of patient management and monitoring, several existing scales and patented panels that also predict the severity of fibrosis. One of the main markers of hepatocyte apoptosis, the definition of which is included in many non-invasive panels for the diagnosis of NASH, is blood plasma cytokeratin -18. Non-invasive imaging techniques, such as ultrasound-based elastography (Fibroscan) and magnetic resonance imaging, are sufficiently accurate studies available to determine the severity of fibrosis in NAFLD, but none of them can replace liver biopsy. The search for the new non-invasive NAFLD markers is ongoing.

Keywords: diagnostics, NAFLD, NASH, fibrosis, fibrogenesis, non-invasive markers.

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Original language: Russian

12. Reviews

 

The multifactorial pathogenesis of non-alcoholic fatty liver disease

V. M. Chernova

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

The pathogenic mechanisms of development of non-alcoholic fatty liver disease (NAFLD) have been elucidatedin the paper. The author outlined that insulin resistance, resulting in a hyperinsulinemia, plays the pivotal role in the steatosis development in liver tissue. Oxidation offree fat acids and export of triglycerides from the liver in a form of very low density lipoproteins are less important. Steatosis livers are played by the decline of oxidization of and. Syndrome of excessive bacterial proliferation in the intestine can also be referred to the pathogenetic mechanisms of NAFLD formation. The effects of lipid peroxidation are considered as most important universal mechanism of NAFLD development. An important place in the pathogenesis of liver steatosis is given to micro-RNA, regulatinglipids’accumulation in hepatocytes. The new data from the study ofthe NAFLD genetic mechanisms have been presented.

Keywords: non-alcoholic fatty liver disease, insulin resistance, metabolic syndrome, free fat acids, micro-RNA, endothelial dysfunction.

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Original language: Russian

13. Reviews

 

The phenomenon of Helicobacter pylori-negative ulcer and its place in clinical practice

V. . Vdovychenko 1, Ya. B. Shvydkyi 1, A. V. Ostroglyad 2

1 Danylo Halytskiy Lviv National Medical University
2 O. O. Bogomolets National Medical University, Kyiv

Consideration has been performed for the modern data on epidemiology, etiology, pathogenesis, features of clinical course and treatment of peptic ulcer of the stomach and duodenum, not associated with Helicobacter pylori infection.

Keywords: Helicobacter pylori-negative peptic ulcer of the stomach and duodenum, epidemiology, etiology, pathogenesis, clinic, treatment.

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Original language: Ukrainian


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