Terapevticheskii arkhiv

Currently, disturbances in the composition and metabolic activity of the intestinal microbiota are considered a key modifiable factor in obesity and associated metabolic disorders. This review summarizes data on the characteristics and variability of the microbiota composition in individuals with obesity. The main mechanisms linking dysbiosis to metabolic disorders are discussed: changes in the production of short-chain fatty acids and other microbial metabolites, as well as the contribution of lipopolysaccharide-induced chronic inflammation. The influence of the microbiota on the regulation of appetite and eating behavior through the microbiota-gut-brain axis and intestinal hormones is discussed separately. Current approaches to the diagnosis of dysbiosis and potential strategies for correcting microbiome-associated disorders in obesity in the context of personalized medicine are presented.

Background. The current study hypothesized that gastrointestinal symptoms would improve following a low-FODMAP diet in patients with irritable bowel syndrome (IBS) due to reduced load on enzyme systems and normalization of the activity of disaccharidases involved in the final assimilation of carbohydrates.

Aim. To evaluate the effect of a low-FODMAP diet on the dynamics of disaccharidase activity in patients with IBS who have symptoms of food intolerance.

Materials and methods. The study included 20 patients with IBS aged 18 to 50 years: median 32.0 years, Q1 = 27.0, Q3 = 38.0, p-value (Shapiro–Wilk) < 0.05. Complaints were collected from patients, dietary history was analyzed with an emphasis on intolerance to FODMAP products and the occurrence/intensification of clinical symptoms when eating dairy products. All patients underwent esophagogastroduodenoscopy with a biopsy from the subbulb of the duodenum to determine the activity of four intestinal carbohydrates: lactase, sucrase, maltase and glucoamylase according to the Dahlquist method as modified by N.I. Belostotsky. The control group consisted of 30 apparently healthy people, comparable in age and gender to the examined IBS patients. Among them were 10 men and 20 women (average age – 31.2 ± 9.2 years). The activity of intestinal enzymes in this group was within the reference values. Statistical processing of data was carried out using the computer program Statistica 8.0 (StatSoft Inc, USA).

Results. The analysis of enzymatic activity showed that initially the level of intestinal carbohydrates in patients with IBS was reduced compared to the control group. 2 months after following the low-FODMAP diet, the activity of all enzymes studied increased, but a statistically significant increase was noted only for lactase and sucrase (p < 0.05). Clinical improvement was observed with adherence to the low-FODMAP diet, decrease in the number of patients with complaints of pain, bloating, rumbling in the abdomen, nausea and diarrhea syndrome, however, a statistical difference was found only for bloating and diarrhea (p < 0.05).

Conclusion. Reducing the substrate load on the enzyme systems of the small intestinal mucosa can help improve clinical symptoms in patients with IBS with symptoms of intolerance to foods containing FODMAPs and have a positive effect on the activity of intestinal enzymes.

Background. In recent years, the role of chronic gastroduodenitis in the occurrence of functional intestinal diseases within the framework of the crossover syndrome, which occurs against the background of minimal inflammation in the stomach and intestines associated with Helicobacter pylori infection, has become increasingly relevant.

Aim. To determine the relationship of chronic gastroduodenitis, associated and not associated with H. pylori infection, with the level of fecal calprotectin (FC) and clinical symptoms of functional intestinal disorders.

Materials and methods. The study included 158 patients with chronic gastroduodenitis: group 1 (80 patients with gastroduodenitis associated with H. pylori infection in the stomach) and group 2 (76 patients without H. pylori infection). All patients had clinical symptoms of the gastrointestinal tract for at least a year. The patients underwent esophagoduodenoscopy and colonoscopy. Verification of H. pylori was based on data from histiobacterioscopy of impression smears from the mucous membrane of the antrum of the stomach. FC content was determined using an express analyzer.

Results. Patients of the first group significantly more often complained of pain, a burning sensation and fullness after eating in the epigastric region, nausea, belching, heartburn, flatulence, pain along the large intestine, a feeling of incomplete evacuation after defecation compared to the group without H. pylori infection. At the same time, in patients with H. pylori infection, FC values were most often determined in the range from 50 to 200 μg/g – in 28.75%, and in patients not infected with H. pylori infection – 13.15% (p < 0.05).

Conclusion. The studies conducted indicate the presence of a statistically significant relationship between chronic gastroduodenitis and functional intestinal disorders, which can be bidirectional in nature, the basis of which is minimal inflammation caused by the presence of H. pylori infection and increased production of FC.

Performing surgical interventions on the mitral valve is one of the main high-tech treatment methods that requires further anticoagulation therapy. However, patients at high risk of bleeding have traditionally become a group requiring a personalized approach and, in many cases, the guidance of a multidisciplinary team of specialists of various profiles. In this clinical case, it is noteworthy that the 72-year-old patient underwent a full amount of preoperative preparation, and no contraindications to surgical treatment were identified. During esophagogastroduodenoscopy, an endoscopic picture of non-erosive reflux esophagitis, grade M (Minimal), was determined against the background of cardia insufficiency. After surgical treatment, on the background of anticoagulant therapy, vomiting of "coffee grounds" and melena were noted. According to the esophagogastroduodenoscopy data, multiple erosive and ulcerative defects of the stomach and duodenum were revealed, and combined endoscopic hemostasis was performed. The patient was prescribed anti-ulcer eradication therapy. The purpose of this clinical case is to emphasize the importance of a personalized approach to the treatment of this group of patients, who often require consultation with a gastroenterologist.

The close relationship between primary sclerosing cholangitis and ulcerative colitis has given rise to a number of hypotheses aimed at deciphering their pathogenesis from the standpoint of bidirectional connections involving immune, endocrine and inflammatory mechanisms. The review examines the main directions of the concept of the "gut-liver axis" from the point of view of the pathogenetic relationships of primary sclerosing cholangitis associated with ulcerative colitis and intestinal microbiota.

The retrogastric location, small size and soft consistency of the pancreas were the reason for the late discovery of the physiology of this organ. The first information about the anatomy and physiology of the pancreas appeared only in the 16th–17th centuries. The role of the pancreas in digestion was studied in the 18th–19th centuries, its participation in carbohydrate metabolism – in the 19th century, and insulin was discovered in the first half of the 20th century. Clinical signs of pancreatitis were first described in the early 19th century, but diagnosis of this disease still presents certain difficulties. The same can be said about the classification of pancreatitis. Due to the variety of etiological factors and clinical manifestations of acute and, especially, chronic pancreatitis, a single universal classification of pancreatitis has not yet been created, despite repeated attempts and existing classifications.