Terapevticheskii arkhiv

In the process of evolution in the gastrointestinal tract, a system of protection against bacterial and food antigens from getting into the blood was formed. The causes of increased intestinal permeability (IIP) can be microbiota imbalance, use of antibiotics, non-steroidal anti-inflammatory drugs, stress, diet rich in fructose, glucose, sucrose and long-chain fatty acids. The appearance of IIP may be of paramount importance in the pathogenesis of autoimmune diseases. A diet low in fermentable oligodimonosaccharides and polyols, pre- and probiotics, polyphenols, vitamins, short-chain fatty acids, dietary fiber, glutamine contributes to the reduction of IIP. It has been established that the cytoprotector rebamipide strengthens the barrier function throughout the gastrointestinal tract, which is reflected in practical recommendations for its use in diseases accompanied by IIP. The study of this direction will contribute to the emergence of a new strategy for the treatment of internal diseases.

Aim. To determine the diagnostic and prognostic value of contrast-enhanced ultrasound (CEUS) in assessment of the vascular structure of the liver in patients with chronic viral hepatitis.

Materials and methods. Based on Clinical hospital №1 in Smolensk from 2018 to 2019 120 people with chronic viral hepatitis and 35 people with unchanged liver parenchyma as a control group were included in the study. All patients were examined by CEUS with 1,0 ml of contrast agent with subsequent evaluation of qualitative and quantitative parameters.

Results. In statistical data processing it was found that the differences in quantitative parameters in the proximal and distal areas, contrast agent transit time from the arterial vascular bed to the venous one, as well as changes in the quality parameters have the most predictive value in the diagnosis of liver parenchyma lesion.

Conclusion. CEUS is a non-invasive method for early diagnosis of changes in the vascular structure of the liver, including viral hepatitis, allowing to estimate the degree of parenchyma damage and on this basis to predict the further course of the disease in the format of a complex clinical-laboratory study.

Diagnostics of enteropathy with membrane digestion disturbance (EMDD) is based on the evaluation of carbohydrase activity in duodenal mucosa (DM). There is no information about diagnostic value of ileum mucosa (IM) carbohydrases.

Aim. Assess the diagnostic value of carbohydrases activity in mucous membrane of duodenum and distal ileum in patients with EMDD and irritable bowel syndrome (IBS).

Materials and methods. The study includes 12 patients with EMDD, 16 patients with IBS and 12 relatively healthy persons (control group). Study design included analysis of food tolerance and evaluation of activity of sucrase, glucoamylase, maltase and lactase in mucous membrane of duodenum and ileum based on the method of Dahlquist with N.I. Belostotsky modification. Microsoft Office Excel and Statistica 10.0 were used for statistical evaluation of material. Mann–Whitney criterion was used to evaluate the differences between quantitative parameters. The differences were considered to be significant at p<0.05. Control group was used for comparison.

Results. In control group the carbohydrases activity in duodenum mucosa was not significantly statistically different from the one in IM. In patients of the IBS group, the activity of glucoamylase and maltase in the IM was significantly higher than in the duodenum: glucoamylase by 2.2 times, maltase by 2 times. In patients with EMDD the activity of glucoamylase, maltase and sucrase in IM is higher than in DM by 5.2, 3.8 and 2 times respectively, which signifies the formation of compensatory reaction of adaptive shift, initially described by A.M. Ugolev in 1985.

Conclusion. The evaluation of carbohydrase activity in IM provides more information about pathogenesis of EMDD and its differential diagnosis with IBS.

Aim. To show a change in the activity of the mucous membrane of the small intestine enzymes in patients with EWIMD under the influence of a cytoprotector (rebamipid) and a low-FODMAP diet; to assess the quality of life of patients with enteropathy with impaired membrane digestion (EWIMD) with various treatment regimens.

Materials and methods. Eighty four patients with clinical symptoms of EWIMD were examined. Each patient had a biopsy taken from the bulbous part of the duodenum. Enzymes of the mucous membrane of the small intestine were studied: glucoamylase, maltase, sucrose, lactase. Enzyme activity was determined by the Dahlquist method modified by N.I. Belostotsky. Each patient filled out the SF-36 questionnaire after completing the therapy stage. The indicators of physical and social functioning (PF and SF), vital activity (VA), emotional well-being (EW), pain level (PL) were studied.

Results. When studying the activity of the mucous membrane of the small intestine enzymes in patients before treatment, it was revealed that the average value of glucoamylase was 104 ng glucose/mg of tissue, maltase – 564, sucrose – 49.6, lactase – 13.2. After 4 weeks of rebamipid therapy, an increase in glucoamylase from baseline values (before treatment) was 1.8 times (p<0.005), maltase 1.4 times (p<0.005), sucrose 1.3 times (p<0.005), lactase 1.5 times (p=0.13). After 8 weeks, a further increase in their activity was detected: glucoamylase increased 2.2 times (p<0.005), maltase 1.8 times (p<0.005), sucrose 1.7 times (p=0.021). The exception was lactase, the activity of which increased 1.3 times (p=0.449), compared with the baseline data, in contrast to the 4-week course of therapy. After 12 weeks of rebamipid therapy, glucoamylase increased 3.2 times (p<0.005), maltase 3 times (p<0.005), sucrose 2.9 times (p<0.005), and lactase 1.9 times (p=0.097). When studying the activity of enzymes under the influence of the low-FODMAP diet, an increase in the activity of glucoamylase by 2.1 times (p<0.005), maltase by 1.7 times (p<0.005), sucrose by 2.06 times (p<0.005), lactase by 2.22 times (p<0.005) was noted. When examining the questionnaire data before the start of treatment, a decrease in VA and EW was revealed (the average values were 44.7 and 50.5, respectively), VA was pronounced (46.58), while the level of PF and SF was satisfactory (78.8 and 62, respectively). After 4 weeks of rebamipid therapy, there was an improvement in all studied indicators. Thus, the level of PF and SF increased to 86 and 78.8, respectively (p<0.005), decreased VA to 64.9 (p<0.005), there was a tendency to increase in VA and EW (56.3 and 59.73, respectively; p<0.005). After 8 weeks, the improvement trend continued. The level of FF and SF reached almost maximum values (98.3 and 92.9, respectively; p<0.005), PL continued to decrease (82.2; p<0.005), the indicators of VA and EW continued to grow (69.1 and 65.3, respectively; p<0.005). After 12 weeks of rebamipid therapy, the maximum values were recorded. Thus, FF and SF were fully restored (100 and 99.16, respectively; p<0.005), almost none of the patients recorded pain sensations – the PL reached 100 (p<0.005). There were also good indicators for VA and EW (79.83 and 75.3, respectively; p<0.005). Under the influence of the low-FODMAP diet, the quality of life level corresponded to the 8-week course of rebamipid (PF – 97, SF – 86.23, PL – 80.6, VA – 66.83, EW – 69.2; p<0.005).

Conclusion. Rebamipid at a dose of 300 mg/day consistently increases the activity of carbohydraz the mucous membrane of the small intestine after 4, 8 and 12 weeks of therapy. When following the low-FODMAP diet for 8 weeks, an increase in enzyme activity is also noted. The most pronounced improvement in the quality of life is recorded against the background of 12 weeks of rebamipid therapy.

Background. Exocrine pancreatic insufficiency (EPI) occurs in most patients with advanced pancreatic cancer (PC) and even more often when a tumor is localized in the head of the pancreas. However, insufficient attention is paid to the diagnosis of EPI and assessment of nutritional status, which negatively affects the results of treatment.

Materials and methods. One hundred fifty eight patients with primary diagnosed locally advanced and metastatic PC were included in the retrospective study. We used the calculation of the odds ratio with 95% CI with an assessment of the p value using the Pearson ÷² test to compare the incidence of clinical and laboratory parameters of nutritional status with values below the lower limit of normal (LLN) depending on the location of the tumor in the pancreas.

Results. Fecal elastase test was performed in only 19 (12%) patients. In this group, the incidence of EPI was 73.6%. Pancreatic enzyme replacement therapy in the minimal sufficient dose was prescribed in 17.1% of the general cohort. The level of hemoglobin, erythrocytes and albumin below the LLN was found in patients with the tumor in the pancreatic head, respectively, 2.742 (95% CI 1.27–5.92), 3.788 (95% CI 1.554–9.232) and 9.767 (95% CI 1.255–76.027) times more often than in patients with cancer in the body-tail of the pancreas. In patients with the tumor in the pancreatic head, the lower levels of hemoglobin (median 125 g/l vs 132 g/l, respectively), erythrocytes (4.19 mil/μl vs 4.51 mil/μl), total protein (69.6 g/l vs 71.5 g/l), and albumin (40.1 g/l vs 42 g/l), as well as the values of nutritional indices: prognostic nutritional index, nutritional risk index, hemoglobin, albumin, lymphocyte and platelet ratio index, and prognostic immune nutritional index were observed.

Conclusion. Diagnosis and treatment of EPI remains inadequately attended. The values of nutritional status parameters in patients with PC in the head are lower than in patients with a tumor in the body-tail of the pancreas, which reflects the contribution of EPI.

The article provides information on the pathogenesis, classification and frequency of ophthalmic extra-intestinal manifestations in patients with inflammatory bowel diseases (IBD). A clinical observation of a patient with autoimmune uveitis and IBD is described, demonstrating the importance of early diagnosis of immuno-inflammatory diseases in the implementation of multidisciplinary management of patients with IBD and extraintestinal manidestations. The use of genetically engineered biological drugs helps to control the course of IBD, ophthalmic manifestations and prevents the development of complications.

For more than a century, physicians have noted the relationship of chronic gastritis with the development of gastric cancer, which prompted great interest in the study and systematization of chronic gastritis in order to better understand the prognosis and develop approaches for cancer prevention. The accumulated knowledge about the etiology, pathogenesis and morphology of gastritis has made it possible to coordinate the general ideas about gastritis in the classifications used by practicing physicians today, and the systems developed and implemented into practice for assessing atrophy/intestinal metaplasia (OLGA/OLGIM) undoubtedly can help the doctor in determining the tactics of curation of the patient.

The human gut microbiome is a complex biological system whose functions and metabolic processes are the result of multiple interactions between microbial groups. Within these groups and between them, specific relationships are formed that allow duplicating and reserving individual functions, systematically managing their implementation and, in general, ensuring the reliable functioning of the entire microbiome, including in the interests of the host macroorganism. The functional and metabolic microbial nucleus plays a crucial role in the functioning of microbiocenosis as a whole system. Due to its natural properties, the modern probiotic Lactobacillus paracasei DG performs the function of a conductor of the microbiocenosis of the gastrointestinal tract, regulating the metabolic activity of the intestinal normoflora, realizing immunotropic effects due to the production of exopolysaccharides, including previously unknown exopolysaccharides b, maintaining the integrity of the intestinal epithelial barrier, exerting antiviral action, exerting distant effects against microbiocenoses of other ecological niches.

Atrial fibrillation (AF) is the most common heart rhythm disorder. According to current recommendations, the treatment of AF includes 3 main directions: "A" – the appointment of anticoagulant therapy with an increased risk of thromboembolic complications, "B" – control of arrhythmia symptoms, choice of a strategy for rhythm control or control of ventricular contractions, "C" – treatment of concomitant diseases and correction of risk factors. The rhythm control strategy includes performing cardioversion, prescribing long-term antiarrhythmic therapy, or performing radiofrequency catheter ablation. According to the latest recommendations of 2020, antiarrhythmic drugs of IC and III classes are currently used for pharmacological cardioversion of AF and long-term retention of sinus rhythm. The choice of a specific antiarrhythmic drug is based on its safety and effectiveness. â-Blockers, non-dihydropyridine calcium channel blockers and digoxin are used to control CHS. The results of modern research have significantly expanded our understanding of the molecular mechanisms underlying various forms of AF. Currently, the search for new drugs is actively underway that will allow preventing the development of AF and its progression at the molecular level.

Aim. To present the materials of the Expert Forum "New therapeutic horizons of NAFLD," held on December 19, 2023, on the updated nomenclature of fatty liver disease (FLD), its main issues of diagnosis and treatment, the burden of cardiovascular risk in FLD patients. Executive Summary of the Resolution. It is recommended that the latest update of the FLD nomenclature be considered for adaptation to the clinical practice of doctors of all therapeutic specialties. Due to the high prevalence of a combination of non-alcoholic fatty liver disease (NAFLD) and an alcoholic component in the Russian Federation, it is essential to distinguish this subgroup of patients. Numerous clinical conditions associated with NAFLD include cardiovascular disease, pre-diabetes/type 2 diabetes mellitus, polycystic ovary syndrome, obstructive sleep apnea, sarcopenic obesity, cholelithiasis, and chronic kidney disease. Once a diagnosis of NAFLD has been made, further examination of patients should be aimed at detecting the presence of fibrosis using non-invasive methods such as transient liver elastography, FibroTest, and calculation of the FIB-4 fibrosis index. The original ademethionine can be considered a universal drug in treating NAFLD due to reducing oxidative stress and correcting concomitant fatigue and asthenia.

Based on the analysis of literary and archival sources, the authors revise the generally accepted position about three founders of the scientific therapeutic clinic in Russia and propose to consider it to be founded by four outstanding clinicians of the second half of the 19th – early 20th centuries – S.P. Botkin (Petersburg), G.A. Zakharyin and A.A. Ostroumov (Moscow) and V.P. Obraztsov (Kyiv).