Vol 84, No 2 (2012)


What we gained from a century of investigations of symbiontic intestinal microflora

Parfenov A.I., Bondarenko V.M., Parfenov A.I., Bondarenko V.M.


Symbiontic microflora prevents contamination of human intestine with foreign microflora; microbial enzymes split cellular tissue, proteins, fat, starch, deconjugate bile acids, synthetize B vitamins, amino acids, cholesterol and other substances. Microbial metabolism products - short-chain fatty acids - stimulate intestinal motility and are effective in some intestinal diseases. Bacterial therapy is able to modulate immune system and suppress chemical signalization of pathogenic microbes. Probiotics and functional nutrition represent a perspective trend in prophylaxis and treatment of human diseases. A criterion of probiotic efficacy is its ability to suppress foreign microflora and maintenance of normal microbial flora of the host. An essential probiotic function - support of normal immune system. In the future, probiotics will be employed in prevention and treatment of many human diseases. New probiotics and other forms of biopreparations should be designed basing on various species of symbiontic intestinal microflora.
Terapevticheskii arkhiv. 2012;84(2):5-10
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The role of Helicobacter pylori in normal microbiocenosis and dysbacteriosis of mucous microflora of the esophagogastroduodenal zone in its inflammation, erosion and ulcer

Chernin V.V., Bondarenko V.M., Chervinets V.M., Bazlov S.N., Chernin V.V., Bondarenko V.M., Chervinets V.M., Bazlov S.N.


Aim. To determine a population level and significance of Helicobacter pylori in normal microbiocenosis and dysbiosis of mucosal microflora in the esophagogastroduodenal zone. Material and methods. Qualitative and quantitative composition of mucosal microflora was defined in biopsy specimens from different parts of the esophagus, stomach and duodenum and clinical and histological examinations were made in 50 healthy volunteers, 130 duodenal ulcer patients, 24 patients with gastric ulcer, 36 with chronic gastritis and 24 with chronic esophagitis. Results. H. pylori is a component of normal mucosal microbiota of the oesophagus, stomach and duodenum. These bacteria protect normal gastrointestinal microflora. Exacerbations of peptic ulcer, chronic gastritis and oesophagitis are accompanied with overgrowth of dysbiotic mucosal microflora and reduction of H. pylori content in most cases. Healing and scar formation occur both in the presence and absence of H. pylori. Conclusion. The presence of H. pylori in mucosal microbiocenosis in the oesophagogastroduodenal zone has no independent significance in exacerbation of ulcer disease, gastritis and oesophagitis and does not require eradication.
Terapevticheskii arkhiv. 2012;84(2):10-16
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Factors affecting efficacy of gastroesophageal reflux disease treatment with proton pump inhibitors

Lazebnik L.B., Bordin D.S., Masharova A.A., Firsova L.D., Sil'vestrova S.Y., Lazebnik L.B., Bordin D.S., Masharova A.A., Firsova L.D., Silvestrova S.Y.


Aim. The aim of the study was to determine causes of proton pump inhibitors (PPIs) inefficacy in some patients suffering from gastroesophageal reflux disease (GERD). Material and methods. In our study of 154 GERD patients, 50 received omeprazole, 51 - lansoprazole and 53 - pantoprazole in a standard daily dose. GERD symptoms (heartburn and regurgitation) were scored by Likert scale; the patients' quality of life (SF-36) and their mental status (SMALL) were examined. Upper gastrointestinal endoscopy, 24-h intraesophageal pH monitoring, esophageal manometry and pharmacokinetic study were performed. Results. The treatment with a standard dose of PPIs was ineffective in 21 (13.6%) patients. Causes of PPIs inefficacy in 4.5% patients were rapid PPI metabolism and in 9.1% - "driving gear" of symptoms formation related with psychic dysadaptation.
Terapevticheskii arkhiv. 2012;84(2):16-21
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New approaches to morphological diagnosis of gluten-sensitive celiac disease

Vorob'eva N.N., Khomeriki S.G., Parfenov A.I., Vorobyeva N.N., Khomeriki S.G., Parfenov A.I.


Aim. To characterize cell adhesion molecules (CAM), components of intercellular matrix (ICM) in gluten-sensitive celiac disease (GSCD). Material and methods. A histological examination was made of biopsies of small intestinal mucosa (SIM) obtained from 890 patients with clinical and laboratory symptoms of GSCD. Of them, 124(14%) patients had signs of chronic atrophic duodenitis of different severity corresponding to GSCD. Newly diagnosed GSCD was in 63(7.1%) patients, 61 (6,9 %) patients kept aglutenic diet. Biopsy specimens from unaffected mucosa of distal parts of the duodenum from 10 patients served control. Immunohistochemical examination of CAM and ICM was made using antibodies to E-cadgerin, beta-catenin, CD44, type IV collagen, matrix metalloproteinase of type 9 (MMP-9). Results. Interrupted weak reaction in epithelial basal membrane and enhanced expression of this antigen in stroma were observed in SIM in GSCD of stage IIIC by Marsh. Subnormal irregular expression of E-cadgerin and beta-catenin were seen in membrane of surface epithelium and cryptal epithelium. Moreover, high CD44 expression was detected in membrane of SIM stroma cells and high expression of MMP-9 in the cytoplasm of stromal cells and intercellular matrix. Conclusion. The detected disorders of intercellular and cellular-matrix interaction in GSCD promote tissue lesion, increased permeability of epithelial barrier and changes in histogenesis processes. Further study of minimal disorders in SIM in GSCD on the molecular level will facilitate diagnosis of early stages of the disease and prognosis of its course.
Terapevticheskii arkhiv. 2012;84(2):21-25
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Determination of subepithelial deposits of IgA antibodies to tissue transglutaminase: practical experience with application for diagnosis of gluten-sensitive celiac disease

Vokhmyanina N.V., Kozlov A.V., Parfenov A.I., Oreshko L.S., Vokhmyanina N.V., Kozlov A.V., Parfenov A.I., Oreshko L.S.


Aim. To estimate subepithelial deposites of IgA antibodies to tissue transglutaminase (IGA-tTG) in biopsy specimens of small intestinal mucosa and to determine its diagnostic significance for detection of gluten-sensitive celiac disease (GSCD). Material and methods. Enzyme immunoassay examined IGA-tTG deposits after their isolation from biopsy specimens of small intestinal mucosa of 53 patients with GSCD and 45 control patients. Results. Elevated levels of IGA-tTG deposits were found in 98% patients with GSCD. This elevation in the controls occurred in patients with autoimmune pathology and in patients with such levels of the serum markers which were in the range of reference limits in the absence of GSCD morphometric characteristics in biopsy specimen but with verified diagnosis celiac disease. Conclusion. This method showed high diagnostic efficacy in detection of subepithelial IGA-tTG deposits for diagnosis of GSCD and monitoring of pathogenetic diet therapy.
Terapevticheskii arkhiv. 2012;84(2):26-30
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Prevalence of gluten-sensitive celiac disease in women with reproductive dysfunction

Bykova S.V., Parfenov A.I., Tetruashvili N.K., Sabel'nikova E.A., Gudkova R.B., Krums L.M., Vorob'eva N.N., Repina E.A., Vityazeva I.I., Petukhova G.S., Bykova S.V., Parfenov A.I., Tetruashvili N.K., Sabelnikova E.A., Gudkova R.B., Krums L.M., Vorobyeva N.N., Repina E.A., Vityazeva I.N., Petukhova G.S.


Aim. To determine prevalence of gluten-sensitive celiac disease (GSCD) in women with reproductive dysfunction (RD). Material and methods. Tests for blood serum antibodies to tissue transglutaminase (ABtTG) of IgA class were made in 217 women with RD. Tests for antibodies to gliadin (ABG) were performed in 180 of them. Esophagogastroduodenoscopy (EGDS) with biopsy to verify GSCD was conducted in patients with elevated ABtTG. The control group consisted of 15 healthy females of a reproductive age. Results. The examinees exhibited IgA ABtTG in the range 1 to 280 IU/ml, while 16 of them had elevated level - 50.2 ± 194 IU/ml, on the average. The controls had 0-10 IU/ml level of ABtTG, mean level 4.3±1.5 IU/ml. EGDS with duodenobiopsy was performed in 14 women. The examination of biopsies from small intestinal mucosa has detected pathohistological signs of celiac disease in 7 of 14 women. At the moment of the study two women with a history of spontaneous abortion were pregnant. Their ABtTG was 21.7 and 15.9 IU/mg, respectively, EGDS was not performed because of potential pregnancy complication but in view of possible celiac disease they received recommendations on aglutenic diet. Conclusion. Incidence rate of GSCD in women with RD is 4,1%. Aglutenic diet in GSCD women with RD contributes to reproductive function recovery and normal outcome of pregnancy. Elevation of ABtTG titers in women with RD is an indication to histological examination of small intestinal mucosa to detect GSCD.
Terapevticheskii arkhiv. 2012;84(2):31-36
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Clinicopathogenetic variants of anemia in patients with intestinal inflammation

Drozdov V.N., Lishchinskaya A.A., Parfenov A.I., Noskova K.K., Ruchkina I.N., Varvanina G.G., Tkachenko E.V., Drozdov V.N., Lischinskaya A.A., Parfenov A.I., Noskova K.K., Ruchkina I.N., Varvanina G.G., Tkachenko E.V.


Aim. To study factors of anemia pathogenesis in patients with ulcerative colitis (UC) and Crohn's disease (CD). Material and methods. A total of 80 patients (56% males and 44% females, mean age 39±15.8 years) with UC and CD were divided into two groups: group 1 - 40 patients with anemia; group 2 - 40 controls free of anemia with the same gender characteristics. The examination protocol included: total blood count, parameters of iron metabolism ( TIBC, LIBC, transferrin saturation with iron, ferritin, transferring, etc.), the levels of erythropoietin, C-reactive protein, TNF-alpha, hepsidin, vitamin B12, folic acid. Results. Group 1 patients had a significantly lower mean level of iron in the blood and transferrin saturation with iron while the other parameters of iron metabolism (TIBC, LIBC, transferrin, ferritin) did not significantly differ from these of group 2. Conclusion. Anemia in intestinal inflammation is an independent disease with complicated pathogenesis. This demands complete examination of such patients to prescribe adequate combined treatment of anemia with consideration of all pathogenetic factors of its development.
Terapevticheskii arkhiv. 2012;84(2):36-41
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Impairment of intestinal mucosa composition in mechanisms of intestinal dysfunction development in patients with hepatic cirrhosis

Yakovenko E.P., Kagramanova A.V., Yakovenko A.V., Ivanov A.N., Agafonova N.A., Obukhovskiy B.I., Gioeva I.Z., Pryanishnikova A.S., Yakovenko E.P., Kagramanova A.V., Yakovenko A.V., Ivanov A.N., Agafonova N.A., Obukhovsky B.I., Gioeva I.Z., Pryanishnikova A.S.


Aim. To investigate the role of intestinal microflora impairment in development of clinical manifestations of intestinal dyspepsia in patients with hepatic cirrhosis (HC). Material and methods. Endoscopic and morphological examinations of duodenal and colon mucosa were performed in 160 patients with viral HC and portal hypertension (PH) taking consideration of the presence of portal chypertensive duodeno- and colonopathy. Intestinal microflora was studied with lactulose respiration hydrogen test, bacteriological examination of the feces was also made. Clinical manifestations of intestinal dyspepcia were analysed as in irritable colon syndrome (ICS). The following disturbances were recognized: diarrhea, constipation, mixed, syndrome of duodenal hypertension. Results. Most of HC patients suffered from disturbed intestinal microflora composition, 46,3 % had bacterial overgrowth in the small intestine, 38 (23,8 %) - isolated impairment of colon microflora. Structural changes of intestinal mucosa associated with HC were found in 80% patients. Abnormal intestinal biocenosis occurred more often in patients with portal hypertensive duodeno- and colonopathy. ICS-like disorders were detected in 80,4 % patients with abnormal intestinal biocenosis, 33,1 % - had symptoms characteristic of duodenal hypertension. Conclusion. In HC patients intestinal dysbiosis is an essential pathogenetic factor of formation of intestinal dyspeptic syndrome. Detection of portal hypertensive dyodenopathy and/or colonopathy in HC patients is a definite risk factor of impairment of normal composition of intestinal microflora.
Terapevticheskii arkhiv. 2012;84(2):41-45
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The study of cholelithiasis prevalence basing on prognostic investigation of hepatobiliary diseases

Khokhlacheva N.A., Gorbunov A.Y., Vakhrushev Y.M., Khokhlacheva N.A., Gorbunov A.Y., Vakhrushev Y.M.


Aim. To study trends in hepatobiliary diseases (HBD) and prognosis of cholelithiasis morbidity for the nearest future. Material and methods. We studied biochemical bile properties in 404 patients with different hepatobiliary diseases and analysed statistics on hepatobiliary morbidity in Udmurt Republic for 2005-2009 using the method of statistical forecasting (trend modeling). Results. The Udmurt Republic has stable statistics on digestive organs morbidity. However, now there is a trend for a rise in overall and primary hepatobiliary morbidity. All the examinees with HBD had the first stage of cholelithiasis (lithogenic bile, biliary sludge). Conclusion. By trend prognostication of hepatobiliary morbidity, the near future will present an increased number of patients with stage 1 (prestone) cholelithiasis.
Terapevticheskii arkhiv. 2012;84(2):45-49
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Specific dynamic action of food in patients with chronic pancreatitis accompanied with metabolic syndrome

Vakhrushev Y.M., Volkova A.A., Vakhrushev Y.M., Volkova A.A.


Aim. To study hormone component of food specific dynamic action (FSDA) in chronic pancreatitis (CP) accompanied with metabolic syndrome (MS). Material and methods. A total of 60 patients were examined: 30 patients with CP and 30 patients with CP accompanied with MS. The study of fasting levels of thyrotrophic hormone, thyroxin, cortisol, insulin, C-peptide was conducted as well as one and two hours after carbohydrate breakfast to assess development of FSDA. Results. The study revealed that development of FSDA is characterized by systemic reaction, including changes in multiple hormonal parameters. However, patients with CP accompanied with MS demonstrated abnormal basal secretion and postprandial secretory responses of the above hormones. The absence of hormonal responses to food intake impairs FSDA and thus is involved in pathogenesis of metabolic disorders in patients with CP accompanied with MS. Conclusion. The study of the development of FSDA brings valuable information that can be used in clinical practice for studying mechanisms of metabolic disorders in various pathological conditions.
Terapevticheskii arkhiv. 2012;84(2):49-52
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Pulmonary lesion in a female patient with hormone-dependent ulcerative colitis

Mikhaylova Z.F., Baryshnikov E.N., Ruchkina I.N., Tsvetkova O.A., Rogova E.F., Parfenov A.I., Mikhailova Z.F., Baryshnikov E.N., Ruchkina I.N., Tsvetkova O.A., Rogova E.F., Parfenov A.I.


A case of a 42-year-old female patient with pulmonary pathology associated with steroid-resistant ulcerative colitis (UC) is presented. Prevalence of pulmonary alterations is considered to be low among other extraintestinal manifestations of UC. However, being clinically overt they can significantly complicate therapeutic management and worsen the prognosis. In such cases differential diagnosis with drug-induced pulmonary injury is needed.
Terapevticheskii arkhiv. 2012;84(2):52-55
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Autoimmune pancreatitis: current status

Maev I.V., Kucheryavyy Y.A., Oganesyan T.S., Maev I.V., Kucheryavy Y.A., Oganesyan T.S.


Diagnosis of autoimmune pancreatitis (AIP) is rather complicated because of low incidence of the disease, insufficient research, scare knowledge about AIP in medical profession, polymorphism of clinical characteristics. Administration of corticosteroid drugs is effective for relief of pancreatic inflammation though its long-term effects on the disease course is not studied well.
Terapevticheskii arkhiv. 2012;84(2):56-61
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Hepatotropic medicines: current status

Okovityy S.V., Sukhanov D.S., Petrov A.Y., Romantsov M.G., Okovity S.V., Sukhanov D.S., Petrov A.Y., Romantsov M.G.


Limits of administration, efficacy and safety of hepatotropic drugs are not finally formulated yet because of lack of clinical trials which satisfy current principles of evidence-based medicine. The review analyses data on clinical use of drugs for which hepatotropic action is leading, prevalent or clinically independent; gives information on composition of some drugs, pharmacodynamics, pharmacokinetics, principles of clinical administration, side effects, clinical trials; outlines a mechanism of action and area of application of a new original hepatotropic drug remaxol. Experimental data are available on remaxol ability to reduce hepatic affection induced by hepatotoxic agents and severity of carbohydrate, protein and fat dystrophy, to activate regeneration of the liver. Clinical trials demonstrate remaxol efficacy in management of toxemia, cytolysis, cholestasis. The above effectiveness and its antiasthenic and antidepressive activity makes this drug a universal hepatotropic medicine effective in various hepatic diseases (viral hepatitis C, toxic and pharmacological damage) both in therapeutic and prophylactic schemes.
Terapevticheskii arkhiv. 2012;84(2):62-68
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From classification medicine to clinical medicine (the end of the XVIII century - 1870s). Communication 6. Reforms in therapy in 1860-1875. Introduction of modern antiseptics

Stochik A.M., Zatravkin S.N., Stochik A.M., Zatravkin S.N.


This communication describes reformative activity of L. Paster and J.Lister underlying present-day antiseptics and its impact on development of practical medicine.
Terapevticheskii arkhiv. 2012;84(2):69-73
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