Vol 85, No 2 (2013)


New horizons of gluten sensitivity studies

Parfenov A.I.


Gluten sensitivity may be a cause of gluten-sensitivity celiac disease (GCD). Some gluten-sensitive subjects may have symptoms of GCD, but lack its characteristic changes in the small bowel mucosa (SBM) and a gluten-free diet results in the disappearance of clinical symptoms of GCD. If there is no gluten allergy, the concept "gluten intolerance (GI) unassociated with celiac disease" is applicable in these cases. There is an increase in the prevalence of GCD and GI, which is associated with the use of gluten in food industry to improve the taste and energy density of foods and with the damaging effect of viruses and bacteria on enterocyte membranes, thereby facilitating the penetration of gluten through SBM. The paper gives an update on progress in the diagnosis of GCD and GI and on prospects for designing gluten-free cereals.
Terapevticheskii arkhiv. 2013;85(2):4-7
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The clinical and pathogenetic types of gastroesophageal reflux disease: Risk factors and predictors

Dzhulaĭ G.S., Sekareva E.V., Kuritsyn V.M., Dzhulaĭ T.E.


AIM: To study the clinical and pathogenetic types of gastroesophageal reflux disease (GERD) in terms of different types of reflux into the esophagus, their risk factors and predictors. Materials and methods. The clinical, morphological, motor tonic characteristics of the esophagogastroduodenal area, the phenotypic and visceral signs of existing undifferentiated connective tissue dysplasias (UDCTD), and the suprasegmental and segmental autonomic apparatus were studied in detail in 124 patients with GERD/RESULTS: Two clinical and pathogenetic types of GERD associated with the predominance of gastroesophageal or duodenogastroesophageal refluxes (GER and DGER) are identified. The type of the disease running in the predominance of GER develops in subjects with the high rate of visceral stigmas of UDCTD - cardiac failure and hiatal hernias, sympathetic autonomic tone in the digestive system. The feeding preference of piquant and spicy dishes and spices serves to realize the predictors of this type. The DGER-associated type develops in subjects with a concurrence of sympathetic and parasympathetic total autonomic tones in the digestive system in the presence of preexisting biliary tract diseases, including abnormalities in the structure of the gallbladder as visceral signs of UDCTD and it is realized in the feeding preference of high-calorie dishes/CONCLUSION: It is promising to study the autonomic status and the signs of UDCTD as structural and functional predictors of GERD and its types for the prediction of the disease, professional orientation, and the acquisition of eating behavior primarily in young people.
Terapevticheskii arkhiv. 2013;85(2):8-12
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Calcium and phosphorus balance and its significance for the course of recurrent peptic ulcer disease

Chernin V.V., Fomina L.A.


AIM: To evaluate calcium and phosphorus balances during recurrent peptic ulcer disease (PUD) and to estimate the impact of found changes on the course of an ulcerative process, secretory and motor functions in the stomach/MATERIAL AND METHODS: Sixty patients with recurrent PUD were examined. They underwent determinations of blood and urinary calcium and phosphorus levels and gastric secretory and motor functions in addition to clinical and endoscopic examinations/RESULTS: Recurrent PUD was shown to be accompanied by significantly elevated blood calcium and substantially decreased blood phosphorus, insignificant hypercalciuria and hyperphosphaturia. These changes were attended by considerably increased acid- and pepsinogen-forming functions of the stomach, lower gastromucoprotein production, and gastric hypermotor dyskinesis. More pronounced shifts in calcium and phosphorus balance were revealed in the acute phase of a disease recurrence in young men with duodenal ulcers/CONCLUSION: A clear relationship between calcium and phosphorus metabolic disturbances, ulcerative process activity, and gastric functional changes may point to the significance of found shifts in ulcerogenesis and to the pathogenetic substantiation of correction of these disorders in the treatment of a disease recurrence.
Terapevticheskii arkhiv. 2013;85(2):13-16
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A new system of specialized gastroenterological care to patients with inflammatory bowel diseases in Saint Petersburg

Baranovskiĭ A.I., Kondrashina É.A., Segal' A.M.


AIM: To substantiate the effectiveness of the set-up center in the early detection of patients with inflammatory bowel diseases (IBD) and in its organization and implementation of current therapeutic programs. Materials and methods. The therapeutic activity of the specialized medical care system set up in Saint Petersburg for patients with IBD (ulcerative colitis (UC) and Crohn's disease (CD)), which is based on a multifunctional inflammatory bowel disease center at City Clinical Hospital Thirty-One, was analyzed/RESULTS: The effective work of the center could reduce time for verification of the diagnosis of UC from 6.4±1.4 to 3.6±0.8 months and CD from 28.6±6.7 to 15.3±4.2 months, respectively; decline the annual number of patients with moderate and severe UC from 73.4 to 53.6 and CD from 66.7 to 47%, and also set up a centralized system for all required types of current therapeutic and diagnostic care for these patients/CONCLUSION: The establishment of the Saint Petersburg Center for the diagnosis and treatment of inflammatory bowel diseases could develop and realize in practice a new closed-loop urban system for the early detection and notification of IBD patients, the organization and rendering of individual effective therapeutic-and-prophylactic care.
Terapevticheskii arkhiv. 2013;85(2):17-20
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The role of the small bowel microflora in the development of secondary lactase deficiency and the possibilities of its treatment with probiotics

Ruchkina I.N., Fadeeva N.A., Parfenov A.I., Shcherbakov P.L., Gubina A.V., Poleva N.I., Khomeriki S.G., Chikunova B.Z.


AIM: To estimate the incidence of secondary lactase deficiency (SLD) in patients with postinfectious irritable bowel syndrome (PIBS) and the value of the small bowel microflora in its development and to elaborate treatment options for SLD/MATERIAL AND METHODS: One hundred and thirty-eight patients with PIBS, including 112 (81.2%) women and 26 (18.8%) men, were examined. The patients' mean age was 33.9±9.1 years. The duration of the disease was 2.6±1.4 years. Lactase deficiency (LD) was diagnosed using the color scale to test biopsy specimens from the duodenal retrobulbar region. The bacterial overgrowth syndrome (BOS) was identified by a 2-hour lactulose (20 ml) hydrogen breath test. Sixty patients with moderate SLD were randomized to 2 groups: 1) 41 patients received basic therapy (mesim forte as one tablet t.i.d., no-spa, 40 mg, t.i.d.) and combined probiotic bifiform (Ferrosan) containing Bifidobacterium longum 107, Enterococcus faecium 107 as one capsule t.i.d. for 14 days. Group 2 patients (n=19) had basic therapy in combination with placebo/RESULTS: SLD was detected in 59.4% of the patients with PIBS, including 43.5 and 15.9% with moderate and severe forms, respectively. In all cases, SLD was accompanied by BOS in the small bowel lumen, as confirmed by the results of a hydrogen breath test [101±37 ppm (a normal value of <20 ppm)]. After a 14-day course of therapy with the combined probiotic bifiform, restoration of eubiosis in the small bowel lumen was achieved in 70.8% of the patients, as shown by the lesser degree of BOS (86.9±40.9 and 17.4±6.6 ppm before and after treatment, respectively; р<0.01) and by normalization of the lactase test (р<0.01). In the comparative placebo group, 68.4% showed no clear positive changes, SLD and BOS remained/CONCLUSION: The changes in the small bowel intraluminal microflora, which developed after prior intestinal infection, played a great role in the development of SLD. Bifiform belongs to the currently available probiotics and may be recommended to correct SLD in patients with PIBS resulting from the impaired microbiota of the small bowel and to prevent BOS.
Terapevticheskii arkhiv. 2013;85(2):21-26
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Diagnostic value of serum markers of fibrosis in chronic liver diseases

Vinnitskaia E.V., Drozdov V.N., Iunusova I.M., Varvanina G.G., Shaposhnikova N.A., Petrakov A.V., Tkachenko E.V., Lazebnik L.B.


AIM: To estimate the diagnostic value (DV) of direct markers of liver fibrosis, such as type IV collagen (C-IV), hyaluronic acid (HA), tissue inhibitor of metalloproteinases-1 (TIMP-1) in combination with indirect markers of fibrosis, such as alanine aminotransferase (АLT), aspartate aminotransferase (AST), and γ-glutamyl transpeptidase (γ-GTP), alkaline phosphatase (ALP), platelets, tumor necrosis factor-α (TNF-α) in evaluating liver fibrosis/MATERIAL AND METHODS: Sixty-seven patients with chronic diffuse liver diseases were examined. ALT, AST, γ-GTP, and ALP were determined as indirect indicators of fibrosis. The levels of TIMP-1, HA, C-IV, and TNF-α were estimated by ELISA; the stage of fibrosis was determined by the results of indirect liver ultrasound fibroelastography (FE)/RESULTS: According to the results of FE, the patients were divided into 2 groups: 1) (n=25) F≤2 METAVIR and 2) (n=42) F3-F4. While estimating DV of severe fibrosis stages (F3-F4), the area under the ROC curve (AUC) increased for platelets, HA, and C-IV. DV of ALT, AST declined with the higher degree of fibrosis. The highest ratio of test specificity and sensitivity (TSp and TSen) and AUC were observed for AST and HA. ALT and platelets showed low TSen, and TNF-α and TIMP-1 had no TSp. For evaluation of fibrosis (F4), a HA increase of over 57.7 ng/ml had 92.6% TSen and 67.5% TSp; for a C-IV elevation of above 133.1mkg/l, TSen was 85.2%, TSp was 57.5%; for a TIMP-1 rise from 24.4 ng/ml, TSen was 74.1% and TSp was 62.5%. For the diagnosis of fibrosis (F4) with a HA rise of more than 57.7 ng/ml, DV of a positive test was 65.8 (48.65-80.4; 95% CI) and that of a negative test was 93.1 (76.8-99.2; 95% CI). Thus, the negative rather than positive test results are of great diagnostic value for evaluation of the degree of fibrosis/CONCLUSION: The results of the investigation convincingly suggest that examination of the serum markers of fibrosis allows one to estimate with a high probability its presence and severity in patients with hepatic cirrhosis. The so-called direct markers (substances reflecting the biochemistry and regulation of fibrogenesis) are undoubtedly of great diagnostic value.
Terapevticheskii arkhiv. 2013;85(2):27-31
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Cholagenic diarrhea is a type of postcholescystectomy syndrome

Krums L.M., Parfenov A.I., Gubina A.V., Sil'vestrova S.I., Smirnova A.V.


AIM: To study the role of biliary acids (BAs) in the pathogenesis of chronic diarrhea (CD) in patients undergoing cholecystectomy (CE)/MATERIAL AND METHODS: Twenty-five patients with post-CE diarrhea were examined. A comparison group consisted of 11 patients with diarrhea-predominant irritable bowel syndrome (IBS). The results of an examination of 15 healthy individuals were taken as normal values. Daily fecal BAs were determined by an enzyme spectrophotometric technique/RESULTS: In the patients after CE, daily fecal BA losses were found to be thrice as large as that in the healthy individuals. In the comparison group of patients with IBS, fecal bile excretion was not greater than the normal values. Stool normalization with a simultaneous decrease in fecal BA losses was seen in 92% of the post-CE patients receiving a course of therapy with adsorbents and astringents/CONCLUSION: Post-CE CD is a type of postcholescystectomy syndrome.
Terapevticheskii arkhiv. 2013;85(2):32-35
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Gastrointestinal diseases and abdominal pain in combat veterans

Pal'tsev A.I., Torgashov M.N., Popova O.S.


AIM: To analyze the role of consequences of combat stress in the development of gastrointestinal tract (GIT) diseases/MATERIAL AND METHODS: One hundred and sixty-one combat veterans aged 24 to 69 years were examined. All underwent a clinical and neurological examination using the McGill pain questionnaire (MPQ), Beck depression inventory, Kotenev trauma stress questionnaire, and visual analogue scale to determine pain intensity. Anxiety, impairments in memory and sleep, and depression were identified. The SF-36 questionnaire was used to estimate quality of life in the patients. Gastric secretory function was investigated; esophagogastroduodenoscopy, X-ray and ultrasound studies, clinical and biochemical blood tests, coprological examinations, fecal tests for dysbiosis, if indicated, occult blood were made/RESULTS: Combat stress and its consequences as posttraumatic stress disorder have been shown to play an important role in the pathogenesis of GIT diseases and in the development of chronic abdominal pain. GIT diseases in combat veterans are in larger measure a sequel of impaired processes of adjustment to combat stress. Chronic abdominal pains were heterogeneous. On the one hand, chronic GIT disease serves as a source of pain syndrome; on the other hand, the central nervous system is of importance in the development of chronic abdominal pain/CONCLUSION: In addition to therapy for GIT and hepatobiliary diseases, the treatment of GIT diseases in this category of patients involves psychotherapy and neuroprotection, aimed at reducing the consequences of combat stress in combat veterans.
Terapevticheskii arkhiv. 2013;85(2):36-42
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Clinical characteristics of dyspepsia in patients with diabetes mellitus type 2

Osipenko M.F., Zhuk E.A., Medvedeva O.V.


AIM: To estimate the prevalence of dyspepsia and to study its clinical manifestations and risk factors in patients with type 2 diabetes mellitus/MATERIAL AND METHODS: One hundred and seven patients with type 2 DM and 33 with functional dyspepsia were examined. A clinical and laboratory study and testing were made to identify the symptoms of dyspepsia; dyspepsia-associated factors were studied/RESULTS: Dyspepsia was observed in 71.0 % of the examined patients with type 2 DM. It may be attributed to organic gastrointestinal tract (GIT) diseases only in 42.3% of cases. In the type 2 DM patients, dyspepsia that could not be explained by organic GIT diseases was mainly manifested by a dyskinetic type while an ulcer-like type was prevalent in those with organic GIT diseases. In the patients with type 2 DM, dyspepsia that could not be accounted for GIT diseases was associated with the duration of carbohydrate metabolism disturbance, the presence of diabetic complications, Helicobacter pylori infection, and patient age. Some symptoms of dyspepsia (repletion and epigastric discomfort), which could not be explained by organic GIT diseases in patients with type 2 DM were associated with diabetic complications and carbohydrate metabolic parameters/CONCLUSION: Dyspepsia in type 2 DM was observed in 71% of cases; it can be due to organic GIT diseases in 42.3% and its association with digestive organ pathology was not revealed in 57.7%.
Terapevticheskii arkhiv. 2013;85(2):43-47
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IgG4-related disease: patient group characterization and rituximab therapy

Sedyshev S.K., Vasil'ev V.I., Kovrigina A.M., Logvinenko O.A., Rodionova E.B., Safonova T.N., Gaĭduk I.V., Silin A.I., Komov D.V., Nasonov E.L.


AIM: To characterize a group of patients with IgG4-related disease (IgG4-RD) in a Russian population and to evaluate the efficiency of rituximab therapy/MATERIAL AND METHODS: In 2009 to 2011, at the Research Institute of Rheumatology, Russian Academy of Medical Sciences, 30 patients (16 men and 14 women; mean age 44 years) were diagnosed with IgG4-RD that was confirmed by determination of serum IgG4 levels and immunohistochemical study of biopsy samples stained for IgG4-positive plasma cells. Seven patients received rituximab therapy/RESULTS: It was assumed at baseline that there were different types of neoplasias in 12 (40%), non-Hodgkin's and Hodgkin's lymphomas in 10 (33.3%), Sjögren's syndrome in 5 (16.7%), and Wegener's granulomatosis in 3 (10%). When 2 or more locations were involved, the condition was regarded as multifocal fibrosclerosis (33.3%). Localized forms were revealed in 20 (66.7%) patients. Among them, the largest number of patients was those who had orbital pseudotumor, Mikulicz's disease, or retroperitoneal fibrosclerosis. The most common sites of involvement were orbits (66.7%), salivary glands (70%) and lymph nodes (36.7%). Comparison of serum IgG4 levels in 28 patients with IgG4-RD, 22 patients with Sjögren's disease, salivary and lacrimal gland lymphomas, and 10 healthy controls showed that the concentration of IgG4 was significantly higher in Group 1 (median 2.6 g/l; IQR 1.22-4.65 (p<0.001). Tissue IgG4/IgG ratio varied from 25 to 50% and averaged 38%. A moiré-like pattern of varying fibrosis was noted in 83% of cases. Analysis of laboratory data revealed elevated C-reactive protein concentrations (46.7% with a mean of 39.5 mg/l; normal values <5.0 mg/ l), increased erythrocyte sedimentation rate (60% with a mean of 37.6 mm/h), hypergammaglobulinemia (30% with a mean of 29.4%; normal range 13-22%), and rheumatoid factor (23.3%). After rituximab therapy, all the patients showed a decrease of IgG4 levels to the normal levels and positive changes evidenced by visualization techniques (computed tomography, magnetic resonance imaging)/CONCLUSION: IgG4-RD is a novel problem in modern medicine, which requires a multidisciplinary approach and further study. Rituximab therapy is a promising treatment.
Terapevticheskii arkhiv. 2013;85(2):48-53
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Gluten-sensitivity celiac disease associated with recurrent aphthous stomatitis and schizophrenia

Sabel'nikova E.A., Krums L.M., Parfenov A.I., Ruchkina I.N., Gudkova R.B., Vorob'eva N.N., Levchenko S.V.


The paper describes a clinical case of celiac disease with grade 3 malabsorption, which is associated with recurrent aphthous stomatitis and schizophrenia. On readmission after 8 months of strict adherence to his gluten-free diet, the patient was observed to be in clinical remission and to have normalized laboratory indices and immunological tests. The signs of recurrent stomatitis disappeared. However, the symptoms of the mental disease remained.
Terapevticheskii arkhiv. 2013;85(2):54-56
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New possibilities for overcoming the secondary inefficiency of anti-cytokine therapy in patients with inflammatory bowel diseases

Kniazev O.V., Parfenov A.I., Ruchkina I.N., Konopliannikov A.G., Drozdov V.N., Sagynbaeva V.É., Ivkina T.I.


A search for ways to overcome the secondary inefficiency of anti-cytokine therapy (ACT) with infliximab (IFX) in patients with inflammatory bowel diseases (IBD) remains relevant and determines the need for new approaches to solving this problem. The secondary inefficiency of ACT has been found to depend on the level of antibodies to IFX (anti-IFX Ab). The Department of Intestinal Pathology, Central Research Institute of Gastroenterology, is investigating the mechanisms for the occurrence of primary and secondary inefficiency of ACT, as well as ways to overcome them by cultured allogenic bone marrow mesenchymal stromal cells (MSC). In the framework of the searching investigation evaluating the efficiency and safety of MSC in patients with IBD, the investigators revealed that was a phenomenon of a decrease in anti-IFX Ab and came to the conclusion that the secondary inefficiency of ACT should be overcome in a patient with ulcerative colitis (UC). The elevated anti-IFX Ab levels were directly associated with the worsening clinical and endoscopic picture of UC and with the enhanced activity of an inflammatory process. The administration of cultures MSC contributed to lower anti-IFX Ab levels, overcome secondary inefficiency (an escape phenomenon) during ACT, and enhanced IFX sensitivity. The clinical observation indicated that MSC administration reduced anti-IFX concentrations and promoted UC remission during IFX therapy. Thus, MSC transplantation can be considered as a promising method for overcoming the secondary inefficiency of ACT, which aids in increasing the previously lost response to anti-inflammatory therapy.
Terapevticheskii arkhiv. 2013;85(2):57-60
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Diagnostic difficulties and remission criteria of autoimmune pancreatitis

Vinokurova L.V., Dubtsova E.A., Bystrovskaia E.V., Orlova I.N., Agafonov M.A.


The paper describes a clinical case in a 56-year-old female patient who has been suffering from chronic autoimmune pancreatitis, chronic recurrent cholangitis for 3 years. It demonstrates diagnostic difficulties at the early stage of the disease, the specific features of its course, the sequence of treatment in the patient, and problems in choosing a therapy option to achieve a remission.
Terapevticheskii arkhiv. 2013;85(2):61-64
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Difficulties and errors in the management tactics of patients with chronic pancreatitis

Maev I.V., Kucheriavyĭ I.A., Samsonov A.A., Andreev D.N.


The paper deals with the difficulties and errors that are most commonly used in clinical practice to manage patients with chronic pancreatitis (CP). The higher interest in CP is inspired by the wide prevalence of this disease with its constant upward trend. At the same time, a variety of the etiological forms of CP, from generically determined to infectious and autoimmune ones, in combination with a weak theoretical basis in a number of practitioners gives rise to a broad spectrum of tactical errors in the management of patients with CP. The paper summarizes and analyzes the most common defects and errors in the management tactics of patients with this nosological entity, including the aspects of diagnosis and medical treatment. Ways to solve the set optimization problems in management protocols for patients with CP are proposed in the context of evidence-based medicine.
Terapevticheskii arkhiv. 2013;85(2):65-72
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Helicobacter pylori eradication: Current aspects

Tsukanov V.V., Amel'chugova O.S., Butorin N.N., Tret'iakova O.V., Vasiutin A.V.


The paper gives an update on the efficiency of Helicobacter pylori eradication. Triple therapy (a proton pump inhibitor + clarithromycin + amoxicillin) therapy is shown to hold top positions as first-line therapy for H. pylori eradication as before. The leading second-line therapy regimens are quadruple and 10-day triple schemes including levofloxacin. This point of view is supported by the Russian Gastroenterology Association. To reduce an increase in H. pylori resistance to clarithromycin, it is advisable to use Klacid (generic name: clarithromycin) in the eradication schemes.
Terapevticheskii arkhiv. 2013;85(2):73-75
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Boceprevir: New possibilities for the antiviral treatment of chronic hepatitis C

Nikitin I.G., Baĭkova I.E., Gogova L.M., Volynkina V.M., Kisliakov V.A.


The given clinical review covers current antiviral therapy for chronic hepatitis C. Traditional antiviral therapy with pegylated interferon-α and ribavirin in patients with chronic hepatitis C virus genotype 1 allows a sustained virological response (SVR) to be achieved in no more than 40% of the treated patients. The practical introduction of the third component of the therapy as direct-acting antiviral agents makes it possible to substantially increase SVR, on the one hand, and to reduce treatment time, on the other hand. This review carefully analyzes the results of clinical trials of boceprevir (a new direct-acting antiviral agent and an NS3 serine protease inhibitor) that, when incorporated into an antiviral therapy regimen with pegylated interferons and ribavirin, considerably improves treatment results in patients with chronic hepatitis C virus genotype 1. Also, it discusses the safety and tolerance of drugs that belong to the class of hepatitis C virus serine protease inhibitors, as well as the problem of viral resistance.
Terapevticheskii arkhiv. 2013;85(2):76-84
pages 76-84 views

Antibiotic-associated diarrhea in clinical practice

Luzina E.V., Lareva N.V.


Antibiotic-associated diarrhea (AAD) is considered to mean at least 3 shapeless stool episodes within 2 or more consecutive days when using antibacterial agents. Due to the fact that antibiotics are used most commonly to treat many diseases, AAD is one of the topical problems for different clinical specialists. There has recently been increased interest in this condition due to its higher morbidity and mortality rates and the emergence of novel treatment-resistant virulent strains of Clostridium difficile 027 and 078/126. The paper discusses the possible risk of developing AAD depending on the class of the antibiotic used, as well as the mechanisms of its development. Infectious diarrhea most frequently results from bacterial overgrowth due to that the obligate intestinal microflora is suppressed by antibacterial drugs. C. difficile, Clostridium perfringers, Staphylococcus aureus, Salmonella spp., Klebsiella oxytoca, and Candida spp. are etiological factors in the development of this diarrhea. The severest intestinal lesions include pseudomembranous colitis (PMC) caused by C. difficile. The clinical and endoscopic picture and methods for the diagnosis and treatment of PMC are described. Therapy for this menacing condition is traditionally based on the use of metronidazole and vancomycin. In 2011, the US Food and Drug Administration approved the new drug fidaxomycin whose superiority over vancomycin has been demonstrated by a recurrence criterion. The paper discusses in detail other treatment options, including the use of probiotics.
Terapevticheskii arkhiv. 2013;85(2):85-88
pages 85-88 views

Serotoninergic regulation of colonic motor function

Lychkova A.É.


The review deals with the serotoninergic regulation of colonic motor function. Serotonin (HT), its receptors and transporter, the enzymes of synthesis and degradation, play an important role in the regulation of colonic motor activity. Activation of 5-НТ1, 5-НТ2В, 5-НТ3, and 5-НТ4 receptors leads to increased colonic motor function. The elevation of serotonin levels determines the higher sensitivity of the colonic wall in irritable bowel syndrome. Serotonin plays a pathogenetic role in the development of ulcerative colitis and colostasis.
Terapevticheskii arkhiv. 2013;85(2):89-92
pages 89-92 views

Progress in endoscopy-based diagnosis of small bowel diseases

Shcherbakov P.L.


The paper deals with new endoscopic imaging techniques for evaluating the mucosa of deep intestinal segments, mainly the small bowel. It shows the history of an enteroscopic method and its technical capabilities. Some pathological conditions for which deep enteroscopic techniques are best suited are characterized.
Terapevticheskii arkhiv. 2013;85(2):93-95
pages 93-95 views

S.P. Botkin and his works in gastroenterology (on the occasion of the 180th anniversary of his birth

Beliaeva V.S.


S.P. Botkin' works in gastroenterology are indicated. S.P. Botkin did especially many works on acute hepatitis and biliary colic.
Terapevticheskii arkhiv. 2013;85(2):96-98
pages 96-98 views
pages 99-103 views

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