Vol 86, No 2 (2014)

Editorial
Current approaches to the diagnosis and treatment for enteropathies
Parfenov A.I.
Abstract
Enteropathies (EP) are the common name for pathological (inflammatory, hemorrhagic, erosive-ulcerative, and atrophic) changes in the small bowel. The paper describes the nosological entities of EP and the significance of laboratory and instrumental methods used for their diagnosis. It outlines the principles of etiotropic and pathogenetic therapies.
Terapevticheskii arkhiv. 2014;86(2):4-12
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Value of the calcium-regulating system in the development of microcirculatory and hemostatic disorders in recurrent peptic ulcer disease
Fomina L.A.
Abstract
AIM: To elucidate the state and importance of the calcium-regulating system, calcium and phosphorus balances, their impact on ulcer activity, regional microcirculation, and hemostasis during recurrent peptic ulcer disease (PUD)/MATERIAL AND METHODS: Sixty patients with recurrent PUD were examined. They underwent determinations of blood parathyrin and calcitonin and blood and urinary calcium and phosphorus levels and studies of regional microcirculation in the gastroduodenal mucosa and systemic hemostatic parameters in addition to clinical and endoscopic examinations/RESULTS: Recurrent PUD is accompanied by a significant blood parathyrin rise and some calcitonin increase and by calcium-phosphorus imbalance. Impaired calcium-regulating system functions attend significant microcirculatory disorders in the gastroduodenal mucosa and hemostatic changes characteristic of consumptive coagulopathy/CONCLUSION: A clear relationship between calcium-regulating hormone impairments, calcium and phosphorus metabolism with ulcer activity and microcirculatory and hemostatic changes may suggest the found shifts in ulcerogenesis and the pathogenetic substantiation of correction of these disorders may be of importance for the treatment of a disease recurrence.
Terapevticheskii arkhiv. 2014;86(2):13-16
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Gastroesophageal reflux disease associated with duodenogastroesophageal reflux in patients with biliary pathology: The specific features of the course and esophagogastroduodenal microbial biocenosis
Dzhulaĭ G.S., Sekareva E.V., Chervinets V.M., Mikhaĭlova E.S., Dzhulaĭ T.E.
Abstract
AIM: To study the specific features of the clinical course of gastroesophageal reflux disease (GERD) associated with duodenogastroesophageal reflux (DGER) in patients with chronic acalculous cholecystitis (CAC) and cholelithiasis (CL), as well as qualitative and quantitative characteristics/MATERIAL AND METHODS: The clinical, morphological, motor tonic characteristics of the esophagogastroduodenal area, mucosal microbial biocenosis in the esophagus, stomach, and duodenum were studied in detail in 83 patients with GERD that was associated with DGER and ran concurrently with CAC or CL/RESULTS: Impaired duodenal propulsive activity as a concomitance of the signs of gastrostasis and duodenal dyskinesia with dyscoordination of both anthroduodenal and duodenojejunal propulsion and with the development of duodenogastric reflux and DGER, which in turn determine esophageal and gastric pH values is shown to be of importance in CAC and CL, which match GERD. Abnormal microbiocenosis in the upper digestive tract is characterized by the higher quantitative and qualitative content of the mucous microflora. Opportunistic microorganisms exhibit cytotoxic, hemolytic, lecithinase, caseinolytic, urease, and RNAase activities/CONCLUSION: The found specific features of the course of GERD associated with DGER in patients with biliary tract abnormalities lead us to search for novel therapeutic approaches based on the correction of digestive motor tonic disorders and abnormal microbiocenoses of the mucous flora in the esophagus, stomach, and duodenum.
Terapevticheskii arkhiv. 2014;86(2):17-22
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Clinical aspects of gastroesophageal reflux disease in elderly patients: Results of a 5-year prospective study
Tsukanov V.V., Onuchina E.V., Vasiutin A.V., Butorin N.N., Amel'chugova O.S.
Abstract
AIM: To evaluate the clinical manifestations and changes of non-erosive reflux disease, erosive reflux disease, and Barrett's esophagus (BE) in a cohort of elderly patients during a 5-year follow-up/MATERIAL AND METHODS: A continuous method was used to compare the clinical manifestations of gastroesophageal reflux disease (GERD) in 950 patients aged 60 to 75 years and 453 patients aged 36 to 60 years. All the patients underwent clinical examination using the Mayo clinic questionnaire and fibroesophagogastroduodenoscopy. A prospective cohort study was performed in 950 patients aged 60 to 75 years for an average of 5 years. GERD was diagnosed on the basis of the Montreal Consensus guidelines (2006); the degree of esophageal mucosal injury was evaluated according to the Los-Angeles classification (1999). The diagnosis of BE was morphologically verified/RESULTS: The frequency of weekly heartburn was 10% higher in the mature-aged patients; but that of nocturnal heartburn, belching, and BE prevailed in the elderly patients. The 5-year prospective follow-up revealed a significant increase in the rate of erosive esophagitis and BE in the elderly patients with GERD. The risk factors of the latter were no maintenance therapy with proton pump inhibitors, as well as obesity and hiatal hernia/CONCLUSION: GERD shows clinical features and progression in the elderly patients.
Terapevticheskii arkhiv. 2014;86(2):23-26
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Patient compliance as one of the factors determining the efficiency of eradication therapy
Osipenko M.F., Livzan M.A., Bikbulatova E.A.
Abstract
AIM: To improve the quality of eradication therapy (ET), by increasing patient compliance/MATERIAL AND METHODS: An open-label cohort multicenter randomized study was conducted. A total of 350 patients with Helicobacter pylori infection-associated diseases and indications for ET were examined. Work was done to improve compliance in a study patient group before treatment/RESULTS: In the study group of patients motivated for treatment, the efficiency of ET was significantly higher than in the control group. The factors influencing treatment adherence were identified and methods to optimize compliance during H. pylori eradication were developed/CONCLUSION: Awareness of the essence of the disease in a patient and his higher motivation for compliance are one of the components of successful H. pylori eradication.
Terapevticheskii arkhiv. 2014;86(2):27-31
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Value of adhesion molecules for evaluating the efficiency of therapy for ulcerative colitis and Crohn's disease
Parfenov A.I., Boldyreva O.N., Ruchkina I.N., Kniazev O.V., Sagynbaeva V.É., Shcherbakov P.L., Khomeriki S.G., Lazebnik L.B., Konopliannikov A.G.
Abstract
AIM: To define the value of adhesion molecules (sVCAM-1 integrin, P-selectin, E-selectin, and L-selectin) for the prediction and evaluation of the efficiency of treatment in patients with ulcerative colitis (UC) and Crohn's disease/MATERIAL AND METHODS: Twenty-six patients with UC and 14 patients with CD were examined. Of them, 16 patients took infliximab (INF) in a dose of 5 mg/kg of body weight according to the standard scheme; 14 patients received cultured mesenchymal stem stromal cells (MSSCs) in a quantity of 150·108 cells, and 10 had azathioprine (AZA) 2 mg/kg and glucocorticosteroids (GCS) 1 mg/kg of body weight. Enzyme immunoassay was used to determine the serum concentration of the adhesion molecules (L-selectin, E-selectin, P-selectin, and sVCAM-1 integrin) before and 2 months after treatment/RESULTS: The signs of bowel inflammatory disease activity and the elevated levels of adhesion molecules whose synthesis did not occur under normal conditions remained in the patients receiving GCS and AZA. INF treatment caused a decrease in P-selectin, E-selectin, and sVCAM-1 levels to 8.9±1.0, 5.5±1.7, and 9.5±4.4 ng/ml, respectively (p<0.001). Incorporation of MSSCs was followed by a reduction of the concentrations of P-selectin and E-selectin to 6.9±1.1 and 5.7±1.3 ng/ml, respectively (р<0.001). The level of integrin (cVCAM-1) fell to 12.2±2.2 ng/ml (p>0.1); that of L-selectin did not drop after MSSC administration and INF induction therapy/CONCLUSION: P-selectin, E-selectin, L-selectin, and sVCAM-1 integrin are current inflammatory markers and may be used to evaluate the efficiency of standard and biological therapies for inflammatory bowel diseases and to predict disease course.
Terapevticheskii arkhiv. 2014;86(2):32-38
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Significance of a method for determination of deamidated gliadin peptide in the diagnosis of celiac disease
Sabel'nikova E.A., Parfenov A.I., Krums L.M., Gudkova R.B., Sagynbaeva V.É., Bykova S.V.
Abstract
AIM: To define the value of a new enzyme immunoassay in determining the level of anti-deamidated gliadin peptide (DGP) antibodies (Abs) in the diagnosis of celiac disease/MATERIAL AND METHODS: One hundred and twenty-four patients treated at the Department of Intestinal Pathology, Central Research Institute of Gastroenterology, were examined. Enzyme-linked immunosorbent assay (ELISA) was employed to determine Abs to tissue transglutaminase (tTG) and DGP of the IgA and IgG classes in the sera of all the patients. The diagnosis of celiac disease was verified by the histological examination of small bowel mucosa biopsy specimens/RESULTS: The examinees were divided into 3 groups: 1) 27 patients first diagnosed with celiac disease; 2) 40 patients keeping a gluten-free diet (GFD); 3) 57 patients with other gastrointestinal diseases (a comparison group). In the patients first diagnosed with celiac disease, the detection rate of elevated titers of anti-tTG and anti-DGP Abs in the IgA class was equal and constituted 92.5%; that in the IgG class was 96.2 and 55.5%, respectively. The comparison group showed an increase in the DGP levels in the IgA and IgG classes in 4 (7%) patients and a rise in tTG concentrations in the IgA and IgG classes was seen in only 2 (3.5%) patients/CONCLUSION: In the patents first diagnosed with celiac disease, the detection rate of elevated levels of anti-DGP Abs in the IgA and IgG classes is 92.5 and 96.2%, respectively, and significantly indifferent from that of IgA and IgG anti-tTG Abs. The patients keeping GFD displayed a reduction in anti-DGP Abs. The high detection rate of IgA anti-DGP Abs in the patients first diagnosed with celiac disease allows this method to be recommended for immunological diagnosis of this disease in adults.
Terapevticheskii arkhiv. 2014;86(2):39-43
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Role of transforming growth factor-beta in the development of some liver diseases
Raĭkhel'son K.L., Karev V.E., Marchenko N.V., Semenov N.V., Pal'gova L.K., Baranovskiĭ A.I.
Abstract
AIM: To investigate the expression of transforming growth factor-beta 1 (TGF-Β1) in the liver tissue of patients with autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and chronic hepatitis C (CHC). Materials and methods. Liver biopsy specimens were histologically and immunohistologically examined in 37 patients with verified liver diseases (12 with AIH, 15 with PBC, and 10 with CHC)/RESULTS: The expression of TGF-Β1 in the non-parenchymal liver cells of the patients with AIH and PBC with liver cirrhosis was statistically significantly higher than in those without the latter (p=0.01 and p=0.04, respectively). There was a positive relationship between the stage of fibrosis and the absolute content TGF-Β1 and CD68+ cells in the portal tracts (r=0.51). The higher expression of TGF-Β1 was found in the patients with HCV and AIH than in those with PBC (р=0.03 and р<0.05, respectively). There were no differences in the expression of TGF-Β1 in the patients with AIH as compared to those with CHC (p=0.55). The number of CD68-positive macrophages was higher in CHC than in AIH and PBC (p=0.004 and p=0.01, respectively). In autoimmune liver diseases, TGF-Β1 was mainly expressed by the macrophages located in the portal tracts and, in CHC, within the hepatic lobules/CONCLUSION: The enhanced TGF-Β1 expression in the nonparenchymal liver cells in AIH and PBC with liver cirrhosis confirms the role of this cytokine in development of fibrosis in autoimmune liver diseases. That in hepatitis of various etiologies versus PBC suggests that the TGF-Β1 signaling pathway may play an important role in an inappropriate immune response in hepatitides; and the variations found in the location of the macrophages expressing TGF-Β1 reflect a difference in the mechanisms of lesions.
Terapevticheskii arkhiv. 2014;86(2):44-48
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Polymorphism of ethanol metabolism genes in alcoholic chronic pancreatitis
Gubergrits N.B., Kishenia M.S., Golubova O.A.
Abstract
AIM: To study the gene polymorphisms of alcohol dehydrogenase (ADH), aldehyde dehydrogenase (ALDH), and cytochrome CYP2E1 in patients with alcoholic chronic pancreatitis (ACP) and to compare them with laboratory and instrumental findings/MATERIAL AND METHODS: Seventy-two patients with ACP and 80 healthy individuals were examined. Polymorphic DNA loci were analyzed by polymerase chain reaction of DNA synthesis, followed by electrophoretic detection. Polymorphism in genes involved in ethanol metabolism was studied/RESULTS: The patents with ACP had mutations in the genes involved in ethanol metabolism. The study results of the rate of the alleles and genotypes of ADH, ALDH, and CYP2E1 genes were controversial. However, investigating the combinations of the genotypes of ADH and ALDH revealed that the patients having ADH1B*47His and ALDH2*2 genotypes had a much higher risk for ACP and constituted more than 50% of the ACP patients. With this combination, ACP took its course with more evident structural and functional disorders of the pancreas. The CYP2E1 С/С homozygotes had an especially high risk of ACP/CONCLUSION: The investigation perspectives are to increase the number of examined patients and apparently healthy individuals and to find correlations between clinical, laboratory, and instrumental parameters and genotyping findings. The results of these investigations can define the possible strategy of prevention of CAP.
Terapevticheskii arkhiv. 2014;86(2):49-55
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Blood lipid parameters in combat veterans with posttraumatic stress disorders
Pal'tsev A.I., Miakotnykh V.S., Torgashov M.N.
Abstract
AIM: To study the specific features of blood lipid composition in combat veterans (CVs) with posttraumatic stress disorder (PTSD)/MATERIAL AND METHODS: One hundred and sixty-one CVs were examined; their mean age was 42.8±0.7 years. All the patients underwent a clinical and neurological examination using additional studies. I.O. Kotenev's trauma stress questionnaire was used. The mean intensity of PTSD was 65.5±0.95 scores. Fasting biochemical blood tests were carried out using clinical chemical analyzers/RESULTS: Dyslipidemias characterized mainly by elevated levels of total cholesterol and low-density lipoproteins are identified in the majority of present-day CVs. Higher triglyceride levels and lower high-density lipoproteins are encountered 2 and 1.5 times more frequently, respectively. A tendency has been found towards an inverse correlation between the degree of PTSD and the levels of total cholesterol and low-density lipoproteins/CONCLUSION: Neuroendocrine changes accompanying PTSD and leading to intensified adrenergic influences are an important trigger of accelerated hyperlipidemia development in CVs. Age-related changes and metabolic hepatic disorders associated with alcohol abuse and consequences of prior infectious diseases have become to play an important role in the pathogenesis of dyslipidemias in patients over 40-45 years of age.
Terapevticheskii arkhiv. 2014;86(2):56-62
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Use of fendivia transdermal therapeutic system in Russian patients with malignant neoplasms during palliative care: Pharmacoeconomic aspects
Riazhenov V.V., Abuzarova G.R., Gorokhova S.G., Emchenko I.V., Matveev N.V.
Abstract
AIM: To make a comparative clinical and economic assessment of a transdermal therapeutic system (TTS) for fendivia and traditional opioid analgesics in patients with malignant neoplasms (MN) during palliative care. Materials and methods. Pharmacoeconomic analysis of opioid analgesics used in patients with MN during analgesic therapy was made using the cost-effectiveness analysis in the framework of a budget impact analysis (BIA)/RESULTS: The assessment of the medical cost structure in the fendivia and morphine groups (100 patients in each group), which was made in the framework of BIA, demonstrated that the cost of pharmacotherapy in the fendivia group was comparable with that of an ambulance call for additional analgesia and correction of the side effects of performed therapy (615,804.00 and 645,337.60 rbl. monthly, respectively). At the same time, in the morphine group the cost of an ambulance call was more than 20 times that of pharmacotherapy (2,117,514.00 and 93,120.00 rbl. monthly, respectively). Thus, the total savings from applying the fendivia TTS in the group of 100 patients ranged up to 949,492.40 rbl. monthly/CONCLUSION: The application of the fendivia TTS is clinically and pharmacoeconomically valid and leads to a considerable reduction in public health care costs.
Terapevticheskii arkhiv. 2014;86(2):63-68
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Whipple's disease in a patient with infantile cerebral palsy and hepatitis B virus cirrhosis
Krums L.M., Sabel'nikova E.A., Golovanova E.V., Chikunova B.Z., Parfenov A.I.
Abstract
The paper describes a patient who has developed Whipple's disease in the presence of infantile cerebral palsy and hepatitis B virus cirrhosis. After 5-year treatment with co-trimoxazole (480 mg b.i.d.), the clinical manifestations subsided and PAS-positive macrophages were no longer detectable in the small intestinal mucosal biopsy specimens. Subsequent worsening of the patient's condition was associated with the progression of liver cirrhosis.
Terapevticheskii arkhiv. 2014;86(2):69-71
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Shwachman-Diamond syndrome
Vinokurova L.V., Dubtsova E.A., Iashina N.I., Shuliat'ev I.S., Osipenko I.V.
Abstract
Shwachman-Diamond syndrome is an inherited autosomal recessive disease that appears as exocrine pancreatic insufficiency, neutropenia, impaired neutrophil chemotaxis, aplastic anemia, thrombocytopenia, metaphyseal dysplasia, and physical retardation. Its worldwide prevalence is 1:10,000 to 1:20,000 live births depending on the region. The SBDS gene and a few mutations, which lead to this syndrome, have been found in the past decade. The paper describes a case of this rare disease in a 28-year-old male patient who has all characteristic manifestations as lipomatosis and severe exocrine pancreatic insufficiency, neutropenia with bone marrow hypoplasia, physical retardation, glucose intolerance, secondary osteopenia, and minor cardiac anomalies. Its clinical diagnosis was verified by molecular genetic testing.
Terapevticheskii arkhiv. 2014;86(2):72-75
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The acid pocket as the pathogenic basis and therapeutic target in gastroesophageal reflux disease
Bordin D.S.
Abstract
Gastroesophageal reflux is the leading factor of the pathogenesis of gastroesophageal reflux disease (GERD). A number of mechanisms (decreased pressure and transient relaxation of the lower esophageal sphincter, increased intraabdominal pressure, hiatal hernia) for its development are described. At the same time, the acid pocket occurring after meals is a source of reflux. The data available in the literature on the clinical relevance of the acid pocket in GERD and on the factors influencing its size and location are given. The efficacy of drugs used to treat GERD in terms of their effect on the acid pocket is shown. Proton pump inhibitors reduce the volume of the acid pocket and increase its pH, by affecting gastric acid production. Prokinetic agents are able to displace the acid pocket from the gastroesophageal junction. An alginate-antacid formulation combines the physical antireflux effect of alginate and the acid-induced neutralization of the acid pocket.
Terapevticheskii arkhiv. 2014;86(2):76-81
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Evolution of clinical ideas about Zollinger-Ellison syndrome
Maev I.V., Andreev D.N., Kucheriavyĭ I.A., Barkalova E.V.
Abstract
The paper gives the current views of the diagnosis and treatment of Zollinger-Ellison syndrome (ZES). It underlines the importance of including ZES in differential diagnosis in patient with frequently recurrent and standard-dose proton pump inhibitor therapy-resistant erosive and ulcerative lesions of the upper gastrointestinal tract. It provides the current stepwise algorithm for the diagnosis of the pathology in question. Relevant and promising treatments in patients with ZES are considered.
Terapevticheskii arkhiv. 2014;86(2):82-89
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Morphofunctional rearrangement of the hepatic vasculature in the pathogenesis of portal hypertension in liver cirrhosis
Garbuzenko D.V.
Abstract
The paper presents an update on the mechanisms for enhanced hepatic vascular resistance to the portal circulation underlying the pathogenesis of portal hypertension in liver cirrhosis. In addition to gross hepatic structural disorders related to diffuse fibrosis and formation of regenerative nodules, the morphofunctional rearrangement of the hepatic vasculature is shown to play an important role in this process. It is characterized by endothelial dysfunction and impaired paracrine interaction between activated stellate hepatocytes and sinusoidal endotheliocytes, sinusoidal remodeling and capillarization, as well as intrahepatic angiogenesis.
Terapevticheskii arkhiv. 2014;86(2):90-95
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Promising immunonutrients in general medical practice
Sheviakov M.A., Burygina E.V.
Abstract
The review gives data on prospects for using agents based on probiotics and trace elements for immunomodulation. It presents information on that a Lactobacillus casei rhamnosus 35-based probiotic is able to reduce the incidence and severity of viral and bacterial infections. The potential of zinc and selenium as immunotropic agents is shown.
Terapevticheskii arkhiv. 2014;86(2):96-101
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Combination biological therapy for fistular Crohn's disease: Clinical demonstration
Kniazev O.V., Parfenov A.I., Shcherbakov P.L., Konopliannikov A.G., Ruchkina I.N., Lishchinskaia A.A.
Abstract
Perianal fistulas are the most common and frequently encountered types of fistulas in Crohn's disease (CD). They are incurable, may worsen quality of life in a patient and increase the risk of total bowel resection. Despite the significant impact of biological (anticytokine) therapy for fistular CD, treatment in this category of patients remains a difficult task with the high risk of recurrent CD. Mesenchymal stromal cells (MSCs) having immunomodulatory properties and a great regenerative potential are currently also used to treat fistulas in CD and perianal fistulas of another etiology. The given clinical case demonstrates that complete fistula healing could be achieved only after a few local administrations of MSCs in combination with infliximab and azathioprine. World and our experiences indicate that there is a need for randomized controlled trials with a sufficient number of patients to prove the efficacy of MSCs in the combination therapy of fistulas in CD.
Terapevticheskii arkhiv. 2014;86(2):102-105
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On the occasion of the 90th anniversary of A.S. Loginov's birth
Beliaeva V.S.
Terapevticheskii arkhiv. 2014;86(2):106-107
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39th Session of the Central Research Institute of Gastroenterology
Bordin D.S.
Terapevticheskii arkhiv. 2014;86(2):108-110
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