Vol 87, No 2 (2015)


Pharmacotherapy for irritable bowel syndrome in the context of evidence-based medicine

Maev I.V., Cheremushkin S.V., Kucheriavyĭ I.A., Cheremushkina N.V.


The paper analyzes an evidence base for the pharmacotherapy of irritable bowel syndrome (IBS) A large number of randomized placebo-controlled trials (RPCTs) systematized in a number of meta-analyses suggest that monotherapy regimens with spasmolytics, antidepressants, dietary fibers, polyethylene glycol, rifaximin, probiotics, and mesalamine are effective. Only some RPCTs evaluate the efficiency of combined pharmacotherapy versus placebo for IBS. Since the basis for the pathophysiology of the latter is motility and functional disorders, visceral hypersensitivity, and, probably, impaired microbiota, we anticipate that the need to use combined approaches to treating the majority of patients with IBS, by covering a few components of its pathogenesis, is relevant. Thus, to choose pharmacotherapy for IBS in each specific case is a challenge as this is determined by the form of IBS, the availability of an approved medicine on the domestic market, the indications for use, possible long-term use, high safety, and efficacy evidence drawn from RPCTs.
Terapevticheskii arkhiv. 2015;87(2):4-10
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Indicators of apoptosis in the gastric mucosa in patients with atrophic gastritis among the indigenous and nonindigenous dwellers of Evenkia

Tsukanov V.V., Amel'chugova O.S., Kasparov É.V., Vasiutin A.V., Butorin N.N., Tonkikh I.L.


Aim. To study the indicators of apoptosis in the gastric mucosa (GM) in relation to atrophy and the presence of CagA gene-containing Helicobacter pylori strains in the indigenous and nonindigenous dwellers of Evenkia. Subjects and methods. Clinical and morphological examinations and fibrogastroscopy of GM were performed in 159 Caucasians and 136 Mongoloids (Evenks). The TUNEL assay was used to determine GM apoptosis in 24 Caucasians and 22 Evenks and the H. pylori strains containing the CagA gene were detected in all the 295 patients. Results. The extent of atrophic gastritis in the gastric antrum and body was higher in the Caucasians than in the Evenks. The total indicator of GM apoptosis in the gastric antrum was 5.19±0.26% in the newcomers and 4.04±0.28% in the aboriginals (p=0.01). Apoptosis in both populations was associated with GM atrophy and the presence of H. pylori strains containing CagA gene. Conclusion. There were ethnic differences in the extent of atrophic gastritis, which may be attributable to differences in the rate of GM apoptosis and the spread of H. pylori strains containing CagA gene in the indigenous and non-indigenous dwellers of Evenkia.
Terapevticheskii arkhiv. 2015;87(2):11-14
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Clinical and pathogenetic features of inflammatory and atrophic changes in the gastroduodenal zone in patients with varying severity of chronic heart failure associated with coronary artery disease

Osadchiĭ V.A., Bukanova T.I.


Aim. To study the clinical features of inflammatory and atrophic changes (IAIs) in the gastroduodenal zone (GDZ) in people with varying severity of chronic heart failure (CHF) associated with coronary artery disease (CAD) and to determine gastric secretion, local microcirculation, and the presence of Helicobacter pylori. Subjects and methods. Seventy-four patients with CHF and gastric duodenal (GD) IAIs who were divided into 2 groups according to its severity were examined. The specific features of impaired gastric secretory function and blood flow in the GD mucosa and its contamination with Н. pylori were elucidated. Results. GD IAIs were ascertained to be mainly focal in the patients with Stages I-IIa CHF and focal or diffuse in those with Stages IIb-III. According the clinical findings, these changes were generally shown in the concurrence of transient and unstable (in early-stage circulatory insufficiency) and prolonged and persistent (during severe congestive events) phenomena. The development of IAIs in the GDZ was linked to its thrombohemorrhagic microcirculatory disorders, the severity of which increased as the symptoms of CHF progressed. In Stages I-IIa circulatory insufficiency, this was accompanied by the normal activity of acid-peptic factor, by the decreased production gastromucoproteins, and, in 58.3% of cases, by H. pylori. The patients with Stages IIb-III showed the suppressed production of all constituents of gastric secretion and H. pylori in 63.2% of cases. Conclusion. The clinical manifestations and mechanisms of GD IAIs in CHF associated with CAD have a number of substantial differences in relation to its severity, which should be kept in mind when elaborating therapeutic and diagnostic measures.
Terapevticheskii arkhiv. 2015;87(2):15-19
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Small intestinal bacterial overgrowth as a cause of lactase deficiency

Fadeeva N.A., Ruchkina I.N., Parfenov A.I., Shcherbakov P.L.


Aim. To establish the rate of lactase deficiency (LD) in patients with post-infectious irritable bowel syndrome (PI-IBS), to define a role of enteric bacteria in the pathogenesis of hypolactasia, and to evaluate the efficiency of probiotic therapy. Subjects and methods. Examinations were made in 386 patients with PI-IBS, including 112 (79.4%) women; mean age 33.9±9.1 years; disease duration 2.6±1.4 years. Rapid tests of small intestinal mucosa (SIM) biopsy specimens obtained from the duodenal retrobulbar segment were used to diagnose LD. Bacterial growth was estimated by a hydrogen breath test using a Н2 MICRO gas analyzer. Results. The patients with PI-IBS were revealed to have moderate and severe LD in 25.6 and 10.9%, respectively. All the patients with LD were detected to have small intestinal (SI) bacterial overgrowth (BOG). An inverse correlation was found between LD and the degree of SI BOG (r=-0.53; p<0.001). 73.7% of the patients with moderate LD showed a positive effect of probiotic therapy as regression of clinical symptoms of LD, a decrease of hydrogen levels in expired air from 72.4±25.1 to 16.4±13.2 ppm (р<0.05), an increase of lactate activity in the SIM biopsy specimens and an improvement of quality of life from 2.69±0.53 to 5.53±0.64 scores according to the GCI scale. No improvement occurred in 73.8% of the patients with severe LD. Conclusion. LD was identified in 36.5% of the patients with PI-IBS. There was an inverse correlation between the degree of LD and SI BOG. The good therapeutic effect of probiotics in LD suggests that the symbiotic gut microflora positively affects the activity of lactase in the human SIM. No therapeutic effect of probiotics in patients with severe LN serves as the basis for a search for more active probiotic therapy.
Terapevticheskii arkhiv. 2015;87(2):20-23
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Carbohydrase activities may serve as a marker for small intestinal mucosal recovery in patients with celiac disease

Parfenov A.I., Akhmadullina O.V., Sabel'nikova E.A., Belostotskiĭ N.I., Gudkova R.B., Khomeriki S.G.


Aim. To clinically evaluate the activity of glucoamylase, maltase, saccharase, and lactase in the small intestinal mucosa (SIM) of patients with celiac disease. Subjects and methods. Twenty-nine patents with celiac disease were examined. The disease was first detected in 8 patients; in the remaining patients, it had been diagnosed 6 months to 35 years before. The diagnosis was verified by histological examinations of duodenal biopsy specimens and by determination of immunoglobulin (Ig) A and G antibodies to tissue transglutaminase (atTG) and gliadin (AGA) by an enzyme-linked immunosorbent assay (ELISA). Carbohydrase activities were estimated in the duodenal biopsy specimens, by applying the method of A. Dahlquist. Results. In the control group, the activities of glucoamylase, maltase, saccharase, and lactase averaged 598.8±184.2, 825.3±239.3, 180.2±68.1, and 53.4±16.3 ng/glucose/mg tissue min, respectively. In the patients with celiac disease, the average activities of all the examined enteric enzymes were significantly below the normal value even they had been on a gluten-free diet (GFD) for 10 years or longer. Complete SIM structural recovery (Marsh stage 0) occurred in only 7 of 18 patients who had been on a strictly GFD. Serological (atTG and AGA) tests got also negative in all the 7 patients with completely recovered SIM. Six of the latter patients continued to have abdominal bloating and borborygmus, unstable stool with a propensity for diarrhea and weakness. Each was detected to have a lower activity of one or a few enzymes. The activity of all the carbohydrases reached its normal value in only 1 patient and she felt healthy, without perceiving any food intolerance. Conclusion. The activity of membrane enzymes may serve as a marker for the degree of SIM recovery in patients with celiac disease.
Terapevticheskii arkhiv. 2015;87(2):24-29
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Fecal calprotectin concentration in the differential diagnosis of bowel diseases

Osipenko M.F., Livzan M.A., Skalinskaia M.I., Lialiukova E.A.


Aim. To estimate the informative value of a noninvasive fecal (calprotectin) test in the differential diagnosis of bowel diseases. Subjects and methods. One hundred and forty-two patients who had visited their physicians with intestinal disorders (a change in stool frequency and patterns, abdominal pain) were examined in an open-label multicenter cross-sectional study. The examinees' mean age was 35±2.43 years. Gender- and age-matched comparison groups consisted of healthy individuals and patients with irritable bowel syndrome. Fecal calprotectin (FCP) was determined using a BUHLMANN Calprotectin ELISA kit. All the patients underwent colonoscopy. Results. In the patients with organic bowel diseases (ulcerative colitis, Crohn's disease, lymphocytic colitis, colonic diverticular disease, colonic adenomas, celiac disease), the concentration of FCP was found to be substantially higher than that in the healthy individuals and patients with irritable bowel syndrome. The highest calprotectin levels were noted in the patients with inflammatory bowel diseases. Conclusion. This study demonstrated the high diagnostic value of the calprotectin test for the differential diagnosis of organic and functional bowel diseases.
Terapevticheskii arkhiv. 2015;87(2):30-33
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Long-term results of medical treatment in patients with a severe attack of ulcerative colitis

Khalif I.L., Nanaeva B.A., Golovenko A.O., Golovenko O.V.


Aim. To assess the long-term result of medical treatment in patients with a severe attack (SA) of ulcerative colitis (UC). Subjects and methods. The course of UC was analyzed in 56 patients who were accessible by telephone contact and consecutively recruited for a year after therapy for a SA of UC. All the patients were stated to have a SA of UC according to the Truelove-Witts' criteria; they received therapy with intravenous glucocorticosteroids (GCS) (prednisolone 2 mg/kg) along with anti-recurrence therapy with mesalasine (5-ASA) or azathioprine (AZA). Ten (17.9%) GCS-resistant patients were given infliximab (INF) (5 mg/kg), followed by its maintenance infusions. Anti-recurrence therapy using 5-ASA, AZA, and INF was performed in 33 (58.9%), 13 (23.2%), and 10 (17.9%) patients, respectively. Results. During one year, 14 (25%) patients continued to be in clinical remission on maintenance therapy or to have attacks stopped without using GCS, immunosuppressive agents, or INF (a satisfactory response group). Colectomy was carried out in 23 (41.1%) patients; due to recurrent UC when decreasing the dose of GCS, 5 (8.9%) patients continued to take the latter during a year. A GCS cycle was repeated in 3 patients who had received AZA (the basic therapy was not corrected) and 11 patients who had taken 5-ASA. The prognostic factors for a long-term result of medical therapy included the choice of AZA as an anti-recurrent drug (57.1 and 11.9% in the satisfactory and poor treatment outcome groups, respectively; p=0.004) and patient age (34.4 and 42.8 years, respectively; p=0.0357). Conclusion. During 1 year after a SA of UC, indications for colectomy and repeated GCS use occurred in 41 and 34% of the patients, respectively. The long-term efficiency of medical therapy for a SA of UC declines with advancing age. The use of AZA as an anti-recurrence agent after termination of GCS intake increases the probability of long-term clinical response.
Terapevticheskii arkhiv. 2015;87(2):34-38
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Safety of mesenchymal stromal cell therapy for inflammatory bowel diseases: Results of a 5-year follow-up

Kniazev O.V., Parfenov A.I., Konopliannikov A.G., Ruchkina I.N., Churikova A.A., Bykova S.V., Albulova E.A., Boldyreva O.N., Fadeeva N.A., Lishchinskaia A.A.


Aim. To compare the safety of therapy in patients with ulcerative colitis (UC) and Crohn's disease (CD) who have received combination anti-inflammatory therapy using bone marrow mesenchymal stromal cells (MSC) and standard therapy with 5-aminosalicylic acid, glucocorticosteroids, and immunosuppressive agents. Subjects and methods. Unfavorable consequences were analyzed in 103 patients (56 with UC and 47 with CD) with inflammatory bowel disease (IBD) after MSC administration. The findings were compared with data obtained in 208 patients with UC and CD on standard anti-inflammatory therapy. All the patients were similar in demographic parameters, the duration of disease, the extent of intestinal injury, the nature of a course, the type and degree of disease. The analyzed groups did not include patients who had received therapy with anti-TNF-α drugs. The safety of therapy was evaluated from the presence of complications occurring during the follow-up. Results. By analyzing the unfavorable consequences in 103 patients with IBD and comparing them with treatment results in 208 patients with UC and CD on standard anti-inflammatory therapy, the authors revealed no differences in the development of acute posttransfusion reactions, infectious complications, exacerbations of chronic inflammatory diseases, severe infectious complications, malignant transformation, and fatal cases in patients with UC and CD, except for those with transient fever. Conclusion. The results of this study demonstrate that the innovative method of cell therapy is clinically safe.
Terapevticheskii arkhiv. 2015;87(2):39-44
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Normative values for peripheral electrical gastroenterocolonography

Butov M.A., Shurpo E.M., Kuznetsov P.S., Dzhurzhevich M.D.


Aim. To elaborate the normative values of peripheral electrical gastroenterocolonography (EGECG). Subjects and methods. Fifty apparently healthy young people (14 women and 36 men; mean age 20.2±4.7 years) were examined. Peripheral EGECG was used to study the motor-evacuating function of the gastrointestinal tract (GIT). Results. The values of the main indicators and coefficients of GIT electrical activity were defined; the concepts of normal physiological values for GIT electrical activity were identified and their values were determined. Conclusion. Peripheral EGECG makes it possible to significantly estimate the bioelectrical activity of the gut. The informative markers of peripheral EGECG are relative electrical activity, ratio coefficient, rhythmicity coefficient, as well as the average amplitude and frequency of bioelectrical activity.
Terapevticheskii arkhiv. 2015;87(2):45-48
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Catalase gene rs1001179 polymorphism and oxidative stress in patients with chronic hepatitis C and ulcerative colitis

Bulatova I.A., Tret'iakova I.I., Shchekotov V.V., Shchekotova A.P., Ulitina P.V., Krivtsov A.V., Nenasheva O.I.


Aim. To study the rs1001179 polymorphism of the catalase (CAT) gene and to estimate the serum levels of the enzymes catalase and glutathione peroxidase (GP) in patients with chronic hepatitis C (CHC) and in those with ulcerative colitis (UC) in the Perm Territory. Subjects and methods. Ninety patients with reactivation-phase CHC and 50 patients with exacerbation-phase UC were examined. The serum levels of catalase and GP were determined and the polymorphic variants of the marker of CAT gene rs1001179 in the DNA isolated from whole blood were found in all the patients. Results. In the CHC and UC groups, the levels of catalase and GP were found to be lower than that in apparently healthy individuals. Furthermore, both groups showed a direct correlation between the activities of the enzymes. In the patients with CHC and in those with UC, the spread of genotypes and alleles generally failed to virtually differ from that in the control group. The G/G genotype was prevalent in all the groups. In the patients with CHC, the minor A allele demonstrated a significant inverse correlation with the enzyme catalase (r=-0.16; p=0.02) and GP (r=-0.13; р=0.047). Conclusion. The lower serum levels of catalase and GP are indicative of oxidative stress in the patients with CHC or UC. In the patients with CHC, the significant correlation of the pathological rs1001179 A allele marker with the processes of synthesis of antioxidant enzymes may suggest that CAT gene polymorphism in the A/A homozygotes might affect the regulation mechanism involved in the antioxidant system in the liver.
Terapevticheskii arkhiv. 2015;87(2):49-53
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Cholelithiasis as a possible manifestation of systemic digestive diseases

Vakhrushev I.M., Gorbunov A.I., Tronina D.V., Suchkova E.V., Liapina M.V., Khokhlacheva N.A.


Aim. To comprehensively study of the function of digestive organs in cholelithiasis (CL). Subjects and methods. Three hundred and seventeen patients with the early (prestone) stage of CL were examined. The latter was verified by ultrasonography (USG) and biochemical bile tests. The patients underwent pH metry and esophagogastroduodenoscopy, followed by histological examination of gastroduodenal mucosa (GDM) biopsy specimens. Manometry was used to evaluate duodenal function. The serum levels of pepsinogen-1 (PG-1), pepsinogen-2 (PG-2), cholecystokinin (CCK), gastrin, cyclic nucleotides (cAMP and cGMP), α1-antitrypsin, insulin, and C-peptide were analyzed by an enzyme immunoassay. Small intestinal function was examined using a set of diagnostic tests. Results. Gallbladder USG revealed biliary sludge in 273 (86.1%) patients. Biochemical examination of bile established a lower cholatocholesterol coefficient in its cystic as well as hepatic portions, suggesting enhanced bile lithogenicity. Manometry of the duodenum showed its hypertension, hypotension, and normotension in 57.6, 24.8, and 17.6% of the CL patients, respectively. There were significant increases in basal gastric body pH and PG-1 and PG-2 levels as compared to the control group. Morphological examination of GDM biopsy specimens revealed chronic superficial gastritis in 61.8% of the patients, chronic atrophic gastritis in 17.4%, and moderate diffuse duodenitis in 18.3%. In 148 (46.7%) patients with CL, the latter was burdened by pancreatic comorbidity. Stress tests using water-soluble starch, sucrose, and glucose demonstrated impairments in various stages of digestion; substantially decreased levels of CCK, gastrin and cyclic nucleotides were observed in the patients with CL compared to the controls. Conclusion. Most patients with CL were detected to have digestive organ structural and functional disorders. Moreover, CL may be regarded as a possible manifestation of systemic digestive diseases.
Terapevticheskii arkhiv. 2015;87(2):54-58
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Capabilities of ultrasonic histography in the evaluation of the degree of pancreatic fibrosis in chronic pancreatitis

Gubergrits N.B., Kolkina V.I.


Aim. To analyze the clinical and pathogenetic significance of ultrasonic histography in pancreatic fibrosis in patients with chronic pancreatitis (CP). Subjects and methods. One hundred and eighty-six patients with CP were examined. Complete blood count, urinalysis, biochemical blood and urine tests, duodenal intubation test, coproscopy, enzyme immunoassay, and radioimmune assay were performed. The levels of blood transforming growth factor Β1 (TGFΒ1) and fecal elastase-1 were measured. Ultrasonography and ultrasonic histography of the pancreas and liver, Doppler sound study of the abdominal aorta, celiac trunk, and superior mesenteric artery were carried out. Results. There were correlations suggesting the decreased exocrine function of the pancreas as its fibrosis progressed, which was indirectly reflected in the increased L index of an ultrasonic histogram. The positive correlation between L index and TGFΒ1 also showed increased L index in more obvious pancreatic fibrosis. A CP exacerbation was shown to be accompanied by decreased Kgst and N, which was confirmed by pronounced hyperenzymenia (the blood enzyme release phenomenon) with the decrease of those indicators. Pancreatic fibrosis was reflected in the magnitude of clinical manifestations of CP, particularly in the rise of the number of dyspeptic complaints showing diminished pancreatic exocrine secretion. This was also supported by the fact that as the L index increased, the debit hour of lipase and the activity of fecal elastase-1 decreased. There were correlations pointing to more significant fibrosis of the pancreas and its insufficiency with worsened blood flow in it. Moreover, ultrasonic histographic findings accounted for a positive correlation between pancreatic and hepatic fibrosis. Conclusion. Examination of ultrasonic histographic correlations of the pancreas has led to the conclusion that this technique may be used to indirectly estimate the degree of pancreatic fibrosis and a СP exacerbation.
Terapevticheskii arkhiv. 2015;87(2):59-63
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Hypertensive patients' adherence, motivation, and awareness during fixed-dose perindopril A and amlodipine combination treatment (Results of the CONSTANTA trial)

Kotovskaia I.V., Villeval'de S.V., Tigaĭ Z.G., Kobalava Z.D.


Aim. To estimate changes in treatment adherence and motivation and quality of life in Prestance-treated population of the observational CONSTANTA program. Subjects and methods. The effect of Prestance on treatment adherence and motivation and quality of life was evaluated in 2435 participants of the CONSTANTA program. It included patients with uncontrolled hypertension who generally received angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists alone or in conjunction with free or fixed-dose combinations of 2-3 antihypertensive agents and who were additionally given Prestance to correct antihypertensive therapy, as decided by their doctors. The goal blood pressure (BP) was less than <140/90 mm Hg for all the patients. A modified Morisky-Green questionnaire was used to measure adherence, motivation, and awareness in the patients. Their treatment lasted three months. Results. A total of 1992 (81.8%) patients in the analyzed group achieved the goal BP. When included in the study, 1076 (44.2%) patients were defined as adherent to therapy; the mean adherence index was equal to 3.12±0.86 scores; at 3 months of therapy, the number of adherents increased up to 1997 (82%) and the mean adherence index rose up to 3.6±0.74 scores. With high baseline motivation, its mean score was 1.25±0.79 in 40.1% of the patients; at 3 months the number of the motivated rose up to 70.9% (p<0.05) and the mean score was as high as 1.75±0.60 (p<0/05). At baseline, 44.2% of the patients showed a high awareness; its mean score was 1.42±1.12; at 3 months of therapy, both indicators significantly increased up to 82% (p<0.05) and 2.38±0.80, respectively. Conclusion. The well tolerable BP lowering during Prestance therapy is attended by a substantial rise in treatment adherence and motivations in the patients even in the absence of special purposeful measures.
Terapevticheskii arkhiv. 2015;87(2):64-69
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Impact of bariatric surgery on vitamin metabolisms in obese patients

Bodunova N.A., Askerkhanov R.G., Khat'kov I.E., Sabel'nikova E.A., Parfenov A.I., Tkachenko E.V., Varvanina G.G., Feĭdorov I.I.


Aim. To investigate the impact of bariatric surgery (BS) on the level of vitamins in obese patients. Subjects and methods. One hundred obese patients (78 women and 22 men) aged 19 to 61 years were examined. Controlled gastric banding (CGB) was carried out in 20 patients (mean body mass index (BMI), 41.3±8.2 kg/m2); gastric sleeve resection (GSR) in 40 patients, and gastric shunting (GS) in 40 (the mean BMI in these groups were 41.1±17.8 and 45.9±6.2 kg/m2, respectively). A control group consisted of 10 apparently healthy individuals (BMI, 24.9±3.2 kg/m2). An enzyme immunoassay was used to determine the serum concentrations of vitamins В1, В2, В5, В6, В9, В12, С, and D, niacin, biotin, and retinol-binding protein (RBP) before and 1 year after surgery. Results. All the three groups showed a considerable decrease in the levels of vitamins C, В5, В6, and D, and RBP both prior to and following BS. More than 50% of the patients who had undergone GSR had also a lower baseline niacin level. A year after CGB, GSR, and GS, the number of patents with deficiency of these vitamins remained the same or increased. The majority of patients with the same level of vitamin B2, niacin, and folic acid (FA) were observed to have its decrease a year postsurgery. The concentration of the other test vitamins was also reduced a year after all operations; however, it remained within the normal range. GS had no substantial impact on the concentrations of FA, vitamins B2, B12, B1, and biotin. The lower serum vitamin levels were not accompanied by clinical symptoms in most patients following BS. Conclusion. In 80% of the patients with obesity, the levels of vitamins C, B6, and D were decreased to a variable degree. After BS, there was a rise in the number of patients with low serum vitamin C, D, B6, B5, niacin, FA, and RBP concentrations, at the same time the number of patients with FA deficiency increased by more than twice. BS did not significantly affect the metabolism of vitamins В1, В2, В12, and biotin.
Terapevticheskii arkhiv. 2015;87(2):70-76
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Complicated gastroesophageal reflux disease in the presence of congenital esophageal shortening

Ianova O.B., Berezina O.I., Vasnev O.S., Bordin D.S.


The paper presents a clinical case of complicated gastroesophageal reflux disease (GERD) and describes problems in the differential diagnosis of malignant esophageal lesion in patients with GERD and a treatment modality used in this clinical case.
Terapevticheskii arkhiv. 2015;87(2):77-79
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Eosinophilic enterocolitis: A clinical case

Sovalkin V.I., Ignat'ev I.T., Pavlov A.V., Tret'iakova T.V., Smirnova L.M., Bikbavova G.R., Sazonova E.I., Labuzina N.S.


The paper describes a clinical case of primary eosinophilic enterocolitis in a 41-year-old female patent. It presents a brief review of the literature on the problem of primary eosinophil-associated gastrointestinal diseases.
Terapevticheskii arkhiv. 2015;87(2):80-84
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Inadequate response to proton pump inhibitor therapy: Causes and patient management tactics

Evsiutina I.V., Trukhmanov A.S.


The past decade has been marked by a considerable increase in the number of patients with gastroesophageal reflux disease and gastroduodenal ulcer who show an inadequate response to proton pump inhibitor (PPI) therapy. At the present time, most of the causes diminishing the response have been elucidated. Unfortunately, they cannot always be eliminated by drug therapy; nonetheless, rabeprazole has a number of advantages over other PPIs. The major causes of an inadequate response to PPI therapy are low treatment motivation; nocturnal gastric acid breakthroughs; genetically determined CYP polymorphism; chiefly nighttime symptoms of gastroesophageal reflux disease; non-acid refluxes; hypersensitive esophagus; overweight and obesity.
Terapevticheskii arkhiv. 2015;87(2):85-89
pages 85-89 views

Fortieth Anniversary Session of the Central Research Institute of Gastroenterology

Bordin D.S.
Terapevticheskii arkhiv. 2015;87(2):90-92
pages 90-92 views

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