Vol 89, No 2 (2017)

Editorial
Protein-losing enteropathy
Parfenov A.I., Krums L.M.
Abstract
Protein-losing enteropathy (PLE) is a rare complication of intestinal diseases. Its main manifestation is hypoproteinemic edema. The diagnosis of PLE is based on the verification of protein loss into the intestinal lumen, by determining fecal α1-antitrypsin concentration and clearance. The localization of the affected colonic segment is clarified using radiologic and endoscopic techniques. The mainstay of treatment for PLE is a fat-free diet enriched with medium-chain triglycerides. Surgical resection of the affected segment of the colon may be the treatment of choice for severe hypoproteinemia resistant to drug therapy.
Terapevticheskii arkhiv. 2017;89(2):4-9
views
Pathogenetic bases and efficacy of slow calcium channel blockers in the therapy of recurrent peptic ulcer disease associated with hypertension
Fomina L.A., Chernin V.V.
Abstract
Aim. To clarify blood calcium concentrations (BCCs) as an indicator of the functional state of the calcium-regulating system in the concomitant course of recurrent peptic ulcer disease (PUD) and hypertension, by comparing with the severity of a ulcerous process, with changes in regional microcirculation, and with the functions of the stomach. To elucidate the pathogenetic justification for and clinical efficacy of slow calcium channel blockers (SCCBs) in the treatment of this comorbidity. Subjects and methods. In the case-control study, each patient with recurrent PUD and grade 1, Stage I hypertension (Group 1; n=23) corresponded to a recurrent PUD patient matched for sex, age, and ulcer site (Group 2, n=23). The complex of treatment for these patients included the SCCB nifedipine. A control group consisted of 56 recurrent PUD patients who received combination therapy without nifedipine. All the patients over time underwent clinical and endoscopic examinations and determinations of BCCs, indicators of gastric secretory and motor functions, and regional microcirculation in the gastroduodenal mucosal biopsy specimens. Results. Recurrent PUD was present with a reliable BCC increase that was more substantial when it was associated with hypertension. Calcium imbalance was accompanied by changes in regional microcirculation and gastric secretory and motor functional indicators forming an acid peptic factor, as well as by hypermotor dyskinesia, which were more pronounced in patients with comorbidity. Incorporation of a SCCB into a complex of therapy for recurrent PUD to eliminate the pathogenic effect of blood calcium contributed to more rapid arrest of the clinical symptoms of a recurrence, to elimination of acute-phase microcirculatory disorders in the gastroduodenal zone, and to the recovery of gastric functional indicators. Elevated blood pressure was ruled out during the therapy of concomitant diseases. Conclusion. Incorporation of a SCCB into the combination therapy of recurrent PUD associated with hypertension is pathogenetically sound and clinically effective.
Terapevticheskii arkhiv. 2017;89(2):10-14
views
The prevalence of bacterial overgrowth syndrome and its associated factors in patients with inflammatory bowel diseases (according to the data of the Novosibirsk registry)
Kulygina Y.A., Osipenko M.F., Skalinskaya M.I., Palchunova K.D.
Abstract
Aim. To assess the prevalence of bacterial overgrowth syndrome (BOS) and its risk factors in patients with inflammatory bowel diseases (IBD). Subjects and methods. The patients from the Novosibirsk IBD registry, who had undergone a hydrogen breath test (HBT) using a Gastro+ device, were examined. Results. In 93 IBD patients who had undergone a HBD, the prevalence of BOS was 48% (46.2% for ulcerative colitis and 51.2% for Crohn’s disease). There was a strong correlation between abdominal bloating, abdominal rumbling, and positive HBT results in both patient groups. During the HBT, the patients with BOS frequently complained of diarrhea, borborygmi, belching, and anxiety. Conclusion. The findings suggest that BOS is highly prevalent among patients with IBD. BOS is associated with clinical symptoms, such as abdominal bloating, abdominal rumbling, tearfulness, and irritability.
Terapevticheskii arkhiv. 2017;89(2):15-19
views
Efficacy of adalimumab for Crohn’s disease in real clinical practice
Knyazev O.V., Kagramanova A.V., Ruchkina I.N., Fadeeva N.A., Lishchinskaya A.A., Boldyreva O.N., Zhulina E.Y., Shcherbakov P.L., Orlova N.V., Kirova M.V., Parfenov A.I.
Abstract
Aim. To evaluate the efficacy and safety of adalimumab (ADA) in patients with Crohn’s disease (CD) treated at the Department of Inflammatory Bowel Diseases, Moscow Clinical Research and Practical Center, and to determine the predictors of a therapy response. Subjects and methods. All the patients with CD treated with ADA were followed up for at least 6 months or until the drug was discontinued. Therapeutic effectiveness was evaluated at 4 weeks and 6 months after the initiation of treatment and at the end of a follow-up. Complete intestinal mucosal healing was assessed at 3 and 12 months following treatment initiation. Univariate and multivariate analyses were used to determine the predictors of treatment response. Results. A clinical analysis covered 70 patients (57.1% male); the follow-up period averaged 112 weeks. Perianal fistulas were at baseline established in 22 (31.4%) patients with CD. 12 (17.4%) patients had been previously treated with infliximab (INF), 7 of them discontinued the drug for secondary loss of response and 5 for adverse reactions. 68 (97.1%) patients responded to an induction course of ADA. At 4 weeks, 6 months, and at the end of the follow-up, clinical remission occurred in 66.7, 80.4 and 67.4 % of patients with luminal CD and in 45.4, 36.5, and 36.4% of those with perianal CD, respectively. At 3 and 12 months and at the end of the follow-up, there was complete healing of the intestinal mucosa in 23.5, and 41.2 and 29.5% of cases, respectively. Six (8.8%) patients responding to the induction course needed to be optimized with ADA to 40 mg weekly. The time interval between treatment initiation and dose optimization averaged 30 weeks (range 12-120 months). There were 15 (21,4%) adverse events that were responsible for ADA discontinuation in 3 (4,2%) patients. Conclusion. The findings demonstrate the efficacy and safety of ADA used in clinical practice.
Terapevticheskii arkhiv. 2017;89(2):20-27
views
Specific features of impaired intestinal digestion, absorption, and microbiocenosis in patients with cholelithiasis
Vakhrushev Y.M., Lukashevich А.Р.
Abstract
Aim. To perform a comprehensive study of intestinal digestion, absorption, and microbiocenosis in various stages of cholelithiasis (CL). Subjects and methods. A total of 76 patients with of CL, including 44 patients with its Stage I and 32 patients with Stage II, were examined. Mono-, di - and polysaccharide load tests and a scatological study were performed to evaluate the processes of digestion and absorption in the intestine. The hydrogen breath test using lactulose was carried out to study small intestinal bacterial overgrowth (SIBO). The state of colon microbiocenosis was determined by plating feces onto various selective nutrient media. Results. All digestive process stages in the small intestine were noted to be impaired in CL. In Stage I CL, cavitary digestion was mainly impaired; in Stage II, all digestive and absorptive processes were abnormal. Scatological examination in patients with Stage I CL revealed steatorrhea in 79.5%, creatorrhea in 75%, and amylorrhea in 36.4%. In Stage II CL, digestive and absorptive disorders progressed. SIBO was detected in 68.5% whereas in 70% of cases, it was located in the distal small intestine in the presence of insufficiency of the ileocecal sphincter apparatus. A regularity was found between the severity of SIBO and impaired small intestinal cavitary digestion. SIBO was more common in the pre-gallstone stage of CL than in its gallstone stage. Dysbiosis of the colon was detected in 100% of the examined patients with CL; moreover, as the latter progressed, dysbiosis worsened. Conclusion. There is new information about impaired intestinal digestion and microbiocenosis in patients with CL.
Terapevticheskii arkhiv. 2017;89(2):28-32
views
Elastography in the diagnosis of portal hypertension in patients with liver cirrhosis
Liusina E.O., Pavlov C.S., Ivashkin V.T.
Abstract
Aim. To establish the diagnostic accuracy of liver and spleen density (LD and SD) measurements in patients with compensated alcoholic liver cirrhosis (LC) in the diagnosis of portal hypertension. Subjects and methods. The investigation enrolled 83 patients with compensated alcoholic and viral (hepatitis C virus) LC. All the patients underwent LD and SD determinations, abdominal ultrasonography, and endoscopy to detect esophageal varices (EV), as well as examination of blood indices. Results. In viral LC, there were substantial LD differences in patients with and without EV. The patients with EV were ascertained to have higher LD [27.9 (21—45) kPa] than those without EV [19.5 (16—26.2) kPa]. SD was also significantly higher than that in the EV group than in the non-EV group (p<0.001). There were no statistically significant differences in SD and LD or in spleen size in patients with alcoholic LC in relation to the presence of EV. Comparison of patients with EV of different etiology revealed differences in platelet count and spleen size. Thrombocytopenia was more pronounced in HCV-related LC patients (p=0.04). The spleen size in patients with viral LC was higher than that in those with alcoholic LC. Conclusion. Elastography of the spleen and liver may be used to identify portal hypertension in patients with viral (HCV) LC (83% sensitivity, 75% specificity) with the following threshold values: LD=26 kPa and SD=50 kPa. The threshold LD and SD values obtained for viral LC do not make possible to diagnose clinically significant portal hypertension (EV) in patients with alcoholic LC. There is a need for further investigations to determine the optimal threshold values of LD and SD for the diagnosis of EV.
Terapevticheskii arkhiv. 2017;89(2):33-37
views
Ultrasound elastography of the liver for assessing the risk of complications of its cirrhosis of different etiologies
Stukova N.Y., Kucheryavyi Y.A., Mayevskaya E.A., Maev I.V.
Abstract
Aim. To study the results of dynamic liver ultrasound elastography (LUE) in assessing the risk of complications of liver cirrhosis (LC) of different etiologies and to elaborate a monitoring program for estimation of the predictive value of elastography in patients with LC. Subjects and methods. A total of 194 patients with LC of different etiologies, including 56 patients with alcoholic cirrhosis, 48 with LC and an outcome of nonalcoholic fatty liver disease, 53 with LC and an outcome of chronic hepatitis C, 23 with LC and an outcome of chronic hepatitis B, and 14 with an outcome of coinfection with hepatitis B and D viruses, were examined. An analysis was made between the presence of a number of LC complications and the results of LUE, by constructing the receiver operating characteristic (ROC) curves to select LUE threshold values, in which there was a high risk for LC complications (esophageal varices, bleeding esophageal varices, hepatic encephalopathy, and ascites). Results. The investigation could obtain liver elastography threshold values expressed in kilopascals (kPa), which were proposed for use as a prognostic sign of the presence of complications caused by LC and assessed liver elastography threshold values for its mortality prediction. The predictive value of positive LUE results in determining the risk of different complications was 75.7 to 92.5%; that of negative results was 70 to 92.9%. An algorithm for individualized diagnostic and treatment policy was elaborated in relation to the liver elastography results obtained during the primary examination of a patient. Conclusions. The dynamic LUE findings in patients with LC of different etiologies suggest that the proposed LUE threshold values are efficient and may be used in practical healthcare, which will be able to timely correct management tactics for a patient and to monitor his treatment.
Terapevticheskii arkhiv. 2017;89(2):38-44
views
Clinical and metabolic features of nonalcoholic fatty liver disease in men and women
Krivosheev A.B., Kuimov A.D., Bogoryanova P.A., Kondratova M.A., Kupriyanova L.Y., Popov K.V., Tuguleva T.A.
Abstract
Aim. To evaluate clinical features and metabolic disorders in men and women with non-alcoholic fatty liver disease (NAFLD).
Terapevticheskii arkhiv. 2017;89(2):45-51
views
Features of a necrotic and inflammatory process in different forms of nonalcoholic fatty liver disease
Kurbatova I.V., Dudanova O.P.
Abstract
Aim. To identify the features of development of a necrotic and inflammatory process in different forms of nonalcoholic fatty liver disease (NAFLD), by comparatively analyzing a full set of clinical and laboratory parameters, including the cytokine status and the expression level of enzyme genes controlling the apoptosis of peripheral leukocytes. Subjects and methods 86 patients with NAFLD, including 8 (9.3%) with hepatic steatosis (HS), 70 (81.4%) with nonalcoholic steatohepatitis (NASH), 40, 19, and 11 with mild, moderate, and high disease activity, respectively, and 8 (9.3%) with liver cirrhosis (LC), were examined. A control group consisted of 34 healthy donors. Clinical and biochemical blood indices, cytokine profile, and the level of caspase gene transcripts in the peripheral blood leukocytes (PBL) were estimated. Results. As compared to the controls, the patients with HS had higher tumor necrosis factor-α (TNF-α) and interleukin 6 (IL-6) levels and lower caspase 3, 6, and 8 mRNA in PBL. The concentration of IL-10 in NASH was higher than that in steatosis and positively correlated with the level of proinflammatory cytokines. The levels of TNF-α and IL6 were higher in the patients with NASH than in the controls. Those of C-reactive protein, γ-globulin, IL-6, and cytokeratin-18 fragment increased with the progression of NASH. In the latter, the transcriptional activity of caspase-3 gene decreased relative to the reference value and negatively correlated with the level of proinflammatory cytokines. In the patients with LC, the gene expression profile of caspases in PBL was similar to that in the control group; the level of IL-6 was higher than that in steatosis and NASH, that of IL-1β was higher than in HS and positively correlated the concentration of IL-6 and the activity of alanine aminotransferase and aspartate aminotransferase. Conclusion. The features of a necrotic and inflammatory process were identified in different forms of NAFLD. When the latter progressed, the cytokine profile and gene expression levels of caspases in PBL altered along with a change in the general clinical picture.
Terapevticheskii arkhiv. 2017;89(2):52-58
views
Diabetes mellitus and nonalcoholic fatty liver disease: The verges of contingency
Bakulin I.G., Sandler Y.G., Vinnitskayа E.V., Keiyan V.A., Rodionova S.V., Rotin D.L.
Abstract
Aim. To estimate the incidence of hepatic steatosis (HS) and liver fibrosis (LF) in patients with diabetes mellitus (DM), by applying the noninvasive techniques of liver fibroelastometry (LFE) and a battery of fibrotests (FTs); to determine their diagnostic value and to identify factors influencing the development of LF. Subjects and methods. A comprehensive examination was made in 82 diabetic patients (mean age, 56.7±12.7 years; p=0.033). The data were statistically evaluated using ROC curve analysis, correlation and single-factor analyses of variance, and multiple logistic regression analysis. Results. FTs and LFE revealed that the DM patients had liver cirrhosis (LC) (METAVIR F4) in 12 (14.6%) and 15 (18.2%) patients, respectively. Those showed clinically significant fibrosis (METAVIR fibrosis stages F2-3) in 19 (23.1%) and 23 (28%) patients, respectively. Varying degrees of HS were present in 79 (96.3%) patients. LFE and FTs demonstrated comparable results in detecting LC (the area under the receiver operating characteristics curve (AUROC), 0.83 and 0.81, respectively). The development of LF is influenced by factors, such as the degree of HS, obesity, the activity of an inflammatory process, and the level of alanine aminotransferase and α2-macroglobulin. Conclusion. Diabetic patients are at high risk for NAFLD to develop LF and LC. LFE and FTs showed a comparably high accuracy in the diagnosis of LC in patients with DM and these may be used for screening. With allowance made for the existing risk factors of LF and LC, it is necessary to identify groups of patients with DM for further examination and follow-up. Patients who are diagnosed with stage F4 should be examined carefully to evaluate concurrent diseases and to make liver biopsy.
Terapevticheskii arkhiv. 2017;89(2):59-65
views
Change in the ratio of blood saturated to unsaturated fatty acids is a universal marker of lipid metabolic disorder in patients with cholelithiasis
Tonkikh Y.L., Tsukanov V.V., Kasparov E.V., Bronnikova E.P., Vasyutin A.V.
Abstract
Aim. To study the spectrum of serum fatty acids (SSFA) and the composition of blood lipids in cholelithiasis (CL) in various ethnic groups of East Siberia. Subjects and methods. A clinical and epidemiological study was conducted, during which ultrasonography and oral cholecystography were used to examine 991 Khakases and 934 Europoids in Khakassia and 652 Evenks and 996 Europoids in Evenkia. Biochemical tests were performed to determine serum lipids in 20% of the random sample. Gas liquid chromatography was applied to investigate ASSFA in 220 patients in Khakassia and 157 people in Evenkia. Results. The manifestations of hyperlipidemia were detected in the Europoids with CL in Evenkia and Khakassia. These changes were less pronounced in the Evenks with CL and absent in the Khakases with CL. In all populations, the blood levels of saturated FAs and ratios of saturated to unsaturated FAs were considerably higher in the patients with CL than in the healthy individuals. Conclusion. The higher levels of saturated FAs and the lower proportion of serum unsaturated FAs are a universal marker of lipid metabolic disturbances in patients with CL in genetically different populations.
Terapevticheskii arkhiv. 2017;89(2):66-69
views
Abdominal pain syndrome and quality of life in patients with cholelithiasis after cholecystectomy during a 10-year follow-up
Makarovа Y.V., Litvinova N.V., Osipenko M.F., Voloshina N.B.
Abstract
Aim. To estimate the incidence of abdominal pain syndrome (APS) and to assess quality of life (QOL) in patients within 10 years after cholecystectomy (CE). Subjects and methods. This investigation is part of a long-term prospective follow-up study of patients after CE for cholelithiasis (CL). It enrolled 145 people: 30 (21.5%) patients with baseline asymptomatic CL and 115 (80.7%) with its clinical manifestations. The time course of changes in APS and QOL were analyzed. Results. Over 10 years, all the patients showed a decrease in the incidence of APS from 84.1% (n=95) to 66.4% (n=75; p=0.004). In Group 1 (n=89), APS was at baseline detected in all the patients; 10 years later, its incidence declined to 67.4% (n=60; p < 0.001). Biliary pains were predominant; these had been identified significantly less frequently over the 10-year period in 47 (52.8%) patients; p<0.001). In Group 2 (n=24), pre-CE APS was generally detected in 6 (25%) patients; following 10 years, the incidence rates of pain significantly increased to 62.5% (n=15; p=0.035), among which there were predominant biliary pains (in 54.2%; p<0.001) and dyspepsia from 33.3% (n=8) up to 66.7% (n=16; p=0.039). QOL in the physical and mental health domains was found to decrease in both groups. Conclusion. Ten years after CE, the group with the baseline clinical manifestations of CL and poorer QOL showed a lower incidence of APS mainly due to the reduced incidence of biliary pains and the baseline asymptomatic group exhibited a rise in the incidence of APS due to the appearance of biliary pains and dyspepsia.
Terapevticheskii arkhiv. 2017;89(2):70-75
views
Possibilities of pH impedance and high-resolution manometry in managing patients with refractory gastroesophageal reflux disease
Maev I.V., Barkalova E.V., Ovsepyan M.A., Kucheryavyi Y.A., Andreev D.N.
Abstract
Gastroesophageal reflux disease (GERD) is a common condition that has a substantial impact on quality of life in patients and is a leading risk factor for esophageal adenocarcinoma. Now therapy with proton pump inhibitors (PPIs) is a basic method in the treatment of patients with GERD; however, one third of the patients do not respond to the therapy used. The causes of refractory GERD are a fairly large group of heterogeneous factors contributing to the inefficacy of PPIs in adequate dosage. Among these factors, there is low compliance by patients to the prescribed treatment regimen; nocturnal acid breakthrough; СУР2С19 gene polymorphism; chiasm syndrome with functional diseases of the gastrointestinal tract; non-acidic refluxes in a patient; thoracic esophageal motility disorders; the increased number and duration of transient lower esophageal sphincter relaxation periods; hiatus hernia; and misdiagnosis. 24-hour pH impedance and high-resolution esophageal manometry are now the most informative diagnostic techniques in patients who fail to respond to PPI therapy. These techniques allow one to timely recognize the causes of refractory GERD, to make a differential diagnosis with other nosological entities, and to timely correct therapy for each individual patient.
Terapevticheskii arkhiv. 2017;89(2):76-83
views
Possibilities for optimization of eradication therapy for Helicobacter pylori infection in modern clinical practice
Andreev D.N., Dicheva D.T., Maev I.V.
Abstract
A steady decline in the effectiveness of standard eradication therapy (ET) regimens for Helicobacter pylori infection necessitates a search for ways of their optimization, by enhancing the efficiency of treatment protocols and by improving their safety and tolerability. The review systematizes the data available in the literature on main accessible methods for optimizing ET regimens. Among the optimization methods that can considerably enhance the efficiency of ET regimens, one may identify their addition of a bismuth agent (by 10—20%), the use of rebamipide (by 11.9%), adjuvant therapy with probiotics (by 8.1—13%), or double-dose proton pump inhibitors (by 8%). Only adjuvant therapy with probiotics results in a significant decrease in the incidence of side effects from ET. In posteradication period, rebamipide should be used to potentiate gastric mucosal repair and to regress inflammatory processes.
Terapevticheskii arkhiv. 2017;89(2):84-90
views
Nonalcoholic fatty liver disease: What do we know and what will we have to learn?
Volkova N.I., Porksheyan M.I.
Abstract
The article reviews relevant data on the prevalence, natural history, pathogenesis, diagnosis, and treatment of nonalcoholic fatty liver disease and critically assesses the fixed notion of this disease.
Terapevticheskii arkhiv. 2017;89(2):91-98
views
Neurological disorders associated with gluten sensitivity
Degterev D.A., Damulin I.V., Parfenov A.I.
Abstract
The review considers the pathogenetic, clinical, and therapeutic aspects of neurological disorders associated with gluten sensitivity. Gluten ataxia and polyneuropathy are most common. The clinical features of neurological disorders in patients with gluten sensitivity and the effects of a gluten-free diet are described.
Terapevticheskii arkhiv. 2017;89(2):99-102
views
Whipple’s disease: A clinical case report
Krums L.M., Bodunova N.A., Sabelnikova E.A., Khomeriki S.G., Mirzoev K.M., Sokolova M.S., Parfenov A.I.
Abstract
The paper describes a 56-year-old female patient who in December 2015 lost her appetite and 20 kg of weight, had diarrhea, rapidly increasing weakness, dizziness, joint pains, fever, swelling of the feet, and convulsions. Blood tests revealed anemia, elevated erythrocyte sedimentation rate, and hypoproteinemia. Computed tomography showed enlarged mesenteric and retroperitoneal lymph nodes. The doctor suspected lymphoma and referred her to the Moscow Clinical Research Center. The diagnosis of Whipple’s disease was established by carrying out a small intestinal (duodenal) mucosal biopsy with the PAS reaction. A fat-free diet and antibiotic therapy with co-trimoxazole 2.0 g/day and ciprolen 0.3 g/day were prescribed for the patient. Fever and diarrhea disappeared, appetite appeared, weight gained, and blood counts normalized over 1 month of treatment. The patient was discharged with a recommendation to continue antibiotic treatment until the histopathological signs of the disease ceased.
Terapevticheskii arkhiv. 2017;89(2):103-104
views
The Russian consensus on the diagnosis and treatment of chronic pancreatitis
Khatkov I.E., Maev I.V., Abdulkhakov S.R., Alekseenko S.A., Alieva E.I., Alikhanov R.B., Bakulin I.G., Baranovsky A.Y., Beloborodova E.V., Belousova E.A., Buriev I.M., Bystrovskaya E.V., Vertyankin S.V., Vinokurova L.V., Galperin E.I., Gorelov A.V., Grinevich V.B., Danilov M.V., Darvin V.V., Dubtsova E.A., Dyuzheva T.G., Egorov V.I., Efanov M.G., Zakharova N.V., Zagainov V.E., Ivashkin V.T., Izrailov R.E., Korochanskaya N.V., Kornienko E.A., Korobka V.L., Kokhanenko N.Y., Kucheryavyi Y.A., Livzan M.A., Loranskaya I.D., Nikolskaya K.A., Osipenko M.F., Okhlobystin A.V., Pasechnikov V.D., Plotnikova E.Y., Polyakova S.I., Sablin O.A., Simanenkov V.I., Ursova N.I., Tsvirkun V.V., Tsukanov V.V., Shabunin A.V., Bordin D.S.
Abstract
1Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children’s Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky Saratov State Medical University, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Ministry of Emergency Situations of Russia, Saint Petersburg; 27Federal Research Center, Krasnoyarsk Research Center, Siberian Branch, Russian Academy of Sciences, Research Institute of Medical Problems of the North, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus (a consensus document) on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian «Pancreatic Club» under the Delphi system. Its aim was to identify and consolidate the opinions of Russian experts on the most topical issues of the diagnosis and treatment of chronic pancreatitis. The interdisciplinary approach involved the participation of leading gastroenterologists, surgeons, and pediatricians.
Terapevticheskii arkhiv. 2017;89(2):105-113
views
views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies