Vol 94, No 2 (2022)

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Full Issue


Food intolerances and the small intestine

Parfenov A.I.


The article presents an analysis of the literature on food intolerance (FS) associated with the presence in the diet of fermentable oligodimosaccharides and polyols FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), histamine and food additives. The relationship between FS and insufficient activity of enzymes of the small intestine mucosa, in particular, in patients with irritable bowel syndrome, is discussed. FS often noted in them forces them to strictly adhere to the elimination diet and significantly impair the quality of life due to dissatisfaction with the results of treatment. Analysis of the literature has confirmed in many patients with irritable bowel syndrome an etiotropic relationship with poor food tolerance and dictates the need for randomized studies to further study the pathogenetic mechanisms of increasing food tolerance under the influence of cytoprotective therapy.

Terapevticheskii arkhiv. 2022;94(2):153-159
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Original articles

Assessment of ten-year dynamics of cases of hospitalizations of patients with peptic ulcer disease, chronic gastritis and chronic duodenitis

Butov M.A., Zhestkova T.V., Esakova E.M., Efanova L.V.


Aim. To assess of the ten-year dynamics of cases of hospitalizations of patients with peptic ulcer disease (PUD), chronic gastritis and chronic duodenitis relative to the total number of people treated in the gastroenterological departments of the hospital in 2010–2019.

Materials and methods. Data of the annual reports of the work of the hospital departments were studied retrospectively.

Results. The relative number of persons hospitalized for chronic duodenitis decreased 2.8 times (p<0.001), but the proportion of patients with chronic gastritis did not tend to decrease. This is most likely due to diagnostic errors. The cases of hospitalization of persons with uncomplicated PUD decreased by 3.1 times (p<0.001), the proportion of men with duodenal ulcer decreased by 6.3 times (p<0.001), with gastric ulcer decreased 1.9 times (p<0.01). The proportion of women hospitalized with duodenal ulcer decreased 2.3 times (p<0.01). The number of hospitalized men with duodenal ulcer is 3.8 times more than females (p<0.001). It can be explained by a decrease in social stressful influences and active anti-Helicobacter pylori therapy.

Conclusion. Over the period of follow-up, the cases of hospitalization of patients with uncomplicated PUD decreased, primarily due to a decrease in the proportion of persons with ulcer of the duodenum and duodenitis, while the number of patients with chronic gastritis not undergoing modern examination did not have significant dynamics.

Terapevticheskii arkhiv. 2022;94(2):160-165
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Characteristic of disorders of motor-evacuator activities of the stomach and intestinal in chronic duodenal insufficiency

Vakhrushev Y.M., Busygina M.S., Vatulin V.V.


Aim. To assess the psychoemotional status and the state of the autonomic nervous system and their importance in the violation of the motor-evacuation function of the gastrointestinal tract in chronic duodenal insufficiency (CDI).

Materials and methods. A prospective study of 40 patients with CDI was carried out. The control group consisted of 30 healthy individuals. Anamnestic and physical data, results of X-ray and endoscopic studies, and intracavitary manometry were used to verify CDI. The study of the gastrointestinal tract was carried out using the "Gastroscan-GEM". Assessment of autonomic homeostasis was carried out using cardiac rhythmographic research and analysis of heart rate variability using the "Varicard 2.51" complex. To assess personal and situational anxiety – test questionnaire Spielberger–Khanin. Eysenck's test questionnaire was used to determine the type of temperament.

Results and discussion. We revealed a postprandial decrease in the contribution of the frequency spectrum of the duodenum (Pi/Ps – 1.7±0.07; p=0.000) and the colon (Pi/Ps – 39.62±2.45; p=0.000) in the total spectrum in comparison with the starving study, at the same time there is an aberrant significant increase in the contribution of the stomach to the total spectrum (46.5±5.8%; p=0.00). In patients with CDI, the prevalence of the sympathetic division of the autonomic nervous system AMo was noted – 94.0 [92.5; 97.5]% with an asymptotic type of autonomic reactivity (IN2/IN1=1.1 [1.05; 1.17]) and insufficient adaptation reserve coefficients (0.32 [0.2; 0.4]) in relation to the control group. The psychoemotional state in patients with chronic duodenal stasis is in direct correlation with changes in the postprandial ratio of the electrical activity of the stomach and duodenum (r=0.7, p=0.021), and in reverse – with the coefficient of the ratio of intraduodenal pressure to intragastric pressure (r=-0,8, p=0.000).

Conclusion. In patients with CDI, changes in the functional state of the stomach and duodenum are of a systemic nature, which is due to stimulating (parasympathetic) and inhibitory (sympathetic) effects. The relationship between the motor-evacuation activity of the stomach and duodenum and the psychoemotional state in patients with CDI was revealed.

Terapevticheskii arkhiv. 2022;94(2):166-171
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Frequency and risk factors for thromboembolic complications in patients with inflammatory bowel diseases

Lishchinskaya A.A., Knyazev O.V., Kagramanova A.V., Dudina G.A., Sabelnikova E.A., Li I.A., Noskova K.K., Bodunova N.A., Parfenov A.I.


Background. Inflammatory bowel diseases (IBD) are characterized by chronic immune inflammation of the mucous membrane and/or the thickness of the intestinal wall, and are also accompanied by disorders of the blood clotting system and the development of a hypercoagulation state.

Aim. To identify the frequency of thromboembolic complications (TEC) in IBD patients and to determine the influence of acquired and inherited hypercoagulation factors that contribute to the development of TEС.

Materials and methods. The clinical status of 1,238 IBD patients who were treated in 2019 was evaluated. Of these, 748 patients with ulcerative colitis (UC) and 490 patients with Crohn's disease (CD). Among UC patients, there were 369 (49.3%) men and 379 (50.7%) women. In 10.1% of patients with UC, there were clinically significant feasibility studies. There were 227 (46.3%) men and 263 (53.7%) women among patients with CD; 7.3% of patients with CD had clinically significant feasibility studies.

Results. In general 112 (9.0%) of 1,238 IBD patients had clinically significant feasibility studies. Among patients with UC (n=748), 76 (10.2%) showed clinically significant feasibility studies. Among patients with CD (n=490), 36 (7.3%) had a feasibility study. Of 112 IBD patients with clinically significant TEC, 45 (40.2%) had genetic polymorphisms that increase affinity for fibrinogen, increase platelet aggregation, and contribute to a decrease in the activity of folate cycle enzymes, including methylenetetrahydrofolate reductase, which may be manifested by a moderate increase in homocysteine levels. Of the 45 IBD patients with clinically significant TEC due to inherited factors, 30 (66.6%) patients had UC, 15 (33.7%) patients had CD (hazard ratio 1.038, 95% confidence interval 0.746–1.444; χ2=0.049; p=0.83921); 67 (59.8%) patients with IBD who had clinically significant TEC did not have genetic polymorphisms leading to hypercoagulation.

Conclusion. Based on the analysis, we can conclude that such risk factors for the development of TEC as the status of a smoker, long bed rest, taking hormonal contraceptives, varicose veins of the lower extremities, high activity of the disease, glucocorticoids therapy, the extent of intestinal damage in patients with IBD, genetic factors, should be taken into account by gastroenterologists in the treatment of patients with UC and CD. The hereditary factor of hypercoagulation equally affects the development of TEC, both in patients with UC and CD.

Terapevticheskii arkhiv. 2022;94(2):172-179
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The effectiveness of a probiotic containing Bifidobacterium longum BB-46 and Enterococcus faecium ENCfa-68 in the treatment of post-infectious irritable bowel syndrome. Prospective randomized comparative study

Yakovenko E.P., Strokova T.V., Ivanov A.N., Iakovenko A.V., Gioeva I.Z., Aldiyarova M.A.


Background. In the treatment of post-infectious irritable bowel syndrome (PI-IBS), the leading role belongs to the normalization of the composition of the intestinal microbiome, the disturbances of which are associated with previous intestinal infections.

Aim. To study the effectiveness of the drug Bifiform in the treatment of PI-IBS.

Materials and methods. An open, prospective, comparative, randomized study included 62 patients with PI-IBS. The diagnosis was confirmed by the results of clinical, laboratory and endoscopic examination of the intestine and met the diagnostic criteria for IBS of the Rome Consensus IV. The patients were randomized into 2 groups depending on the therapy. The patients of the main group received an antispasmodic drug (mebeverin 200 mg 2 times a day or trimebutin 200 mg 3 times a day for 4 weeks), an antibiotic (rifaximin 400 mg 3 times a day or nifuroxazide 400 mg 2 once a day for 1 week), a drug that normalizes the consistency of feces (dioctahedral smectite or macrogol 4000) and Bifiform 2 capsules 2 times a day for 2 weeks. For patients of control group similar therapy was performed without the Bifiform. Evaluation of the effectiveness of treatment was carried out at the end of the course of therapy and 6 months after its termination.

Results. All included patients with PI-IBS had abdominal pain, flatulence and tenderness to palpation along the bowel, most of them had diarrhea. Disorders of the intestinal microbiota were detected in 77.4% of patients, while excessive bacterial growth in the small intestine occurred in 72.6%, disorders of the colon microbiocenosis with the presence of opportunistic bacteriain 62.9% of patients. A significant part of the patients had a combination of small and large intestinal dysbiosis. Histological examination of the colon mucosa showed signs of low degree of inflammation activity in all patients. The moderate increase in the level of fecal calprotectin was found in 62.2% of patients with colonic dysbiosis. The majority of patients in the main group showed a pronounced positive dynamics of clinical manifestations of the disease, restoration of the normal composition of the intestinal microbiota and normalization of the content of fecal calprotectin at the end of the course therapy. The good result was observed much more often in the main group at the end of the course of treatment and 6 months after its termination.

Conclusion. The inclusion of Bifiform in the complex therapy of PI-IBS significantly increases its effectiveness both in arresting the clinical manifestations of the disease, and in restoring the normal composition of the intestinal microbiome and reducing the inflammatory process in the intestinal mucosa. In the majority of patients receiving Bifiform, the remission of the disease achieved at the end of the course of treatment and persisted even 6 months after its termination.

Terapevticheskii arkhiv. 2022;94(2):180-187
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The study of abdominal and parietal enteric microbiota in patients with non-alcoholic fatty liver disease

Vakhrushev Y.M., Lukashevich A.P., Lyapina M.V.


Aim. To characterize of the features of changes in the cavity and parietal microbiota of the small intestine in patients with non-alcoholic fatty liver disease (NAFLD).

Materials and methods. Fifty four patients with NAFLD at the stage of steatosis and steatohepatitis at the age of 18–60 years were examined. The diagnosis was verified by ultrasound of the hepatobiliary system using a SONIX OP analyzer (Canada), FibroMax test data and liver elastography using an AIXPLORER apparatus (France). The degree of steatohepatitis activity was determined by biochemical blood tests for alanine aminotransferase and aspartate aminotransferase on a Huma Star 600 analyzer (Germany). The cavity microbiota of the small intestine was evaluated using a Lactofan2 analyzer of the Association of Medicine and Analytics company (Russia) using hydrogen breath tests with lactulose. The parietal microbiota of the small intestine was examined using an Agilent 7890 gas chromatograph with mass-selective and plasma-ionization detectors (Agilent Technologies, USA).

Results. In the study of cavity enteric microbiota in patients with NAFLD, the syndrome of excessive bacterial growth was detected in 68.5% of cases, while it was caused in 48.6% of patients by a violation of the function of the ileocecal valve, in 21.7% – by a deficiency of cleavage of lactulose microorganisms and/or slowing down the motility of the digestive tract. When studying the parietal enteral microbiota, the total bacterial load in patients with NAFLD was significantly lower compared with the control group due to a decrease in useful microbiota. At the same time, a decrease in all normal bacterial representatives – Bifidobacterium, Lactobacillus and Lactococcus, Eubacterium and Propionibacterium – was noted. The content of opportunistic microbiota in patients with NAFLD did not reveal significant changes.

Conclusion. The syndrome of excessive bacterial growth in patients with NAFLD is associated with a decrease in useful parietal enteral microbiota.

Terapevticheskii arkhiv. 2022;94(2):188-193
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CYP2D6 gene polymorphic markers role in determining the optimal treatment tactics for portal hypertension in patients with liver cirrhosis

Sychev D.A., Parusov A.I., Loranskaya I.D., Denisenko N.P., Akmalova K.A., Sozaeva Z.A., Turkina O.L., Zastrozhin M.S.


Aim. To study the polymorphic markers CYP2D6*4 (G1846A, rs3892097), CYP2D6*6 (T1707del, rs5030655), CYP2D6*10 (C100T, rs1065852), CYP2D6*41 (G2988A, rs28371725) and CYP2D6*3 (A2549del, rs4986774) role in treatment optimization of portal hypertension with propranolol in patients with liver cirrhosis (LC).

Materials and methods. The study included 60 patients with LC who received propranolol therapy at a daily dose of 30 mg for 14 days. The efficacy of treatment was assessed by ultrasonography measuring the linear blood flow velocity of portal vein. Genotyping of CYP2D6*4, CYP2D6*6, CYP2D6*10, CYP2D6*41 and CYP2D6*3 was carried out by real-time polymerase chain reaction. Evaluation of the CYP2D6 activity was carried out by determining the ratio of pinoline and its metabolite concentration in morning urine using high performance liquid chromatography with mass spectrometry.

Results. Positive hemodynamics in the form of any increase in the mean linear blood flow velocity of the portal vein compared to baseline was observed in 41 patients. Portal vein mean linear blood flow rate increased from 10.4±3.9 to 14.7±4.3 cm/s (p<0.001). Of these, 29 patients showed an increase in this indicator by ≥20% from the initial one with a dynamic of 5.5 cm/s (p<0.001). The regression analysis constructed by us revealed the presence of a statistically significant effect of the CYP2D6 gene polymorphic marker G1846A carriage on the propranolol therapeutic effect (p<0.05). There was no statistically significant effect of polymorphic markers T1707del, C100T, G2988A, and A2549del of the CYP2D6 gene (p>0.05). No convincing reliable dependence of CYP2D6 activity on the severity of LC was revealed (p>0.05).

Conclusion. An association was found between CYP2D6 gene polymorphic marker G1846A carriage and the hemodynamic effect of propranolol in patients with LC of the Russian population. There is a more significant positive dynamics of manifestations of portal hypertension on the background of propranolol therapy in carriers of the homozygous GG CYP2D6*4 genotype, in contrast to patients with the heterozygous GA genotype. Based on the results of the study, an algorithm has been developed for personalizing the treatment of patients with LC with nonselective b-adrenergic blockers using the method of CYP2D6 genotyping. Carriage of polymorphic markers T1707del, C100T, G2988A and A2549del gene CYP2D6 does not affect the effectiveness of propranolol therapy in patients with LC.

Terapevticheskii arkhiv. 2022;94(2):200-208
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The role of the main risk factors and endocrine cells of the antrum of the stomach producing motilin in the occurrence of cholelithiasis

Svistunov A.A., Osadchuk M.A., Mironova E.D., Guliaev P.V., Vasileva I.N.


Aim. To establish the role of the main risk factors and endocrine cells of the antrum of the stomach producing motilin (M-cells) in the occurrence of cholelithiasis.

Materials and methods. The first group included 122 patients with cholelithiasis. The second group consisted of 30 healthy individuals who underwent medical examination. The groups were matched for gender and age. The work analyzed anamnestic, biochemical and anthropometric data. All patients underwent esophagogastroduodenoscopy with targeted biopsy of the mucous membrane from the antrum. Biopsies were subjected to cytological and immunohistochemical studies in order to verify Helicobacter pylori and estimate the number of M-cells.

Results. Patients with cholelithiasis more often belonged to the group of people of mental labor, had low physical activity, were committed to inappropriate nutrition and more often indicated the presence of aggravated heredity for cholelithiasis. Patients with gallstone disease had higher body mass index, waist volume, total cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, lower high-density lipoprotein cholesterol, H. pylori infection was more often verified and M-cell hypoplasia in the mucous membrane was established. stomach in comparison with the representatives of the second group.

Conclusion. Our results suggest that certain external factors, nutritional characteristics of the metabolic syndrome components, hypoplasia of M-cells in the gastric mucosa are important factors in the formation of calculi in the gallbladder.

Terapevticheskii arkhiv. 2022;94(2):194-199
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The effectiveness of eradication therapy of the 1st line of Helicobacter pylori infection in patients with type 2 diabetes mellitus

Maev I.V., Mkrtumyan A.M., Bektemirova L.G., Andreev D.N., Dicheva D.T.


Aim. Evaluation of the efficacy and safety of eradication therapy of infection Helicobacter pylori in patients with H. pylori- associated pathology of the upper gastrointestinal tract and concomitant type 2 diabetes mellitus (DM).

Materials and methods. The prospective randomized study involving 180 patients (87 men and 93 women) with H. pylori- associated pathology of the upper gastrointestinal tract was carried out. The patients were divided into four groups of 45 people: 1patients without diabetes who received the classic triple eradication therapy; 2patients with type 2 DM who received the classic triple eradication therapy; 3patients without DM who underwent quadrotherapy with bismuth preparations; 4patients with type 2 DM who underwent quadrotherapy with bismuth preparations. Eradication therapy was carried out for 14 days. Evaluation of the effectiveness of eradication using a breath test was carried out 4 weeks after completion of the course of treatment. Eradication success was assessed separately for ITT and PP analyzes.

Results. The effectiveness of classical triple eradication therapy in patients with concomitant type 2 DM is 64.4% in the ITT group and 69.05% in the PP: quadrotherapy 73.34 and 80.49%, respectively. The effectiveness of first line eradication therapy is higher in patients without DM compared with groups of patients with concomitant type 2 DM: ITT 83.33%, PP 88.23% and ITT 68.89%, PP 74.70%, respectively. The incidence of side effects in patients with type 2 DM: with the use of classical triple therapy 22.23%, quadrotherapy31.12%.

Conclusion. The data of the study of the efficacy and safety of line I eradication therapy make it possible to recommend the four-component therapy based on bismuth for use in clinical practice, especially in patients with DM.

Terapevticheskii arkhiv. 2022;94(2):209-215
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The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities

Maevskaya M.V., Kotovskaya Y.V., Ivashkin V.T., Tkacheva O.N., Troshina E.A., Shestakova M.V., Breder V.V., Geyvandova N.I., Doshchitsin V.L., Dudinskaya E.N., Ershova E.V., Kodzoeva K.B., Komshilova K.A., Korochanskaya N.V., Mayorov A.Y., Mishina E.E., Nadinskaya M.Y., Nikitin I.G., Pogosova N.V., Tarzimanova A.I., Shamkhalova M.S.


The National Consensus was prepared with the participation of the National Medical Association for the Study of the Multimorbidity, Russian Scientific Liver Society, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians, National Society for Preventive Cardiology, Professional Foundation for the Promotion of Medicine – Fund PROFMEDFORUM.

The aim of the multidisciplinary consensus is a detailed analysis of the course of non-alcoholic fatty liver disease (NAFLD) and the main associated conditions. The definition of NAFLD is given, its prevalence is described, methods for diagnosing its components such as steatosis, inflammation and fibrosis are described. The association of NAFLD with a number of cardio-metabolic diseases (arterial hypertension, atherosclerosis, thrombotic complications, type 2 diabetes mellitus, obesity, dyslipidemia, etc.), chronic kidney disease and the risk of developing hepatocellular cancer were analyzed. The review of non-drug methods of treatment of NAFLD and modern opportunities of pharmacotherapy are presented. The possibilities of new molecules in the treatment of NAFLD are considered: agonists of nuclear receptors, antagonists of pro-inflammatory molecules, etc. The positive properties and disadvantages of currently used drugs (vitamin E, thiazolidinediones, etc.) are described. Special attention is paid to the multi-target ursodeoxycholic acid molecule in the complex treatment of NAFLD as a multifactorial disease. Its anti-inflammatory, anti-oxidant and cytoprotective properties, the ability to reduce steatosis – an independent risk factor for the development of cardiovascular pathology, reduce inflammation and hepatic fibrosis through the modulation of autophagy are considered. The ability of ursodeoxycholic acid to influence glucose and lipid homeostasis and to have an anticarcinogenic effect has been demonstrated. The Consensus statement has advanced provisions for practitioners to optimize the diagnosis and treatment of NAFLD and related common pathogenetic links of cardio-metabolic diseases.

Terapevticheskii arkhiv. 2022;94(2):216-253
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Clinical notes

The development of portal hypertension and liver failure on the background of long-term intake of vitamin A in a young woman. Case report

Arisheva O.S., Avdoshina S.V., Goreva L.A., Markova M.A.


The use of over-the-Counter (OTC) pharmaceuticals is a common phenomenon in today's society. We present a case of liver injury associated with long-term OTC use of vitamin A. The young patient took daily up to 15 capsules of a combined preparation for 2 years containing retinol palmitate 55 mg (100,000 IU) + Alpha-Tocopherol acetate 100 mg, the content of vitamin A in which significantly exceeded the recommended daily dose. Gradually, the patient noted the appearance of arthralgia, skin itching, hyperemia of the palms and feet, exfoliation of the skin on the soles, profuse hair loss, cracks in the corners of the mouth and in the area of the earlobes. Patient's condition worsened with the development of signs of liver cirrhosis in the form of portal hypertension (ascites, splenomegaly) and a decrease in the protein-synthetic function of the organ. Chronic viral hepatitis, autoimmune hepatitis, primary biliary cirrhosis, hemochromatosis, Wilson's disease, alcoholic liver disease were exclude. Liver biopsy showed characteristic signs of hypervitaminosis A without fibrosis. A complete regression of symptoms was observe within 8 months after discontinuation of the drug. A toxicity can lead to serious liver injury and should be considere in the differential diagnosis of chronic liver disease. Vitamin A should only be prescribe for medical reasons, for a limited period of time, and under close medical supervision.

Terapevticheskii arkhiv. 2022;94(2):254-258
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COVID-19 as a trigger of autoimmune hepatitis. Case report

Volchkova E.A., Legkova K.S., Topchy T.B.


Over the past two years, the entire medical community has taken up the fight against the new coronavirus infection. At the initial encounter with COVID-19, it seemed that this virus mainly affects the respiratory system. Still, with long-term observation, it turned out that the consequences of this disease can be much more severe and associated with lung damage and thromboembolic complications, and be a trigger for autoimmune diseases. According to the literature, after suffering COVID-19, some patients debuted systemic lupus erythematosus, hemolytic anemia, thrombocytopenia, developed Guillain–Barré syndrome, vasculitis, and multiple sclerosis, and a case of autoimmune hepatitis (AIH) was described in foreign literature. AIH is a fairly rare disease, the prevalence of which in Europe is 16–18 cases per 100 thousand inhabitants, affecting mainly women. It is known that chemicals and drugs (minocycline, diclofenac, methyldopa, infliximab, etanercept), viruses (HAV, HEV, EBV, HCV, CMV), environmental factors can serve as triggers of the autoimmune process in the liver. This article presents two clinical cases of AIH that developed after suffering a new coronavirus infection, which we consider as the initial provoking factor of autoimmune inflammation. Given the rarity of AIH, the description of new triggers is of clinical interest. It may be useful for doctors of different specialties since they faced drug-induced liver damage against the background of antiviral and immunobiological therapy. In the domestic literature, there have not yet been any publications devoted to the debut of AIH in adults after coronavirus infection.

Terapevticheskii arkhiv. 2022;94(2):259-264
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Pancreatic cancer risk: alcoholic and non-alcoholic beverages

Grigor’eva I.N.


This article provides an overview of the metaanalyzes (PubMed, 1995–2019) of alcohol and non-alcoholic (coffee, tea, dairy products) beverage consumption in relation to risk of pancreatic cancer – PC (PubMed, 1995–2019). Increased the PC risk was associated with high alcohol intake. The increased risk for heavy drinking did not explained by residual confounding by history of pancreatitis or tobacco smoking or diabetes. Light-moderate alcohol intake may reduced the PC risk, probably due to the fasting insulin levels decrement, which leads to the diminished the РС risk. The association between alcohol and the PC was stronger in men than in women. Some metaanalyzes demonstrated that a small amount of coffee may reduce PC risk, and a large amount – to increase PC risk. Another meta-analyzes have not confirmed any association between the PC risk and coffee or tea consumption. One meta-analysis revealed a direct association of the PC risk with the dairy products consumption, but most research showed no such connection. Nutrition is considered to be associated with the PC risk, but the degree of risk due to structure of beverages consumption (dose, duration, alcohol, coffee, tea, dairy products pattern) is still not clear.

Terapevticheskii arkhiv. 2022;94(2):265-270
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Correction of intestinal microbial composition disturbances as a potential link in complex therapy of patients with COVID-19

Akhmedov V.A.


The article reflects the potential for correcting intestinal microbiota disorders in the complex therapy of patients with COVID-19. It has been noted that the inclusion of dietary fiber in the diet contributes to protection against disruption of the integrity of the intestinal barrier and may limit bacterial translocation into the systemic circulation. The possibility of using psyllium (Mucofalk) is reflected, the action of which is realized both through its sorption, cytoprotective and anti-inflammatory properties in viral lesions of the gastrointestinal tract, and through stimulation of the own beneficial intestinal microbiota. The paper presents studies of the prospects for the use of probiotics, synbiotics in the complex therapy of patients with COVID-19. Detailed data are provided on the mechanisms of the positive effect of short-chain fatty acid preparations on reducing the severity of the disease in patients with COVID-19. It was noted that taking the drug Zacofalk® leads to a significant increase in its own butyrate-producing microbiota (Faecalibacterium prausnitzii) and suppression of the growth of opportunistic flora with pro-inflammatory activity. The results of a recent study are presented showing that in patients with a mild course of COVID infection with respiratory and intestinal symptoms, the administration of Zakofalk for 30 days (3 tablets per day) led to significantly faster stool normalization (by day 7), persistent normalization of the frequency and consistency of stools by the 21st day and a significantly more pronounced regression of bloating and abdominal pain, as well as a decrease in the risk of developing post-infectious irritable bowel syndrome.

Terapevticheskii arkhiv. 2022;94(2):277-282
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Erosive and ulcerative lesions of the digestive tract: optimization of diagnosis and management tactics

Osadchuk M.A., Osadchuk A.M.


Erosive and ulcerative lesions of the digestive tract are one of the most pressing problems in the clinic of internal diseases due to the extremely widespread prevalence, the presence of severe complications, often fatal, diagnostic difficulties due to the presence of a large number of asymptomatic pathologies and difficulties in the rational choice of therapy. Particularly noteworthy is the data that during the global pandemic of Covid-19 infection, it is capable, quite often, of causing the development of erosive and ulcerative lesions of the gastrointestinal tract. In this regard, it seems important to use drugs that can not only prevent the occurrence of erosive and ulcerative lesions and strictures throughout the gastrointestinal tract, but also effectively achieve epithelialization of injuries to the mucous membrane of the oral cavity, esophagus, stomach, small and large intestine. One of them is Rebamipid-CZ, which has a fairly high safety and efficacy profile. It seems important to consider the issues of optimizing the prevention and treatment of erosive and ulcerative lesions of various parts of the gastrointestinal tract of various etiologies, taking into account the possibility of using rebamipide both as part of complex therapy and in isolation.

Terapevticheskii arkhiv. 2022;94(2):271-276
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History of medicine

The history of the discovery of the Helicobacter pylori

Bordin D.S., Shengelia M.I., Ivanova V.A., Voynovan I.N.


Helicobacter pylori is a spiral-shaped gram-negative bacterium that colonizes the stomach lining. The presence of a microorganism in humans was described more than a century ago, but from detection to recognition of its role in the etiology and pathogenesis of diseases of the stomach, researchers had to overcome a long path of criticism and mistrust. Coiled bacteria have been mentioned several times in the medical literature, but these bacteria were thought to be contaminants, and any evidence of the bacteria in the stomach was ignored by the medical community. The discovery of H. pylori led to a revolutionary rethinking of the mechanisms of development of a number of diseases: the role of bacteria in the development of chronic gastritis, peptic ulcer disease, stomach cancer and MALT lymphoma was proved. The principles of their prevention and treatment have changed. For this discovery in 2005, Barry Marshall and Robin Warren were awarded the Nobel Prize in Medicine and Physiology.

Terapevticheskii arkhiv. 2022;94(2):283-288
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