Vol 97, No 8 (2025): Treatment issues

Over the past decades, acid production in the stomach has been regulated mainly by proton pump inhibitors (PPIs). However, despite their widespread use and solid evidence base for efficacy, PPIs have pharmacokinetic and pharmacodynamic limitations, such as a slow onset of action, response variability (dependent on CYP2C19 polymorphisms), and the need for activation in an acidic environment. These restrictions underscore the need for innovative molecular approaches to inhibiting acid production, which led to the development of a fundamentally different mechanism of action – potassium-competitive acid blockers (P-CABs), first introduced into clinical practice in 2015. The mechanism of action of P-CABs is based on a reversible ionic interaction with hydrogen potassium adenosine triphosphatase (H⁺/K⁺ ATPase) in parietal cells of the stomach. Direct inhibition of the active enzyme enables more rapid and sustained control of gastric secretion, including nocturnal and postprandial acid production, making this class of drugs particularly relevant in the treatment of gastroesophageal reflux disease, peptic ulcers, and in the eradication of Helicobacter pylori. Recent meta-analyses demonstrate the clinical benefits of P-CABs over PPIs for these indications.

Aim. To evaluate the clinical and prognostic significance of atrial functional mitral regurgitation (AFMR) in patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) on the background of optimal drug therapy.

Materials and methods. The retrospective study included 150 patients (age 75.5 ± 9.9 years, 54% men) with HFpEF with AF and AFMR on the background of optimal drug therapy. Clinical and demographic characteristics (including the scale of assessment of the clinical condition), laboratory and instrumental diagnostic results, and drug therapy were evaluated. MR was assessed as minor, moderate, or severe using a multiparametric approach, including an assessment of the effective area of the regurgitation hole and the MR fraction. The effect of AFMR on rehospitalization for HF, combined endpoint (CE) was studied [cardiovascular death (CVD) and rehospitalization] during the follow-up period of 589 (217–1039) days.

Results. Eighty (53.3%) patients had moderate AFMR, and 23 (15.3%) had severe AFMR. These patients had lower SBP and DBP values (p = 0.014), and permanent AF was more common among them (p = 0.025) compared with patients with minor MR. Independent predictors of moderate/severe AFMR were the constant form of AF (OR 3.3 [1.4–8.0]; p = 0.007), end-systolic left ventricular distance (OR 3.0 [1.4–6.5]; p = 0.006), taking antiplatelet agents (OR 0.11 [0.02–0.70]; p = 0.020). The frequency of outcomes in the general group was 46.7% for CE, 34.0% for rehospitalization for HF, and 14.0% for CVD. The predictors of CE were moderate/severe FMR (HR 2.6 [1.4–4.9]; p = 0.002), scores on the scale of assessment of the clinical condition (HR 1.14 [1.04–1.25]; p = 0.003); severe FMR (HR 4.1 [1.7–10.2]; p = 0.002), moderate FMR (HR 2.7 [1.2–5.8]; p = 0.013), creatinine level (HR 0.990 [0.980–1,000]; p = 0.040).

Conclusion. Despite the limitations, the importance of AFMR as a factor influencing clinical outcomes in patients with HFpEF and AF has been demonstrated. The present study highlights the need for further investigation of this condition and the development of personalized patient management strategies.

Aim. To optimize the algorithm of diagnosis and treatment of patients with gastroesophageal reflux disease (GERD) with comorbid obesity based on a comprehensive analysis of the clinical and functional characteristics of the disease.

Materials and methods. The study included 150 patients who underwent esophagogastroduodenoscopy, 24-hour pH-measurement or 24-hour pH-impedancometry of the esophagus. A stratification was carried out basing on the presence of typical GERD complaints and body mass index (BMI). Group 1 consisted of 30 patients with GERD and normal body weight; group 2 – 60 patients with GERD who were overweight or obese; group 3 – 30 patients without GERD, but overweight or obese; control group – 30 people with normal body weight without GERD, but with similar complaints due to functional disorders of the esophagus.

Results. When comparing esophageal pH-impedancometry data, it was found that the volume clearance time did not differ between the groups of patients with normal body weight and overweight, but in obese people reflux with pH > 7 was recorded more often and for a longer time. The duration of chemical clearance (DCC) was increased in both groups, however, with overweight (BMI > 25 kg/m²), DCC was shorter, and with obesity (BMI > 30 kg/m²), it was longer than in people with normal body weight. At the same time, as body weight increases, the frequency of mixed (gastric and duodenal) reflux also rises up.

Conclusion. A comprehensive analysis of the characteristics of refluxate allows us to assess the course of the disease in more details, make assumptions about a unique combination of aggression factors for each patient, determine the severity of damage to the mucous membrane of the esophagus and, thanks to this, optimize approaches to therapy.

Aim. To evaluate the possibility of using serum markers of atrophy (pepsinogens – PG I and II) to form high-risk groups for gastric cancer (Operative Link for Gastritis Assessment – OLGA stage III–IV) depending on the etiology of gastritis.

Materials and methods. A total of 237 (56 men and 181 women) patients were examined. All patients underwent a ¹³C-urea breath test, a blood test for GastroPanel (PG I, PG II, gastrin-17, antibodies to Helicobacter pylori immunoglobulin G), a blood test for antibodies to gastric parietal cells. All patients underwent esophagogastroduodenoscopy with a biopsy of the gastric mucosa from 5 standard points according to the Sydney system and a histomorphological study according to the OLGA system, as well as a biopsy to detect H. pylori infection using the polymerase chain reaction. The patients were divided into 3 groups depending on the etiology of gastritis: Group 1 included 55 patients with chronic gastritis, autoimmune gastritis and associated with H. pylori gastritis (AIG+HP+); Group 2 – 47 patients with AIG and negative tests for H. pylori infection (AIG+HP-); Group 3 – 135 patients with chronic gastritis associated with H. pylori and negative markers of AIG (AIG-HP+).

Results. The analysis showed that in patients with AIG (group 2), the most reliable serological markers of atrophy predicted severe atrophy (OLGA stage III–IV): when the ratio PG I/PG II was ≤ 3, it was detected in 70.21% of cases, and when PG I decreased to ≤ 30 μg/L, it was found in 68.08%. In group 1, stages III–IV according to OLGA were diagnosed in 20% of cases with PG I/PG II indicators ≤ 3; and in 18.18% with a decrease in PG I ≤ 30 μg/L. When analyzing the diagnostic accuracy of GastroPanel biomarkers in identifying severe atrophy (OLGA stages III–IV) in the total sample of patients (all 3 groups), it was possible to achieve cut-off indicators as close as possible to the reference values while maintaining a relatively high sensitivity and specificity – 75.81% and 81.50% for PG I ≤ 30 μg/L and 85.48% and 64.50% for PG I/PG II ≤ 3, respectively. The optimal cut-off in the study population for the PG I indicator was < 22.5 μg/L (sensitivity – 72.58%, specificity – 88.00%), and for the PG I/PG II ratio ≤ 2 (sensitivity – 80.65%, specificity – 78.50%).

Conclusion. Serum pepsinogens can be used in the Moscow population as a non-invasive marker of gastric mucosa atrophy for the formation of high-risk patient groups for gastric cancer requiring endoscopic examination.

Aim. Identification the characteristics of fatty acids (FAs) in erythrocyte membranes and in blood serum, as well as the electrical and viscoelastic parameters of erythrocytes to assess their ability to be predictors of an unfavorable outcome in patients with colorectal cancer (CRC).

Materials and methods. 112 people with an average age of 63.1 ± 9.5 years (62 men, 50 women) with CRC of stages I–IV were examined. The patients were divided into 2 groups depending on the outcome of the disease after 6 years of follow-up: group 1 – with stabilization of the disease (n = 55), group 2 (n = 57) – with an unfavorable outcome. The FA composition of erythrocyte membranes and blood serum was studied using gas chromatography/mass spectrometry, a system based on three Agilent 7000B quadrupoles (USA). The electrical and viscoelastic parameters of erythrocytes were studied using the method of dielectrophoresis.

Results. An unfavorable outcome in patients with CRC is associated with elevated levels of docosapentaenoic acid (C22:5n-3) (p = 0.0003), docosahexaenoic acid (C22:6n-3) (p = 0.001), docosathetraenoic acid (C22:4n-6) (p = 0.004), and total omega-3 polyunsaturated fatty acids (PUFA) (p = 0.0004) in erythrocyte membranes, eicosadienoic acid (C20:2 n-6) in erythrocyte membranes (p = 0.03) and blood serum (p = 0.01), and, conversely, reduced levels of ratios saturated fatty acids (SFA)/PUFA (p = 0.004), SFA / unsaturated fatty acids (USFA) (p = 0.01) and concentrations of myristic FA (C14:0) (p = 0.03) in erythrocyte membranes, as well as with a number of changes in electrical, viscoelastic parameters of red blood cells: with increased hemolysis of red blood cells at high frequencies (10⁶ Hz – p = 0.0006 and 5 × 10⁵ Hz – p = 0.046), increased aggregation indices at low frequencies (10⁵ Hz – p = 0.04 and 5 × 10⁴ Hz – p = 0.047), as well as a shift in the crossover frequency to the high frequency range (p = 0.036). In patients with stages 1–2 of CRC, omega-6 PUFAs, eicosadienoic acid C20:2n-6 (p = 0.006), docosatetraenoic acid C22:4n-6 (p = 0.012), were of the greatest importance for differentiating disease outcomes, while total content omega-3 PUFAs in erythrocyte membranes (p = 0.0129), docosahexaenoic acid C22:6 n-3 (p = 0.0169), total content (C20:5n-3+C22:6n-3) in erythrocyte membranes (p = 0.0198), docosapentaenoic acid C22:5 n-3 (p = 0.022) were slightly less important. As in the general group of patients with CRC, the degree of hemolysis at a frequency of 10⁶ Hz was a predictor of an unfavorable outcome in people with early stages of the oncological process. ROC analysis revealed a high potential of palmitic acid in erythrocyte membranes to predict an unfavorable CRC outcome (AUC 0.786, 95% confidence interval 0.638–0.901, sensitivity 84.4%, specificity 68.2%). The diagnostic model, which included five parameters – erythrocyte levels C16:0, ratio SFA/PUFA, total USFA, total PUFA, and serum levels C20:2n-6, had an AUC of 0.663 (95% confidence interval 0.483–0.801) with the highest sensitivity of 85.2%, but not high specificity of 60.1% for predicting an unfavorable outcome in CRC.

Conclusion. Fatty acids of erythrocyte membranes, blood serum, electrical, and viscoelastic parameters of erythrocytes should be considered as promising biomarker predictors in patients with CRC that require further study.

Aim. The aim of this study was to identify the prevalence of steatosis degrees and stages of liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD) in connection with the presence of carbohydrate metabolism disorders, such as prediabetes and type 2 diabetes mellitus (DM).

Materials and methods. Retrospective database search (4101 records) was performed. Vibration-controlled transient liver elastography with controlled attenuation parameter module was used for the assessment of liver steatosis and fibrosis. Based on the presence of carbohydrate metabolism disorders, subjects with MASLD were allocated to one of the following groups: MASLD without prediabetes or DM (group 1), MASLD with prediabetes (group 2) and MASLD with DM (group 3).

Results. Proportion of patients with severe liver steatosis (S3) was lowest in the group 1 (61.9%), while no difference was found between groups 2 and 3 (74.3% vs 76.7%; p = 0.5). Moderate-to-severe liver fibrosis (stages F2–F4) was less widespread in the group 1 (24.1%); significant difference by this parameter was also revealed between groups 2 and 3 (34.0% vs 45.4%; p = 0.004). Proportion of patients with metabolic dysfunction-associated steatohepatitis was similar in groups 2 and 3 (33.9% vs 35.4%; p = 0.7), but was lower in the group 1 (26.7% vs 33.9% and 35.4%; p = 0.02 and p < 0.001, respectively).

Conclusion. Carbohydrate metabolism disorders are closely associated with progressive steatosis and liver fibrosis in patients with MASLD. No differences in the severity of liver steatosis was found between groups with prediabetes and T2DM, however, in T2DM, the prevalence of advanced/severe liver fibrosis was highest among all studied groups.

Aim. To study the ability and significance of detecting liver steatosis during chest computed tomography (CT) in patients with viral pneumonia.

Materials and methods. A prospective cohort study included 100 patients over the age of 18 who were hospitalized with an established diagnosis of viral pneumonia. To CT detection significant liver steatosis (more than 33%), several approaches were used: liver density less than 40 HU; decrease in liver density by at least 10 HU less than the spleen; the ratio of decrease in liver density to the spleen is less than 0.9.

Results. According to CT data 2 groups were identified: 25 patients with existing liver steatosis and metabolically associated fatty liver disease, and 74 patients of the control group without signs of significant steatosis, оne patient was excluded due to alcohol abuse. There was a significant difference in the study of liver density (31.68 ± 10.67 and 54.44 ± 5.95; p < 0.001), the ratio of decrease in liver density to spleen density (0.66 ± 0.22 and 1.16 ± 0.13; p < 0.001), as well as a decrease in liver density relative to the spleen (16.30 ± 10.38 and -7.26 ± 6.10; p < 0.001). In the steatosis group, a more severe course of pneumonia was noted (p = 0.041). The incidence of deterioration according to CT was comparable in both groups: 19 (76%) and 45 (60.8%); p = 0.169, although its severity was higher in the group with steatosis (p = 0.012). Patients from the steatosis group were significantly more often prescribed biological (88.0 and 39.19%; p < 0.001) and antibacterial therapy (68.0 and 40.54%; p = 0.017).

Conclusion. The use of assessment of liver steatosis according to CT data simultaneously with the study of the underlying disease can become an important diagnostic step determining the prognosis of the course of the disease, as well as a tool for risk stratification in patients with metabolically associated fatty liver disease.

Idiopathic recurrent pericarditis is a rare pathology characterised by recurrent inflammation in the cardiac cavity. Treatment of recurrent pericarditis is empirical and based on the use of drugs with anti-inflammatory properties. First-line drugs are non-steroidal anti-inflammatory drugs and colchicine, second-line drugs are glucocorticosteroids. This is associated with the development of undesirable side effects, which makes it impossible to continue therapy in a number of patients. This article presents two clinical cases, describes the course of the disease and the development of complications at different stages. This article demonstrates the complexity of selecting the optimal therapy in real clinical practice.

Idiopathic recurrent pericarditis is a rare pathology characterised by recurrent inflammation in the cardiac cavity. Treatment of recurrent pericarditis is The possibilities of using food products based on vegetable protein to correct nutritional patterns in alimentary-dependent diseases (ADDs) of the digestive system have not been sufficiently studied. The purpose of the review is to analyze the literature data to determine the possibilities of using vegetable protein products to correct nutritional patterns in the most common ADDs of the digestive system. We searched the PubMed/MEDLINE, EMBASE, Google Scholar, CyberLeninka, and Elibrary databases with keywords corresponding to the study goals. There were 314 studies identified; however, after excluding duplicate publications and analyzing relevant data, 66 papers were included. The analysis results showed a possible benefit from using vegetable protein, which may be of clinical importance in diseases such as metabolically associated fatty liver disease, gastroesophageal reflux disease, and irritable bowel syndrome. Data on the adequacy of diets with vegetable protein and possible adverse events during their use are presented. The technological and economic prospects of using products based on vegetable proteins to correct nutritional patterns in patients with ADDs of the digestive system are addressed.

The article highlights the main events, discoveries and principles of organizing medical care at the front and in the rear during the Great Patriotic War of 1941–1945. The main aspects of the battlefield medical doctrine, the system of stepwise casualty care, the complex of anti-epidemic measures, the care of motherhood and childhood, the role of outstanding scientists and health care organizers in the victory over fascism are considered.