[Fecal calprotectin as a biomarker effectiveness of various interventions in patients with inflammatory bowel disease].

Among the chronic diseases of the gastrointestinal tract of the special place occupied by inflammatory bowel disease (IBD), in which the lining of the intestine produces a significant number of neutrophils, which has prompted researchers and clinicians use a protein derived from neutrophils as a biomarker for the assessment of the intestinal wall and the effectiveness of treatment in patients IBD. One of these proteins is calprotectin (CP), which can be considered as a biomarker of activation, destruction and loss of neutrophil cells, to a lesser extent-- the activated monocytes and macrophages. Various studies have shown that the concentration of fecal calprotectin (FCP) correlates well with endoscopic and histological parameters of intestinal inflammation. Test the FCP can be used in healthy first-degree relatives of patients with IBD to assess the possible presence of subclinical variant of intestinal inflammation in this population. Thus, a simple test of the FCP can reduce the needs of various expensive and invasive method, including costs associated with them, especially in younger patients, where in terms of differential diagnosis of IBD is often not included neoplasia of the intestine. FCP is a non-invasive, inexpensive and at the same time, highly sensitive and specific biomarker that can be used successfully in the diagnosis, evaluation of the efficacy of treatment and predicting recurrence.

[Gastroenterologist diagnosting left atrial myxoma in patient with gastroesophageal reflux disease].

The authors presents the clinical case of the left atrial myxoma diagnosed by gastroenterologist in patient with gastroesophageal reflux disease.

[Pharmacoeconomic analysis of treatment of certain diseases of the digestive system].

The article provides data of the pharmacoeconomic analysis (cost/effectiveness) of treatment of peptic ulcer, ulcerative colitis, Crohn's disease, gastroesophageal reflux disease, biliary sludge and cholelithiasis. It was shown that the most appropriate treatment scheme is one that characterized by lower costs per unit of effectiveness. Analysis of cost/effectiveness can give an economic assessment of clinical efficacy, compare alternative treatments and help to choose the method by which the efficiency increases faster than the level of costs.

[Selection of "surrogate" and "endpoints" evaluation of the efficacy of medical interventions].

With the advent of new medical technologies and medicines, as well as due to changes in disease patterns and demographic problems rises the need for continued increases in health spending. Increased costs can be totally inadequate, if it has been done without studying the effectiveness of medical interventions, based on the results of evidence-based medicine and economic of their feasibility. To evaluate the clinical effectiveness of medical interventions have been recently used specific criteria, so called points of clinical efficacy (surrogate and endpoints), that allow to conclude feasibility or harmfulness of the introduction or application of the intervention in clinical practice. The endpoint is reliable indicator the effectiveness of medical intervention. Surrogate point--is a biomarker that is intended to replace the endpoint and is a predictor of the effectiveness of medical intervention. The use of surrogate points has several advantages such as simple in identification and measurement, as well as more higher in compare with endpoints the vents frequency, that can significantly reduce the size of the selection and duration and cost of clinical trials, respectively. Finally, the surrogate points allow to evaluate treatment effect in situations where the use of endpoints is difficult or is unethical.

[Pharmacoeconomic benefits of patients with ulcerative colitis treatment with help of mesenchymal stem cells].

UNLABELLED: The aim of the study was to develop economically motivated decision to use MSSK therapy in patients with colitis (UC). In accordance with the intended purpose it was necessary to determine the effect of MSSK transplantation on clinical and morphological characteristics of the UC, and evaluate the safety and cost-effectiveness of this therapy for the patient. MATERIAL AND METHODS: The study included 39 patients with ulcerative colitis--UC (1 group). In the comparison group (2 nd group) were included 30 patients with UC. For 2-3 days prior to the MSSK induction was terminated immunosuppressants, was reduced the dose of corticosteroids to 15-20 mg/and day dose of aminosalicylate was left at the level of 2.0 g/day. To quantify the results were used the average values of indices of Rachmilevitz clinical activity, Mayo and Geb's scales. Monitoring of patients continued to terms ranging from 4 to 8 months. Bone marrow cells were obtained from the sternum or the iliac crest donor. Cultivation was carried out for 5-6 weeks, than we received an allogeneic MSSK donor population in the number (1,5-2) x 108 cells needed for patient transplant. The culture of MSCs were injected in the drip i.v. at once. Clinical activity was assessed UC scored using an Rachmilevitz index. Endoscopic picture of UC was assessed with help of a Mayo scale. Assessment of histological UC preparations was conducted on a Geb's scale. Was conducted pharmacoeconomic analysis (direct costs and cost-effectiveness) of the MSSK-therapy of patients with UC that were compared with standard therapy. CONCLUSION: Most adult patients with UC are economically active population. Average cost (direct costs) of standard and MSSK-therapy patients with UC in the hospital (direct costs) amounted to 26645,9 +/- 1776,1 and 35395 +/- 6532,1 rubles, respectively. Patients with UC after applying MSSK noted a statistically significant reduce of clinical and morphological indices of inflammatory process activity and decrease in frequency of relapses compared to standard therapy. This was accompanied by a decline in demand for glucocorticosteroid and others LP and contributed to additional savings of treatment costs. Transplantation MSSK can be evaluated as a new strategic direction in the therapy of IBD is very relevant, at least in Russia.