[TYPICAL ERRORS IN THERAPY OF GASTROESOPHAGEAL REFLUX DISEASE].

Aim: To analyze compliance of doctors with the clinical guidelines for the management of patients with gastroesophageal reflux disease (GERD) under outpatient clinic conditions. Material and methods: An anonymous questionnaire study involving 104 general practitioners was undertaken. The questionnaires included items concerning lifestyle modifications, the use of proton pump inhibitors (PPI), dosage and time of their administration, combined therapy and endoscopic control. Results: The analysis of the filled questionnaires demonstrated that 15,6% of the doctors always discuss the necessity changing lifestyle with GERD patients, 75% of the doctors discuss it but occasionally, and 9,4% never hold such discussions. 56,7% of the doctors begin treatment from double doses of proton pump inhibitors regardless of the endoscopic stage of esophagus damage. The mode of PPI administration is at variance with that recommended by the instruction in 61,5% of the cases. The basic course of erosive esophagitis treatment lasts 4, 2, and 8 weeks in 45,2%, 9,6%, and 45,2% of the cases. Treatment of GERD starts from combined therapy in 14,4% of the cases. Monotherapy with PPI is inefficient in 85,6% of the cases. Endoscopic control of erosive esophagitis is practiced by 51,9% of the doctors, 48,1% of the respondents recommend this diagnostic procedure only in the absence of clinical effect. Conclusion: Our analysis revealed typical mistakes in the treatment of patients with GERD, demonstrated the importance of expert control and support of training physicians, and introduction of modern quality standards into the practical management of patients with this pathology.

[Role of enteral nutrition in correction of protein-energy metabolism and quality of life indices in liver cirrhosis of viral etiology].

UNLABELLED: The aim of this work is to improve the efficiency of treatment and life quality of patients with HCV hepatic cirrhosis (HC) Class C by means of correction of protein-energy insufficiency (PEI) using enteral nutritive mixtures with branched-chain amino acids (BCAA). OBJECT AND METHODS OF RESEARCH: A randomized prospective controlled open research of the efficiency of therapy with enteral nutritive mixtures with BCAA for patients with HCV hepatic cirrhosis Class C (score: 10-12) was conducted. It evaluated life quality of the patients (by questionnaire SF-36), the degree of hepatic encephalopathy (by number connection test) as well as the protein-energy insufficiency indexes (weight index, arm muscles circumference, skin-fat fold for triceps and albumin). RESULTS: Nutritive support with BCAA prevents progression of protein-energy insufficiency, improves functionality class of patients with HCV hepatic cirrhosis Class C and reduces severity of hepatic encephalopathy, p < 0.003. Enteral nutrition with BCAA improves life quality of patients with HCV hepatic cirrhosis Class C, p < 0.012. CONCLUSION: Enteral nutrition with BCAA for patients with HCV hepatic cirrhosis Class C (score: 10-12) improves treatment efficiency and is safe.

[Effectiveness of nutritional support for the liver-cell deficiency in the liver cirrhosis].

THE AIM: To study the efficiency of enteral nutritional support and its impact on clinical-laboratorial markers of hepatocellular failure of the patients with Child-Pue's hepatic cirrhosis type B suffering from trafologic impairment. MATERIAL AND RESEARCH METHODS: 61 patients with Child-Pue's hepatic cirrhosis type B suffering from trafologic impairment took part in the randomized prospective study. The control group (31 patients) got the conventional treatment with lactulose, beta-blocker, spironolactone on the basis of 1.2 g/kg protein weight and 30 kcal/kg body weight per day. There were 30 patients in the second group (the principal one) and in addition to conventional treatment they got the multisubstrate nutritional cocktail of dietary fibers on the basis of 0.3 g/kg protein weight, 7.5 g fibers per day and 10 kcal/kg body weight during 30 days. To evaluate the efficiency of the treatment we analyzed the clinical presentation and the intensity of blood cholinesterase. The stage of hepatic encephalopathy was defined with the affinity numbers test of Retainer. The parameters under study were checked before the treatment, 30 days and 60 days later after the treatment began. RESULTS: It was found out during the prospective randomized study that the patients under nutritional support showed the positive clinical dynamics (asthenia and hepatic encephalopathy retrogression and the accurate increase of blood cholinesterase from 4365.4 +/- 1028.6 ME up to 5502.7 +/- 1142.6 ME (p < 0.05). CONCLUSION: Nutritional support of the patients with Child-Pue's hepatic cirrhosis type B suffering from trafologic impairment is effective and has an accurate impact upon clinical-laboratorial markers of hepatocellular failure.