[Eradication therapy for Helicobacter pylori infection: review of world trends].

The literature review gives current views on the treatment of Helicobacter pylori infection. The rising antibiotic resistance of H. pylori in the first decade of the 21st century entailed the decreased efficiency of common eradication therapy (ET) regimens, by determining the higher interest in this problem. The paper summarizes data on the efficiency of current ET regimens in different regions of the world in the past 3 years. The prospects of alternative ET regimens are considered. The existing and promising ways of optimizing the current ET regimens are presented.

[Gastric sarcoidosis].

Sarcoidosis is a multisystemic disease of unknown etiology characterized by formation of non-caseificating epithelioid cell granulomas in affected organs. The clinically manifest involvement of the gastrointestinal tract (GIT) in the pathological process is documented in less than 1% of the patients, with stomach being involved in 10% ofthe cases. Pancreatic sarcoidosis is a very rare occurrence. Gastric sarcoidosis (GS) is usually an isolated disease but may be just as well a component of a generalized process. Isolated GS is as a rule a latent condition, its clinical symptoms (epigastric pain, nausea, vomiting) develop in association with erosion and ulceration of gastric mucosa. An endoscopic study of upper GIT may reveal narrowing of the distal half of the stomach with pre-pyloric ulcers or erosion and atrophy; thickened gastric folds may show up diffuse manifestations in the form of a "cobblestone pavement". The leading role in GS diagnostics is played by a histological study of gastric biopsies demonstrating classical sarcoid non-caseificating epithelioid cell granulomas. Treatment of GS must include intake of glucocorticoids and proton pump inhibitors.

[Overview of international recommendations on approaches a view of a physician and surgeon].

In different countries a set of recommendations for the diagnostics and treatment of chronic pancreatitis (CP) have been published, but to date a unified systematic management has not been developed yet. Because CP is within the interests of physicians of various specialties: surgeons, gastroenterologists, endoscopists and others, approaches to the most effective treatment--conservative therapy, endoscopic or surgical treatment--should be determined on an equal footing on the basis of well-known and well-conducted trials at the minimization of possible interpretations of the terms and tactics. In most cases there is a need for a comprehensive approach, which allows to achieve the main tasks: to cut pain short, maintain the function of the gland and/or compensate for pancreatic insufficiency, eliminate or prevent the development of complications, using a combination of the most effective methods of treatment. The opinion of all involved in the fate of particular patient specialists in the absence of common international standards, must be based on the results of the research evidence. The purpose of this review is to analyze the scientific studies in this field with a focus on existing practical guide of pancreatilogical associations of different countries of the world. Formulated during the analysis, the conclusions and provisions on the basis of strict methodological approach can be useful for Russian gastroenterologists, surgeons and general practitioners.

[Current recommendations for the diagnosis of chronic pancreatitis in general clinical practice].

The paper gives practical recommendations based on the provisions of a number of foreign national guidelines for the diagnosis of chronic pancreatitis (CP). There is virtually no evidence for Class I database for its diagnosis. Despite an inadequate scientific rationale, the review of these international guidelines has brought together the basic available data in the context of the current global standards for the diagnosis of CP.

[Difficulties and errors in the management tactics of patients with chronic pancreatitis].

The paper deals with the difficulties and errors that are most commonly used in clinical practice to manage patients with chronic pancreatitis (CP). The higher interest in CP is inspired by the wide prevalence of this disease with its constant upward trend. At the same time, a variety of the etiological forms of CP, from generically determined to infectious and autoimmune ones, in combination with a weak theoretical basis in a number of practitioners gives rise to a broad spectrum of tactical errors in the management of patients with CP. The paper summarizes and analyzes the most common defects and errors in the management tactics of patients with this nosological entity, including the aspects of diagnosis and medical treatment. Ways to solve the set optimization problems in management protocols for patients with CP are proposed in the context of evidence-based medicine.

[Pancreatic secretory trypsin inhibitor gene N34S mutation in patients with idiopathic chronic pancreatitis].

PURPOSE: To determine the frequency and prognostic significance of mutation N34S in the development of CP in a mixed Russian population. METHODS: The study included 83 patients with idiopathic CP and 103 healthy individuals. The diagnosis of CP was based on clinical and instrumental data in accordance with the criteria of M-ANNHEIM. Everyone involved in this study using PCR followed by restriction analysis performed the N34S mutation analysis in the gene for the ICU. RESULTS: N34S mutation was detected in 12 patients with CP and in 3 of the control group, which accounted for 14.6 and 2.9% respectively; p<0,05. The odds ratio (OR) of idiopathic CP in the presence of mutation N34S was 4.62 (95% confidence interval (CI): 1,21-18,37). The difference in frequency of homozygotes the mutant allele was statistically significant: 10.97 and 0.97% in the main and control groups, respectively; p<0,05. The presence of mutations did not affect the frequency and severity of functional disorders of the pancreas, but the mutation N34S was statistically significantly more common in patients with calcifying pancreatitis (p<0,01) and the presence of pseudocysts (p<0,05). OR the development of calcification in patients with the presence of N345 was 13.44 (95% CI: 6,29-23,78). CONCLUSION: These data suggest that the mutation N34S plays a significant role in the development of CP in the Russian population and can detect more than 10% of cases of idiopathic CP.

[Effect of pancreatic secretory trypsin gene mutations on the development of chronic pancreatitis].

For the first time the relationship between mutations in the pancreatic secretory trypsin inhibitor (SPINK1) in humans and the development of chronic pancreatitis was established in 2000. By mid 2011 the number of studies on the influence of SPINK1 gene mutations on the development of pancreatitis exceeds 250, the results vary greatly. According to modern concepts, mutations in SPINK1 gene are associated with the development of both acute and chronic pancreatitis, and are defined in all etiological forms. Literature review shows the data of the most significant studies about the role of SPINK1 gene mutations in pancreatic diseases.

[Assessment of gastrointestinal toxicity at patients with breast cancer receiving Taksans chemotherapy and doxorubicin].

UNLABELLED: The aim--assessment of gastrointestinal toxicity frequency of damaged mucosa of the colon. Type of study. A retrospective multicenter case-control study on the model of neoadjuvant and adjuvant chemotherapy for breast cancer. MATERIALS AND METHODS: Over the period 1993-2003 gg. were surveyed 1643 women (average age 52.3 +/- 2.8 years). RESULTS: It was revealed that the frequency of acute inflammatory and destructive changes in the mucous membrane of the colon in the course of chemotherapy was 13.6%. Frequency of sharp changes in the mucosa of the colon recording was increased almost in 10 times the rate of neoadjuvant to adjuvant that may be related to the cumulative effect of cytostatics. Revealed a higher incidence of toxicity in patients with a history of functional pathology of the intestine, which reached 22.7%. In these patients, the trigger mechanism of toxicity was the beginning of chemotherapy, and no increase in cumulative dose. All patients with inflammatory bowel disease had reported clinical signs of relapse during treatment. Noted a direct correlation between the severity of diarrhea and the severity of rectal (colitis). CONCLUSION: Damage to mucous membrane of the colon occurs often, growing over time (from course to course), to a greater extent in patients with diarrheal syndrome.

[Problems and prospects of non-invasive screening for colorectal cancer].

High prevalence of colorectal cancer makes it a most serious socio-medical problem. Hence, the necessity of overall screening for prodromal changes and malignant neoplasms at the early stages of the disease. Despite a variety of efficacious instrumental diagnostic tools, the development of non-invasive screening techniques based on recent progress in understanding molecular mechanisms of carcinogenesis remains a highly topical issue. A pathogenetic model of colorectal cancer and pathophysiological basis of screening for colonic neoplasms are considered with the emphasis on the detection of tumour cells in faeces and their DNA carrying mutations in suppressor genes and oncogenes. Results of the studies with the use of one or several DNA oncomarkers are analysed in the context of their value for the diagnosis of colorectal neoplasms. High sensitivity and specificity of these methods make them very promising for application to the screening for colorectal cancer.

[Experience with the use of 13C-breath test for the evaluation of the efficacy of enzyme substitution therapy with microencapsulated pancreatinin in patients with severe primary pancreatic insufficiency].

The aim of the study was to evaluate efficiency of creon substitution therapy of severe primary pancreatic insufficiency in the 13C-breath test. It included 32 patients (mean age 48.2 +/- 6.8 yr) with chronic pancreatitis and severe primary exocrine insufficiency. The patients ingested naturally enriched 13C-maize starch and creon (25000 U) before breakfast. Samples of exhaled air were taken before and every 30 min for 4 hours after intake (total: 9). Creon metabolic rate and capacity were measured. Creon accumulation (in %) was assessed by statistical analysis. It significantly decreased in patients with exocrine pancreatic insufficiency suggesting close relationship between clinical symptoms and results of the breath test. Symptom severity score positively correlated with dose accumulation. Only 8 patients showed satisfactory results of the breath test indicative of acceptable outcome of substitution therapy. 75% of the patients proved to receive inadequate treatment. Therefore, they were prescribed a 25 or 50% higher creon dose and the test was repeated. It revealed a dose-dependent rise in the accumulated dose compared with initial values. It is concluded that the lack of clinical markers of exocrine pancreatic insufficiency can not be regarded as a criterion for the efficiency of substitution enzyme therapy.

[Pancreatitis in pregnant women].

Regardless of the fact, that pancreatitis during pregnancy is rare; this disease is characterized by high indices of maternal and perinatal mortality. Among variety of etiological and pathogenetic aspects of pregnant women's acute pancreatitis, leading role in its development belongs to bile-excreting system diseases, conditioned by physiological processes in women's organism during gestational period. Also there is a genetic theory of acute pancreatitis genesis in pregnant women, based on dislipoproteinemia development caused by lipoprotein lipase insufficiency, when severity of pancreatitis course is correlated with morphotype of this enzyme gene mutation. Chronic pancreatitis is conditioned by the same causes and can develop and recur during pregnancy and right after parturition. Diagnostics of pregnant women's pancreatitis is complicated because of limitation of the use of some methods (radiation and endoscopic). Pancreatitis clinical course does not differ from the one in nonpregnant women and is manifested by pain abdominal and dyspeptic syndromes, and also by syndromes of exocrine and endocrine pancreatic insufficiency. The main clinical feature of pregnant women's pancreatitis is high occurrence of painless forms. Approaches to treatment include pain relief disintoxication, use of pancreatic secretion blockers, multienzyme complexes, glycemia correction.

[Intraductal papillary mucinous pancreas tumor].

Data of the literature on the epidemiology, patogenesis, diagnosis, peculiarities of the symptoms and the treatment of the intraduct papillar pancreatic tumor, are analyzed in this review. These tumors are rare, there are up to 1% of the exocrine pancreatic tumors. Intraduct proliferation of the mucin producing cells, that are disposed as papillars is typical of these tumors. There are the symptoms of the acute or chronic pancreatitis, sometimes the diagnosis of this tumor is accidental. The main diagnostic methods are ultrasound (US) and computed tomography (CT). Endoluminal ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are the main methods to reveal the intraduct growth. The surgical treatment is necessary for these patients.