Effectiveness of mebeverine in patients with post-cholecystectomy gastrointestinal spasm: results of prospective observational program "odyssey".

AIM: To assess the effectiveness of mebeverine 200 mg BID in patients with post-cholecystectomy gastrointestinal spasm not requiring surgical treatment. MATERIALS AND METHODS: 218 patients were included in 16 clinical centers in 14 cities in Russia. All patients had post-cholecystectomy gastrointestinal spasms, not requiring surgical treatment and received mebeverine (Duspatalin®) 200 mg BID. The observational assessment period lasted from the moment of their inclusion into the study up to 6 weeks post inlusion. The therapy results were evaluated using visual analog scales (GPA and 11-point numeric rating scale) by patient self-assessment of the dynamics of spasm/discomfort and other post-cholecystectomic gastrointestinal symptoms after 2 and 6 weeks of treatment. Gastrointestinal Quality of Life Index (GIQLI) was used to assess patient quality of life. RESULTS: All 218 patients completed the 2-week mebeverine treatment course, 101 of them finished the 6-week course ("prolonged population"). Significant positive changes in the relief of abdominal pain and dyspepsia were noted as well as normalization of stool frequency and consistency. A more marked change in values was observed during prolonged (up to 6 weeks) therapy. Both 2-week and 6-week mebeverine courses led to a normalization of patient quality of life. After 6 week therapy, an effect of mebeverine on the quality of life 91% of patients was observed comparable to cholecystectomy itself, speficially related to the quality of life subscore 'symptoms'. CONCLUSION: The results of our study demonstrate that mebeverine (Duspatalin®) therapy leads to an effective elimination of clinical symptoms associated with post-cholecystectomy GI-spasm disorders, like abdominal pain, symptoms of dyspepsia and stooldisorders. A more marked change in values was observed during prolonged (up to 6 weeks) therapy.

[Pathogenetic approaches to treating constipations].

Constipation affects 15-25% of people. Its mechanisms are various. There are constipations due to intestinal dyskinesia (functional constipation, irritated bowel syndrome), slow transit (colonic inertia), and muscular apparatus discoordination ensuring defecation (dyssynergic defecation). The treatment of different types of constipation uses prokinetics (type 4 serotonin receptor agonists, chlorine channels activators and guanylate cyclase C channel activators) or spasmolytics, among which pinaverium bromide (dicetel) has demonstrated its high efficacy. Biofeedback therapy or surgical techniques may be used. There is a need to prescribe laxatives in any type of constipation. A pathogenetic approach to treating constipation is most efficient. The paper characterizes stimulant, osmotic, volume, and emollient laxatives and agents stimulating the urge to defecate. It also gives the data of meta-analyses evaluating the efficacy of different drug groups. Particular emphasis is laid of the effect of lactulose and its first preparation--duphalac.

[Treatment and prevention of erosive and ulcerative lesions in the stomach and duodenum caused by intake of non-steroidalanti-inflammatory drugs].

Therapy with non-steroidal anti-inflammatory drugs (NSAIDs) is a diffcult task. Good anti-inflammatory effect increases the risk of gastrointestinal complications with a frequency of 10-50%. The risk further increases with age (above 60-70 yr), the history of ulcer disease concomitant intake of acetylsalicylic acid, anticoagulants, and glucocorticosteroids. Long-term antisecretory therapy with proton pump inhibitors, e.g., esomeprazole, was shown to be an effective prophylactic tool. This drug maintains the intragastric pH value above 4 for 15 hr on the average. The risk of erosive and ulceraive lesions in the stomach and duodenum significantly decreases by selective cyclooxygenase-2 inhibitors, e.g., coxibs, that however increase the risk of thrombotic cardiovascular complications. The author proposes recommendations on the use of NSAIDs in the patients at risk of serious gastrointestinal and cardiovascular pathology. Naproxen in combination with proton pitmp inhibitors is the drug of choice among NSAIDs. Vimovo is a fixed combination of naproxen and esomeprazole. Results of comparative studies on the efficacy of vimovo and celecoxib are presented along with the data on the safety of this. combination compared with that of naproxen monotherapy

[Food value of cichorium intybus].

Cichorium intybus is an herbaceous perennial, known as a coffee substitute. It possesses a wide range of healing characteristics particularly due to inulin, one of its components. Inulin is a natural polysaccharide, a polyfructosane containing 27-35 fructose residues in furanose form and glucose residue. When inulin is in the alimentary tract it passes to the stomach and the small intestine unchangeable. In large intestine inulin is fermented by bifidobacteria and then converted in to a great number of short-chain fatty acids. Due to the process it stimulated the growth of bifidobacteria population and reduces that of pathogenic microorganisms. The increase of pool of healthy intestinalflora normalizes the passage of fieces masses through the intestine, improves immunologic status, regulates carbohydrate and lipid metabolism. The paper presents experimental and clinic studies confirming bifidogenic, immunogenic, anticancerous, hepatoprotective characteristics of inulin and cichorium intybus.

[Anemia and gastrointestinal tract diseases].

The paper considers the causes of iron- and cyanobalamin-deficiency anemias caused by gastrointestinal tract (GT) diseases, among which malabsorption along with loss of these nutrients through the GT is of great importance. The paper reflects the current views of the pathogenesis of deficiency anemias that develop in gluten-sensitive celiac disease and atrophic gastritis. Among the atrophic gastritides, there are two forms caused by autoimmune processes and long-term Helicobacter pylori persistence, whose treatment is an effective measure in refractory anemia. The paper gives the provisions of the Russian Gastroenterology Association Guidelines (2012) for the management of H. pylori infection, which are based on Maastricht IV consensus (2010).

[Antibiotic-associated diarrhea in clinical practice].

Antibiotic-associated diarrhea (AAD) is considered to mean at least 3 shapeless stool episodes within 2 or more consecutive days when using antibacterial agents. Due to the fact that antibiotics are used most commonly to treat many diseases, AAD is one of the topical problems for different clinical specialists. There has recently been increased interest in this condition due to its higher morbidity and mortality rates and the emergence of novel treatment-resistant virulent strains of Clostridium difficile 027 and 078/126. The paper discusses the possible risk of developing AAD depending on the class of the antibiotic used, as well as the mechanisms of its development. Infectious diarrhea most frequently results from bacterial overgrowth due to that the obligate intestinal microflora is suppressed by antibacterial drugs. C. difficile, Clostridium perfringers, Staphylococcus aureus, Salmonella spp., Klebsiella oxytoca, and Candida spp. are etiological factors in the development of this diarrhea. The severest intestinal lesions include pseudomembranous colitis (PMC) caused by C. difficile. The clinical and endoscopic picture and methods for the diagnosis and treatment of PMC are described. Therapy for this menacing condition is traditionally based on the use of metronidazole and vancomycin. In 2011, the US Food and Drug Administration approved the new drug fidaxomycin whose superiority over vancomycin has been demonstrated by a recurrence criterion. The paper discusses in detail other treatment options, including the use of probiotics.

[Caroli's disease: diagnostic problems and possibilities of treatment].

Caroli's disease is a rare congenital condition characterized by segmental non-obstructive fibrocystic dilation of intrahepatic bile ducts. Dilated ducts may be infected and contain stones. This review of the modern literature describes few known cases of the disease, analyses its clinical features and results of treatment. The principal diagnostic methods include visualization by ultrasound study, CT, MRT, retrograde and transhepatic cholangiography. Surgical intervention is the method of choice for the treatment of the disease including resection of liver, placement of hepatico-jejunal anastomoses and transplantation. The choice depends on the extent of the lesion and anticipated complications. The authors' observation of the patient with Caroli's disease in a 35 year-old woman is presented. It was successfully treated by left-hand bisegmentectomy even though the disease was diagnosed 14 years after the first symptoms. It is recommended that the disease, even if a rare one, should be included in the algorithm of differential diagnostics ofrecurrent abdominal pain with manifestations of cholestasis or fever of an unknown origin.

[Obesity and diseases of digestive organs].

Obesity is non-infectious pandemic. Its association with cardiovascular pathology is especially widely discussed, but an overweight patient is actually polymorbid. An increase of body mass provides a pathogenetic basis for many diseases including those of digestive system This review deals with pathogenesis, clinical features, and treatment of gastroesophageal reflux disease, cholelithiasis and non-alcoholic fatty liver disease in obese patients. This pathology and its aggravation result from such pathophysiological processes as a rise in intra-abdominal pressure, excess adipokine, cholesterol and free fatty acid synthesis, activation of lipid peroxidation. Gastroesophageal reflux disease in obese patients has an atypical clinical course characterized by discrepancy between clinical, endoscopic and morphological features in oesophagus and frequent formation of Barrett's oesophagus. Cholelethiasis in obesity is fraught with further progress of the disease after prescription of low-fat diet. The risk of calculi formation can be reduced by prescription of ursodeoxycholic acid that produces both litholytic and hypolipidemic effects. Treatment of non-alcoholic fatty liver disease requires combined therapy with statins, insulin sensitizers, hepatoprotectors and adequate physical activity. Sustained remission of diseases of digestive organs is impossible without correction of body mass and their pharmacotherapy requires increasing doses of medicines and duration of their administration.

[The role of imbalance of fatty acids in formation of endothelium dysfunction in women in menopause].

The article deals with the results of examination of 203 women in condition of natural (61 female patients) and surgical (142 female patients) post menopause. The rate of occurrence of impairment of functional state of endothelium made up to 67% (136 of examined female patients). The nitroxide-producing function of endothelium was decreased in all female patients, most of all in women with surgical menopause. The patients with endothelium dysfunction symptoms had a significant decrease of amount of omega-3 polyunsaturated fatty and arachidonic acids in erythrocytes' membranes and an increase of amount of gamma-linolenic and dihomo-gamma-linolenic acids. The multidirectional correlation dependences between indicators of endothelium function and amount of various fatty acids in erythrocytes' membranes was established.

[Causes, complications and risk factors of severe influenza A (H1N1)].

Analysis of 35 deaths from A(H1N1) influenza virus infection in the Transbaikal region (autumn 2009) is reported. All the cases were under 60 years of age. Viral/bacterial pneumonia complicated by acute respiratory distress syndrome (ARDS) was the main cause of fatal outcomes. Enteroccocci were found in 83.3% of the seeded autopsy samples. Possible enterococcal infection pathways and mechanisms of ARDS development are discussed. The role of heat shock proteins is postulated. Disturbances of lipid metabolism are supposed to be major risk factors of severe influenza and its fatal outcome that may be related to obesity through common pathogenetic pathways.

[Food allergy].

Food allergy (FA)--a condition of high sensitivity to food products--is widely spread allergic disease treated by allergologists, gastroenterologists, dermatologists, physicians, pulmonologists. FA pathogenesis involves immunological mechanisms with participation of immunocompetent cells and production of IgE and IgG. Treatment aims at elimination of causative antigen. Proteins of cow milk, hen's eggs, cereals, fish, citrus fruit, nuts, tomatos are most common such antigens. It is especially important for infants. FA manifests with anaphylactic shock, oral allergic syndrome, respiratory symptoms, abdominal impairments. The digestive system is both a target and a course of FA formation. FA arises mostly because of defects of gastrointestinal immune system, inability to synthetize IgA in adequate quantity while IgA has protective properties. Therefore, FA treatment should include probiotics, cytoprotectors, enzymes, sorbents. Atopic dermatitis, one of FA manifestations, is treated with non-hormonal drugs containing lipids, urea, topic inhibitors of calcinevrin. On demand, topic glucocorticosteroids, sometimes in combination with antimicrobial and antifungal drugs are added. Multidisciplinary approach to FA problem gives positive results.

[Possible mechanisms of development of biliary diseases under the conditions of the Transbaikal region]. / Vozozhnye mekhanizmy razvitiia zabolevanii zhelchevyvodiashchikh putei v usloviiakh Zabaikal'ia.

Eighty one patients with various biliary diseases and 36 apparently healthy individuals were examined. There were relatively elevated lipid peroxidation (LPO) products (E 232/220 and E 278/220) in biliary diskynesia and higher concentrations of LPO intermediate products in cholecystitis. In cholelithiasis, the levels of LPO products were lower than those in cholecystitis. E 232/220 and 278/220 may be used for early diagnosis of biliary dysfunctions. Selenium deficiency observed in the Transbaikal region decreases antiradical protection and increases the incidence of biliary diseases.

[Characterization of Pseudomonas aeruginosa strains isolated at therapeutic institutions of Moscow]. / Kharakteristika shtammov Pseudomonas aeruginosa, vydelennykh v lechebnopm uchrezhdenii Moskvy.

Investigation of 108 P. aeruginosa strains isolated from various clinical material revealed that 54.63% of them belonged to serogroups 2, 5, 16, 18, 20 and 12.96% to serotype 4. Five strains were polyagglutinated. Monocultures of P. aeruginosa were isolated from 55% of patients, in the majority of cases (31 out of 36) these strains were isolated from the urine. Bacterial associations were more frequently detected in discharge from wounds (11 out of 21), in the material obtained by bronchoscopy (9 out of 15), and in the throat (5 out of 6). Assessment of antibioticograms of the isolated P. aeruginosa strains permitted us characterize polymixin, forte ceftazidime, and biseptol as effective agents.

[Evaluation of a system of multimicrotests for biochemical identification of enterobacteria (MMT E2) in a controlled epidemiological trial. 2]. / Otsenka sistemy mul'timikrotestov dlia biokhimicheskoi identifikatsii énterobakterii (MMT E2) v kontroliruemom épidemiologicheskom opyte. Soobshchenie 2.

Commercial system of multimicrotests for biochemical identification of enterobacteria MMT E2 and routine tube tests were compared in a controlled epidemiologic experiment with 205 enterobacterial strains. The system has been developed at the Allergen Research and Production Amalgamation. System MMT E2 fairly well met the requirements to diagnostic preparations of this kind; its results were compatible and well reproducible. This system in complex with commercial MMT E1 system may be used for species identification of enterobacteria. Practical application of both the systems will considerably simplify the process of identification of these microorganisms.

[Assessment of a multimicrotest system for biochemical identification of enterobacteria (MMT E1) in a controlled epidemiological experiment. I]. / Otsenka sistemy mul'timikrotestov dlia biokhimicheskoi identifikatsii énterobakterii (MMT E1) v kontroliruemom épidemiologicheskom opyte. Soobshchenie 1.

Comparative evaluation of a system of multimicrotests for biochemical identification of enterobacteria (MMT E1) developed at the ALLERGEN Research and Production Amalgamation and of tube tests for the same purpose in a controlled epidemiologic experiment has shown that the suggested system meets the requirements to such diagnostic preparations by all the major qualitative parameters (compatibility and reproducibility of the test results). Practical use of MMT E1 system will simplify and facilitate the process of enterobacteria identification.

[Serotypes of Pseudomonas aeruginosa strains isolated in obstetric institutions in Azerbaijan]. / Serotypy shtammov Pseudomonas aeruginosa, vydelennykh v rodovspomogatel'nykh uchrezhdeniiakh Azerbaidzhanskoi SSR.

Examinations of Pseudomonas aeruginosa strains isolated from clinical material from newborns and puerperae and from the environmental objects (washings off, water) have shown that 45.45% of these strains belonged to serotype 04, 24.55% to serotype 02, and 16.38% to other serotypes. Serotype 04 was the most incident in all the tested samples, it was detectable in newborns' biotopes and on environmental objects. Serotype 02 strains ranked second in incidence; they were detected in clinical material from the newborns but not on environmental objects.

[The identification of lactose-negative enterobacteria]. / Identifikatsiia nekotorykh laktozootritsatel'nykh énterobakterii.

Study of the morphologic and enzymatic characteristics of 10 strains of lactose-negative enterobacteria, sent to the L. A. Tarasevich State Institute for Control and Standardization as B. paracoli in order to determine their taxonomic status in accordance with the 1974 and 1984 Bergey classifications has referred 9 of these strains to Hafnia alvei.