[Cycle and maintenance treatments in patients with reflux esophagitis after gastrectomy or gastric resection].

AIM: To evaluate the efficiency and safety of Livodexa monotherapy in patients with reflux esophagitis (RE) after gastric resection or gastrectomy. SUBJECTS AND METHODS: The investigators examined 30 patients (16 men, 14 women) after gastrectomy (n = 15) or gastric resection (n = 15) who had anacidity as shown by pH-metry and the clinical and/or endoscopic signs of RE. During 4 months, Groups 1 and 2 patients received the drug in doses of 10 and 15 mg/kg/day, respectively. Maintenance treatment was performed for 2 months. The maintenance therapy group included 25 patients, including 12 patients who took Livodexa in a dose of 2.5 mg/kg/day (Group 1) and 13 patients who had 5 mg/kg/day (Group 2) during 2 months. RESULTS: Treatment with ursodeoxycholic acid (Livodexa) resulted in the significantly reduced frequency and intensity of the major symptoms of the disease (heartburn, retrosternal pain, bitter eructation), by achieving a maximum effect at 4 months of therapy. Endoscopic remission was observed in 63.3 and 83.3% of the patients at 4 and 6 months of treatment, respectively. There was a significant and steady rise in the quality of life as evidenced by a visual analogue scale. The ursodeoxycholic acid dose of 10 mg/kg was effective in patients with grade 1 RE (single erosions) while it should be increased up to 15 mg/kg in those with more significant esophageal mucosal injury (grades 2-3 RE). Some patients receiving a maintenance dose of 2.5 mg/kg/day were recorded to have recurrent reflux disease with a relapse of clinical manifestations and a morphological substrate as catarrhal esophagitis. The group of patients receiving maintenance therapy (5 mg/kg/day) retained the achieved clinical and morphological remission. CONCLUSION: The findings suggest that Livodexa is effective in patients of this category.

[Outpatient clinic facilities for clinical-laboratory diagnosis of hepatic fibrosis].

AIM: To compare fibrosis stages estimated by histological data obtained at biopsy of hepatic tissue with fibrosis index (FI) calculated with the dominant calculation scale (DCS); to define diagnostic thresholds, sensitivity and specificity of FI estimation. MATERIAL AND METHODS: The trial included 75 chronic hepatitis (CH) patients (54 males and 21 females, mean age 37.4 +/- 9.5 years) with different activity of the disease and at different stages of CH: 51 (68%) with virus hepatitis C (VHC), 8 (10.7%) with virus hepatitis B (VHB), 11 (14.7%) with alcoholic hepatitis and 5 (6.7%) with non-alcohol steatohepatitis (NASH). Puncture hepatic biopsy specimens were obtained from all the examinees. Fibrosis stages were determined by METAVIR. FI by DCS was calculated by the score sum of prothrombin index, platelet count, ALT/AST. RESULTS: By METAVIR, F0 corresponded to FI 1.84 +/- 0.79, F4 (cirrhosis)--to 7.14 +/- 0.64; by ISHAK, F0 corresponded to FI 1.89 +/- 0.35, F6 (cirrhosis)--to 7.33 +/- 0.33. Sensitivity and specificity of FI estimation by DCS depending on fibrosis stage for METAVIR was 88% and 88%, for ISHAK--88% and 82.7%, respectively. In interferon therapy FI elevates due to iatrogenic thrombocytopenia.

[Some comparative aspects of treating the gastroesophageal reflux disease eradication]. / Nekotorye sravnitel'nye aspekty lecheniia gastroézofagal'noi refliuksnoi bolezni.

At present proton pump inhibitors have been the most efficient drugs for treating the gastroesophageal reflux disease (GERD). Pariet may be selected as a drug for treating all forms of GERD as it requires smaller doses and shorter treatment period to obtain the clinical and endoscopic remission. Upon the clinical and endoscopic remission, patients need a supportive treatment. Different patients need various supportive treatment schemes. Our goal comes to the provision of the maximum efficiency of the schemes when prescribing the minimum doses of the drug.

[Composition and role of short chain fatty acids in feces and peripheral blood serum of patients with cholelithiasis]. / Izuchenie sostava i znacheniia korotkotsepochechnykh zhirnykh kislot v fekaliiakh i syvorotke perifericheskoi krovi u patsientov s zhelchekamennoi bolezn'iu.

Gas-liquid chromatography was used to estimate content of short-chain fatty acids (SCFA) in 25 patients with cholelithiasis, 32 patients with irritable colon syndrome and constipation (ICS) and 35 healthy subjects. It was found that SCFA absolute and relative concentration in the feces of cholelithiasis patients is abnormal indicating disturbance of microbiocenosis as shown by changes in functional activity of some anaerobes of the intestinal microflora participating in enterohepatic circulation of bile acids. Alterations of SCFA content in the serum of cholelithiasis patients may be related to steroids disbolism. The study of SCFA in the feces and peripheral blood serum from cholelithiasis patients is of diagnostic value.

[Levels of gastrin and somatostatin in blood and gastroduodenal gastrin and somatostatin cells in the differentiation of treatment of patients with duodenal ulcer]. / Urovni gastrina i somatostatina v krovi, gastroduodenal'nye gastrinovye i somatostatinovye kletki pri differentsirovannom lechenii bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Radioimmunoassay and immunomorphological methods were used in the study of pepsinogen 1, basal and food-stimulated gastrin and somatostatin blood levels, the number of gastroduodenal G- and D-cells as well as gastric secretion during routine-dose treatment with gastrozepin and ranisan of 45 gastroduodenal ulcer patients versus 15 controls. The patients were divided into 2 types according to blood gastrin levels and the number of pyloric G-cells: with hypergastrinemia and/or hyperplasia of the G-cells, with normogastrinemia and normal number of G-cells. A course treatment with gastrozepin of type 1 patients brought about normalization of serum gastrin and the number of the G-cells with elevation of blood somatostatin levels. In patients of type 2 the above parameters did not change. The same picture in them remained after ranisan treatment, though they developed hypergastrinemia. In patients of type 1 after ranisan treatment the above parameters did not change. The data obtained demonstrate once more heterogeneity of duodenal ulcer.

[Cellular and humoral immunity in duodenal peptic ulcer with gastrin cell hyperplasia]. / Kletochnyi i gumoral'nyi immunitet pri iazvennoi bolezni dvenadtsatiperstnoi kishki s giperplaziei gastrinovykh kletok.

A total of 61 patients with frequently relapsing duodenal ulcer were examined. Of these, 18 patients were in the acute phase and 43 experienced remission. Using 1 mm2 of the mucosa, measurements were made of the counts of duodenal and pyloric G-cells (by immunomorphologic assay), of the absolute and relative counts of T and B lymphocytes, the content of IgA, IgM and IgG, histamine and serotonin (by fluorometry) in the blood, and of the concentration of uropepsin in the urine. In the stages of exacerbation and remission, the patients suffering from duodenal ulcer with hyperplasia of G-cells manifested, as compared with the analogous patients without hyperplasia, a decrease of the absolute and relative counts of T cells, especially of those of B cells, combined with a rise of the content of IgM and IgG during exacerbation, followed by its returning to normal in the phase of remission. Over one year part of the duodenal ulcer patients with hyperplasia of G-cells received preventive treatment with ranitidine, which resulted in a tendency towards the lowering of the count of pyloric G-cells and the rise of the absolute and relative counts of T cells.

[Gastroduodenal incretory cells in duodenal ulcer with different levels of gastric secretion]. / Gastroduodenal'nye inkretornye kletki pri iazve dvenadtsatiperstnoi kishki s raznym urovnem zheludochnoi sekretsii.

Immunomorphological PAP method was used in 20 patients with duodenum ulcer and in 10 control individuals to study gastrin (G)-, somatostatin (D)- and calcitonin-gene-related peptide (CGRP) cells in biopsies of the stomach and duodenum. The gastrin and pepsinogen level in the blood, basal and acid production stimulated by pentagastrin were also studied. All patients are subdivided into two groups by their acid production: those with hypersecretion and those with normal secretion. The group with hypersecretion was not homogeneous: some patients had deficiency of D-cells (sometimes in combination with G-cell hyperplasia) and others had a relative and absolute decrease of the number of CGRP cells in combination with foci of parietal cells in pylorus. These patients showed a tendency to the hypergastrinemia and significant hyperpepsinogenemia I in the blood. Stomach hyperplasia in the duodenum, multiple duodenal ulcers, erosive gastroduodenitis and ulcers in close relatives occurred more frequently in these patients. G- and CGRP cells are found to be similar in the form and localization. It is not excluded that G-cell contains, apart from gastrin 1-17, calcitonin-gene related peptide.