[Chronic gastrite: modern state of the problem].

AIM: Тo evaluate the modern view on the problem of chronic gastritis and the effectiveness of the drug ursodexic acid (UHC) Grinterol in the treatment of patients with chronic antral reflux-gastritis (biliar). MATERIALS AND METHODS: The work provides modern ideas about chronic gastritis, the issues of etiology and pathogenesis are considered. Contemporary classifications and the attitude of the authors of the work to them are presented. Clinical studies were conducted in 50 patients with chronic antral reflux-gastritis biliary (32 women and 18 men) between the ages of 20 and 80 years (average age 50.3 to 8.0 years). The treatment uses the drug Grinterol in a daily dose of 12.5 mg/kg of body weight for 4 weeks. RESULTS: Among patients with chronic antral gastritis isolated patients with reflux-gastritis biliary, the pathogenetic factor of which is the damaging property of aggressive bile acids. The main treatment for such patients are drugs UHC (in this study (this study uses Grinterol at a daily dose of 12.5 mg/kg of body weight); the duration of treatment is 4 years. The overall efficiency (according to endomorphological data) was 76%, according to clinical data 100%. DISCUSSION: Critical consideration of the classifications used and proposed for consideration indicates that the time has come for the adoption of a new classification with the allocation of reflux-gastritis biliary. Treatment of this form of antral gastritis is effective with UDHC drugs. CONCLUSION: the selection of a form of antral reflux-gastritis biliar in a separate classification group is scientifically justified. The results suggest that for the treatment of patients with chronic biliary refluxdrugs of choice are drugs UDHC.

THE LONG - TERM RESULTS OF USEFUL ERADICAION PATIENTS WITH PEPTIC ULSERS (a five-year monitoring).

There was held an useful eradication of Helicobacter Pylon in 20 patients with peptic ulcers (Omeprazole, Clarithromycin and Amoxicillin in normal doses). A five - year monitoring period revealed clinical manifestations of relapse in 50% of cases and endoscopic manifestatiQns in 60% of cases (15% - ulcers and 45% - gastral erosions). Relapse of peptic ulcers was accompanied with change of clinical course, it became oligo- or asymptomatic in 83% of patients. Relapse of peptic ulcers was fixed in 45% of patients (15% - in patients with ulcer and 30% - in patients with gastral erosions), at that, erosions were caused by NSAIDs in a half of cases, accompanied with a weak degree of contamination and inflammation of gastral rnucosa.

[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.

[Syndrome of bacterial overgrowth in patients with the reduced stomach acid secretion: some aspects of the diagnosis].

OBJECTIVE: To study the frequency of occurrence of small intestinal bacterial overgrowth (SIBO) in GERD patients with reduced stomach acid secretion receiving long-term PPI treatment, and patients with chronic atrophic gastritis with reduced stomach acid secretion, using the hydrogen breath test (HBT) and studies of short-chain fatty acids (SCFA) in various biological substrates; compare the obtained results. MATERIAL AND METHODS: There were 100 people surveyed: 1 group consisted of 40 patients with chronic atrophic gastritis (HG) with reduced stomach acid secretion; 2 group consisted of 60 patients of GERD in patients receiving PPI different duration (0-6 months, 6-12 months more than 12 months). All the patients were examined by a load of lactulose and research SCFA using gas-liquid chromatographic analysis (GC-analysis) in various biological substrates (duodenal secretion and feces). RESULTS: When performing HBT in patients with chronic atrophic gastritis frequency detection SIBO amounted to 57.5 per cent. In GERD patients receiving PPI SIBO was detected in 8.3% of cases (0-6 months of treatment), 21.7% (6-12 months of treatment), 61.6% (over 12 months). 15% of HG patients and 13.3% of GERD patients receiving PPI, with clinical manifestations of SIBO, the data turned out to be negative. The SCFA parameters in the duodenal secretion in patients with GERD during PPI therapy depending on the duration of the admission and in HG patients with reduced stomach acid secretion were studied, as well as in patients with clinical manifestations of SIBO depending on the data of HBT (+/-). We also studied SCFA parameters in patients with positive HBT results depending on time of registration of the increase of hydrogen concentration. It is established that the study of SCFA in the duodenal secretion is an important diagnostic SIBO test, which allows not only to detect increased activity of the microflora, but also to determine its tribal affiliation. In some cases, its information value exceeds the HBT. The study of SCFA in various biological substrates (duodenal secretion, feces) allows you to specify the localization of existing violations. The rapidity of obtaining results allows to consider this method as screening.

[Probiotics in the treatment of functional intestinal diseases].

OBJECTIVE: to evaluate the clinical effectiveness of biocomplexes "Normoflorin L, B" in the treatment of functional bowel disease with constipation syndrome. The study involved 30 patients with functional bowel disease (Rome criteria III, 2006), with irritable bowel syndrome with predominance of constipatio--16 people with functional constipation--14 people. The criteria of efficacy were: the dynamics of clinical symptoms, bacteriological examination of feces before and after treatment, intestinal transit time of Activated Charcoa- "carbolen" test the definition of short-chain fatty acids (SFA) in the feces by gas-liquid chromatography before and after treatment. The results of the study. In Normoflorin therapy there comes normalization of intestinal motor activity; positive changes in colon ecosystem, consisting of changes of methabolic activity of colonic microflora and its generic composition, normalization of anaerobic-aerobic relations, restoration of intracavitary redox potential of the luminal environment; eliminating the symptoms of intestinal dyspepsia (rumbling, flatulence). Bio-complexes Normofloriny are characterized by good tolerability and safety. The positive effect of "aftereffect" of drugs persists for at least 2 weeks. These data allow us to recommend the use of bio-complexes Normofloriny in treatment of functional bowel disease. These data allow to recommend the use of bio-complexes Normofloriny in treatment of functional bowel disease.

[Fructooligo- and fructopoly-saccharides in correction and prevention of intestinal microbiocenosis disorders in patients with bronchopulmonary pathology receiving antibacterial therapy].

AIM: To evaluate the clinical efficacy BUD "Stimbifid (LLC In-MIN"/LLC ("MedStar", Russia), which contains inulin, oligofructose, vitamins (C, B1, B6, B12, E, PP, folic acid, pantothenic acid, biotin) and minerals (zinc, selenium) in the correction and prevention of violations of the microbiota in patients with chronic and acute diseases of the lungs in the background and after antibiotic therapy (ABT). Was examined total of 50 patients with bronchopulmonary pathology on the background and after antibiotic therapy (including 30 people at a "Stimbifid" reception). The criteria for evaluating the effectiveness were: the dynamics of clinical symptoms, while in transit through the intestines of activated carbon ("carbolex test"), bacteriological examination of feces before and after treatment, the definition of short-chain fatty acids in the faeces before and after treatment. Based on the results of complex research was established the high efficiency of "Stimbifida" in the correction of microbiota in patients with chronic and acute diseases of the lungs in the background and after antibiotic therapy.

[Endoscopic examination for diagnosis of cancer of major duodenal papilla].

Endoscopic procedures were used for diagnosis and treatment of cancer of major duodenal papilla (MDP) at 31 patients. Gastroduodenoscopy (with visual assessment) and endoscopic retrograde cholangiopancreatography were performed at all the patients. Morphological study of tissue sampling permitted to confirm preliminary visual diagnosis only in half of patients. Detection of x-ray symptoms and bile passage disorders at retrograde cholangiopancreatography were high informative. All the patients underwent endoscopic papillosphincterotomy which was effective at 26 (83.9%) patients.

[Age and eradication treatment of duodenal ulcer].

AIM: To study efficacy of Helicobacter pylori (Hp) eradication (different schemes) depending on the age of patients with Hp-associated duodenal ulcer (DU). MATERIAL AND METHODS: A total of 182 patients with Hp-associated exacerbated DU (101 males and 81 females) participated in the trial. The patients were divided into three groups according to their age: group 1 (18-39 years)--71 patients, group 2 (40-60 years)--71 patients, group 3 (61-74 years)--40 patients. Before and 4-6 weeks after treatment the patients were examined according to the standard scheme and with esophagogastroduodenoscopy (EGDS) including biopsy from the body and pyloric portion of the stomach. Seventy five patients received omeprasol+clarithromycin +moxicilline (scheme 1), 37 patients --eprasol+clarithromycin+tinidasol (scheme 2), 40 --eprasol+clarithromycin+furasolidon (scheme 3), 30 ---eprasol+clarithromycin+vicram (scheme 4). RESULTS: Hp dissemination in the pyloric stomach was independent of the age, nonatrophic and atrophic gastritis occurred with equal frequency. Contamination of the gastric body in the aged patients was moderate and mild. Atrophic gastritis incidence increased with age. After treatment according to scheme 1, Hp eradication was achieved in all the patients of group 3, 90%--group 1, 87%--group 2; according to scheme 2--100% patients of group 3, 90%--group 2 and 87%--group 1; according to scheme 3--all patients of groups 2 and 3, 90%--group 1; according to scheme 4--100% cases from groups 1 and 87% in group 2. CONCLUSION: Intensity of Hp dissemination in gastric mucosa does not depend on the age; it changes with deterioration of gastric mucosa atrophy and regress of acid production. Hp eradication efficacy in the same schemes of treatment is higher in presenile and senile patients who, therefore, can be treated with less doses of antibiotics.

[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.

[The condition of intestinal microflora in patients with hematologic tumors receiving polychemotherapy].

The subjects of the study (105 patients with blood system tumors), were divided into 4 groups. The patients of the first group received only cytostatic therapy. The subjects of the second, third and fourth groups were administered a combination of cytostatic and antibacterial agents. In addition to this, the patients of the third and fourth groups received prebiotic preparations as means of corrective therapy. The results obtained by measurement of short-chain fatty acids (SCFA) in feces by means of liquid-gas chromatography were used as criteria for evaluation of the therapy influence on intestinal microflora. The study shows that the cytostatic and combined treatment worsen the disbalance between aerobe and anaerobe populations, which manifests in SCFA spectrum alteration. Use of prebiotic preparations results in improvement of intestinal microflora condition or prevents the aggravation of its disturbance caused by the treatment of the fundamental illness, which becomes apparent in stabilization or normalization of SCFA profile in feces. Study of SCFA makes it possible to monitor microbiocenosis, adjust corrective therapy individually and evaluate its effectiveness.