Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment.

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

[The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy]. / Rossiiskii konsensus po diagnostike i lecheniiu khronicheskogo pankreatita: zamestitel'naia fermentnaia terapiia.

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children's Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

[Effect of HP eradication on the development of gastroesophageal reflux disease: results of the prospective study].

METHODS: Prospective post-eradication evaluations were conducted in 331 H. pylori positive patients with peptic ulcer diseases who were confirmed not to have GERD before eradication therapy. Endoscopic findings of reflux esophagitis were according to the Los Angeles classification system. Patients were categorized in the nonerosive reflux disease (NERD) subgroup by results of 24-hour ambulatory pH-metry (reflux episodes, pathological oesophageal acid exposure, DeMeester score > 14.7). After that all patients received H. pylori eradication therapy. After eradication therapy, during follow-up for up to 5.0 years, endoscopies, 24-hour ambulatory pH-metries were performed on patients with occasions of acid regurgitation or heartburn. RESULTS: GERD developed in 79 of 280 (28%) patients cured of infection and in 6 of 51 (11.8%) patients who had persistent infection (p < 0.013, Pearson's test). The risk of developing GERD in patients cured of infection was still significantly higher than in the patients who had persistent infection (p < 0.036, log-rank test; Kaplan-Meier analysis). NERD and mild esophagitis were in mostly patients. Multivariate analysis with the Cox's Proportional-Hazards Regression identified cure of infection (hazard ratio, 2.294, 95% confidence interval, 1.043-5.494, p = 0.039), hiatal hernia (1.828, 1.177-2.838, p = 0.007), high body mass index (1,084, 1.019-1.152, p = 0.01), male gender (0.139, 0.034-0.567, p = 0.006) as significant factors for the risk of developing of gastroesophageal reflux disease. CONCLUSION: Eradication of H. pylori infection may increase the risk of developing reflux esophagitis in patients with peptic ulcer who were confirmed not to have GERD before eradication therapy. Hiatal hernia, high body mass index, male gender may be serve as additional risk factors.

[The processes of cell renewal in H. pylori-associated chronic atrophic gastritis].

OBJECTIVES: To evaluate the expression of Ki-67 protein in stomach mucosa in H. pylori-associated chronic atrophic gastritis according to the stage of atrophy. MATERIALS AND METHODS: The immunohistochemical and histological study of gastric mucosal biopsies from dyspeptic patients was performed. The new international system of gastric musocal atrophy staging (OLGA) was used. RESULTS: The rates of cellular proliferation increase along the rising of the stage of stomach mucosal atrophy in Hpylori-associated chronic atrophic gastritis. CONCLUSIONS: In H. pylori-associated chronic atrophic gastritis, the acceleration of the cellular renewal was revealed, proportional to a stage of gastric mucosal atrophy that implies the increase of risk of development of precancerous changes.

Morpho-functional comparisons in Helicobacter pylori-associated chronic atrophic gastritis.

PURPOSE: To evaluate serum pepsinogen I (PG I) and gastrin-17 (G-17) levels in patients with Helicobacter pylori (H. pylori)-associated chronic atrophic gastritis, with reference to endoscopical Kimura-Takemoto's staging, chromoendoscopical and histological features. MATERIAL AND METHODS: 267 dyspeptic H. pylori-infected patients were examined by chromoendoscopy with biopsy sampling according to the Sydney System and according to Kimura-Takemoto's scale. Simultaneous assessment of serum pepsinogen I (PG I) and gastrin-17 (G-17) levels by enzyme immunoassay was performed. The serologic and morphologic results were compared with correlation analysis. RESULTS: There was strong reverse correlation between the stomach mucosal atrophy (antral part or corpus) and the proper serologic markers (respectively, G-17 or PG I) in H. pylori-associated chronic gastritis when gastric biopsies taken according to the Sydney System were assessed. The use of Kimura-Takemoto's scale has revealed the decrease of serum PG I levels only at 0-2 and 0-3 grades of the corpus mucosa atrophy. Probably, these results reflects the development of functional failure of the stomach corpus mucosa at late stages of atrophy when its compensatory capacity becomes insufficient. There were not any advantages in sampling biopsies for the detecting of intestinal metaplasia (IM) by the Sydney System, or by Kimura-Takemoto's scheme. The obvious concordance between histologically proven extent of IM and the number of IM foci detected by chromoendoscopy has been revealed. CONCLUSIONS: The biopsy sampling for the diagnosis of precancerous changes of the stomach mucosa after non-invasive screening of atrophic gastritis (e.g., by means of EIA) should be based preferably on the visual signs acquired via chromoendoscopy than through routine endoscopy, independently of the scheme of examination of stomach mucosa, either according to the Sydney System, or to the Kimura-Takemoto's scale.

The non-invasive diagnosis of precancerous changes of stomach mucosa.

PURPOSE: To detect the Helicobacter pylori (H. pylori)-induced gastric precancerous lesions leading to cancer formation, and to evaluate the possibility of non-invasive screening of dyspeptic patients to identify those having high risk of gastric cancer. MATERIAL AND METHODS: 178 consecutive H. pylori-positive dyspeptic patients after assessment of serum pepsinogen-1 (PG-1) and gastrin-17 (G-17) levels by enzyme immunoassay were examined with endoscopy and histology. The serologic and morphologic results were compared with estimating the sensitivity, specificity and prognostic values of the tests. RESULTS: There was statistically significant reverse dependence between the presence and severity of stomach mucosal atrophy (in antrum or corpus) and the proper serologic markers of stomach functional activity (G-17 or PG-1). On the other hand, the presence and the degree of intestinal metaplasia, dysplasia and gastric cancer did not correspond to the serum levels of G-17 or PG-1. The serologic method was quite sensitive in the diagnosis of non-atrophic and severe antral and corpus gastritis. Also, it was characterized by the high positive and negative prognostic values. Additionally, we have established the obvious advantage of the chromoendoscopy method in the diagnosis of intestinal metaplasia in the stomach epithelium. CONCLUSIONS: The assays of serum G-17 and PG-1 levels can be offered as the screening tool for atrophic gastritis. The positive serologic results require further chromoendoscopic examination with mucosal biopsy to disclose the probable progression of atrophic process with development of intestinal metaplasia, dysplasia or gastric cancer.

[Clinico-morphological and molecular-genetic correlations in the stomach pathology associated with Helicobacter pylori]. / Kliniko-morfologicheskie i molekuliarno-geneticheskie sopostavleniia pri patologii zheludka, assotsiirovannoi s Helicobacter pylori.

Some clinicomorphological correlations are made in Helicobacter pylori (H. pylori) associated diseases of the gastroduodenal zone. Genes vacA and cagA in the H. pylori genome were revealed by PCR in stomach biopsies of infected patients and the results were compared with histological changes in the patients' mucous membrane. Specific IgG antibodies to some H. pylori antigens were detected in the serum and a comparative analysis of serological and histological data was performed. The findings suggest that H. pylori associated gastroduodenal pathology is determined by interaction between macro- and microorganisms taking account of genetic characteristics of the infective microorganism, its phenotypic variations and properties of inflammatory and immune response of the host.

[Synthesis of lipoxygenase metabolites of arachidonic acid and their role in the pathogenesis of inflammation of gastric mucosa]. / Sintez lipoksigenaznykh metabolitov arakhidonovoi kisloty i ikh rol' v patogeneze vospaleniia slizistoi obolochki zheludka.

Concentrations of 5-, 12-, 15-HETE versus myeloperoxidase activity in the periulcerous area were investigated in 40 peptic ulcer patients. A control group consisted of 20 healthy subjects. In ulcer patients the activity of lipoxygenase pathway of metabolism of arachidonic acid and myeloperoxidase was enhanced. This is likely to promote chronic inflammation of the mucosa in the periulcerous area, this inflammation being an important prognostic factor for ulcerogenesis.

[The role of cyclic nucleotides in adaptation of the gastric mucosa to hypoxia]. / Rol' tsiklicheskikh nukleotidov v adaptatsii k gipoksii slizistoi obolochki zheludka.

State of oxygen consumption in gastric mucosal membrane evaluated by means of pO2 measurement as well as metabolism of cyclic nucleotides were studied in patients with ulcerous disease. Hypoxia of periulcerous area and alterations in functional activity of the cyclase systems were detected. Reciprocal alterations in the cyclases activity, as a result of which the ratio of cyclic nucleotides was changed under dissimilar conditions of oxygen consumption in gastric mucosal membrane, were considered as essential adaptive reaction related to maintenance of proliferation under conditions of oxygen and energy rich substances deficiency.

[Synthesis of leukotrienes B4 and C4 in the gastric mucosa in peptic ulcer]. / Sintez leikotrienov B4 i C4 v slizistoi obolochke zheludka pri iazvennoi bolezni.

Forty patients suffering from peptic ulcer were examined for concentrations of leukotrienes B4 and C4 as compared to the activity of myeloperoxidase in the periulcerous zone of the gastric mucosa. 20 healthy persons made up the control. It is assumed that the rise of leukotrienes B4 and C4 concentrations as well as myeloperoxidase activation contribute to chronic inflammation in the periulcerous zone. Chronic inflammation of the gastric mucosa is regarded as an important pathogenetic factor of ulcerogenesis.

[Enzyme activity of the gastric mucosal antioxidant system during hypoxia]. / Aktivnost' fermentov antiokislitel'noi sistemy slizistoi obolochki zheludka pri ee gipoksii.

The activity of enzymes of the antioxidant system and pO2 in the gastric mucosa (GM) was studied in patients with gastric ulcer. The various enzymes differed in activity. Along with low activity of superoxide dismutase (SOD), glutathione peroxidase (GP), and glutathione reductase (GR), both normal and increased values were encountered. In GM hypoxia the GP activity increased in the peri-ulcerous zone. There was no statistically significant increase of SOD activity and reduction of GR activity.

[Lipid peroxidation, the enzyme antioxidative system and acid phosphatase content of the gastric mucosa in stomach ulcer]. / Perekisnoe okislenie lipidov, fermentnaia antiokislitel'naia sistema i soderzhanie kisloi fosfatazy v slizistoi obolochke zheludka pri iazvennoi bolezni.

Lipid peroxidation, a state of the antioxidative system and activity of acid phosphatase were studied in mucosal membrane of 53 patients with ulcerous disease of stomach. Increase of the acid phosphatase activity in cytoplasm, activation of lipid peroxidation and inhibition of the antioxidative system were detected in ulcer border and periulcerous region. These alterations in lipid peroxidation and the state of the antioxidative system were considered as distinct pathogenetic factors responsible for deterioration of lysosomal membranes and contributing to chronic and relapsing development of ulcerous disease.

[The role of local factors regulating vascular blood flow in the development of hypoxia of the gastric mucosa in peptic ulcer]. / Rol' mestnykh faktorov reguliatsii sosudistogo krovotoka v razvitii gipoksii slizistoi obolochki zheludka pri iazvennoi bolezni.

In 50 patients with gastric ulcer indices of oxygen tension (pO2) levels were investigated in correlation with the concentration of prostaglandins (E and F2 alpha), prostacyclin, thromboxane as well as with values of transmucous difference of potentials in different parts of the gastric mucosa, they were compared with 30 healthy controls. It has been assumed that the detected increase of reverse diffusion of hydrogen ions (the appearance of positive values of the transmembranous potential) and disorder of the ratio of prostanoids in favor of vasoconstrictors lead to a decrease in the blood flow and pO2 in the periulcerative zone of the patients with gastric ulcer. Hypoxia of the gastric mucosa is regarded as an important pathogenetic factor of ulcerogenesis.

[Lipid peroxidation and the antioxidant enzyme system of the gastric mucosa in peptic ulcer]. / Perekisnoe okislenie lipidov i antiokislitel'naia fermentnaia sistema slizistoi oblochki zheludka pri iazvennoi bolezni.

Lipid peroxidation and the activity of the antioxidant system were studied in the mucous membrane of the stomach of 60 patients with peptic ulcer. Maximum activation of lipid peroxidation was at the ulcer edges and in the surrounding mucosa. In the same regions the following changes were noted: an increase in the activity of superoxide dismutase, depression of activity of glutathione peroxidase and glutathione reductase, a decrease in the amount of reduced glutathione and accumulation of oxidated glutathione. Activation of lipid peroxidation and disruption of activity of the antioxidant system in the mucous membrane of the stomach were considered to be important pathogenetic factors leading to a chronic and recurrent course of peptic ulcer.